Cardiovascular diseases modified

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CARDIOVASCULAR DISEASES

Nelia B Perez RN MSN

PCU ndash MJCN

BSN 2013

THE CARDIOVASCULAR SYSTEM

>

GENERAL CARDIAC ASSESSMENT

bull Health historybull Demographic informationbull Familygenetic historybull Culturalsocial factors

bull Risk factorsbull Modifiable High blood cholesterol

obesity smoking stress hypertension diabetes mellitus

bull Nonmodifiable Family history increasing age gender race

Pathophysiology

ASSESSING CHEST PAIN

COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

Onset Gradual Sudden Sudden Gradual Sudden

Gradual Sudden

Abrupt Gradual Sudden

Precipitating Factors

At rest after exercise or emotional stress

Breathing deeply rotating trunk yawning

Inflammation of GI parts increased HCL medications

After exercise emotional stress eating envtrsquol changes

Hypertension Immobility Prolonged bedrest

Location Substernal anterior chest rarely back radiates to jawneck

Precordial rotates to neck left shoulder amp arm

Xiphoid to umbilicus

Substernal anterior chest poorly localized

Site of rupture anterior chest or back between scapula

Pleural area retrosternal

Quality Crushing burning stabbing squeezing vicelike

Pleuritic sharp Aching burning cramplike gnawing

Squeezing feeling of heavy pressure burning

Sharp tearing ripping

Sharp stabbing

COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

Characteristic

MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

Intensity Asymptomatic to severe increases with time

Mild to severe Mild to severe Mild to moderate

Severe unbearable maximal from onset

Aggravated by breathing

Duration 30 min to 1-2 hours may wax and wane

Continuous Periodic 2-10 min ave 3-5 min

Continuous does not abate once started

Variable

Relief Narcotics Sitting up leaning forward

Physical emotional rest food antacid

Nitroglycerin rest

Large repeated doses of narcotics

02 sitting up morphine

Associated Symptoms

Nausea fatigue heartburn equal peripheral pulses

Fever dyspnea nausea anorexia anxiety

NV dysphagia anorexia weight loss

Belching indigestion dizziness

Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

inadequate to meet the heartrsquos metabolic demands

Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

Pathophysiology

Types

AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

(although those with advance atherosclerosis do not develop angina)

Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

Pain location precordial or substernal chest area

Pain characteristics - constricting squeezing or

suffocating sensation- Usually steady increasing in

intensity only at the onset amp end of attack

- May radiate to left shoulder arm jaw or other chest areas

- Duration lt 15mins- Relieved by rest (preferably sitting

or standing with support) or by use of NTG

B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

Associates in 1659 Cause spasm of coronary

arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

Pain Characteristics occurs during rest or with minimal exercise

- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

Conthellip

C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

ConthellipDx detailed pain history ECG TST

angiogram may be used to confirm amp describe type of angina

Tx directed towards MI prevention- Lifestyle modification (individualized

regular exercise program smoking cessation)

- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

coronary angioplasty) may be indicated if with severe artery occlusion

Drug Therapy Nitroglycerin (NTGs) ndash

vasodilators patch (Deponit

Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

Calcium channel blockers Nifedipine (Calcibloc

Adalat) Diltiazem (Cardizem)

Lipid lowering agents ndashstatins Simvastatin

Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

Classification

Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

Class IV ndash angina occurs even at rest

Nursing Management

Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

limitations NTGs ndash max of 3doses at 5-min intervals

Stinging sensation under the tongue for SL is normal

Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

bottles amp change stocks every 6months Inform clients that headache dizziness

flushed face are common side effects

Do not discontinue the drug For patches rotate skin sites usually on

chest wall Instrct on evaluation of effectiveness based

on pain reliefPropanolols causes bronchospasm amp

hypoglycemia do not administer to asthmatic amp diabetic clients

Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

Nursing Management

Acute Coronary Syndrome

Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

gt20mins)2 New onset exertional angina (increased in

severity of at least 1 class ndash to at least class III) in lt2months

3 Recent acceleration of angina to at least class III in lt2months

Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

Conthellip

ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

myocardial tissue associated with atherosclerotic disease of coronary arteries

Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

elevation Q wave prolongation T wave inversion

Conthellip(MI)

Manifestations chest pain ndash severe crushing

constricting ldquosomeone sitting on my chestrdquo

- substernal radiating to left arm neck or jaw

- prolonged (gt35mins) amp not relieved by rest

Shortness of breath profuse perspirationFeeling of impending doom

Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

profound LV failure from massive MI resulting to low cardiac output

Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

Rupture of myocardiumVentricular aneurysms ndash decreases

pumping efficiency of heart amp increases work of LV

Pathophysiology

Causes atherosclerotic heart disease thrombosisembolism

shock ampor hemorrhage direct traumaMyocardial ischemia

uarrcellular hypoxia

darrmyocardial O2 supplydarr myocardial contractility

darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

uarrperipheral vasoconstriction

uarr myocardial contractility

uarr afterload uarrmyocardial O2 demand

uarr HR uarrdiastolicfilling

darrmyocardial tissue perfusion

Tissue Changes After MI

Time after Onset Type of Injury amp Gross Tissue Changes

0-05hrs Reversible injury

1-2hrs Onset of irreversible injury

4-12hrs Beginning of coagulation necrosis

18-24hrs Continued necrosis gross pallor of infected tissue

1-3days Total necrosis onset of acute inflammatory process

3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

8th week Complete scar tissue replacement

Management of MI Initial Management OMEN

- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

may be given to limit infarction size amp most effective if given within 4hrs of onset)

Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

bull Surgery 1Revascularization

bullPTCAbullCoronary stent implantation

bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

2Resection ndash aneurysm

ASSESSMENT

bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

bull Objective databull VSbull Diaphoresisbull Emotional restlessness

ANALYSIS NURSING DIAGNOSES

bull Decreased cardiac output related to myocardial damage

bull Impaired gas exchange related to poor perfusion shock

bull Pain related to myocardial ischemia

bull Activity intolerance related to pain or inadequate oxygenation

bull Fear related to possibility of death

NURSING CARE PLANbull Goal 1 reduce pain discomfort

bull Narcotics ndash morphine note response Avoid IM

bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

bull Position semi-Fowlerrsquos to improve ventilation

NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

cracklesbull Check labs troponin blood gases electrolytes

clotting timebull CVP (5-15 cm H2O) increases with heart failure

bull ROM of lower extremities antiembolic stockings

NURSING CARE PLAN

bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

bull Anticipate needs of client call light water Reassurance

bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

NURSING CARE PLAN

bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

Mg)bull Monitor ECGbull Diet progressive low

calorie low sodium low cholesterol low fat without caffeine

NURSING CARE PLAN

bull Goal 5 facilitate fecal eliminationbull Medications stool

softeners to prevent Valsalva maneuver mouth breathing during bowel movement

bull Bedside commode

NURSING CARE PLAN

bull Goal 6 provide emotional supportbull Recognize fear of dying

denial anger withdrawalbull Encourage expression of

feelings fears concernsbull Discuss rehabilitation lifestyle

changes prevent cardiac-invalid syndrome by promoting self-care activities independence

NURSING CARE PLAN

bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

bull Identify need for referral for sexual counselling

NURSING CARE PLAN

bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

bull Information about sexual activity less fatiguing positions

bull Support groups Follow-up carebull Medications administration importance untoward

effects pulse takingbull Control risk factors rest diet exercise no smoking

weight control stress reduction

EVALUATION

bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

CONGESTIVE HEART FAILURE

bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

PATHOPHYSIOLOGY

Increased cardiac workload

decreased effective myocardial contractility

Decreased cardiac output

LV failure Pulmonary congestion

RA RV failure

Systemic congestion

Peripheral edema

ASSESSMENTbull Subjective data

bull Shortness of breathbull Orthopnea (sleeps on two

or more pillows)bull Paroxysmal nocturnal

dyspnea (sudden breathlessness during sleep)

bull Dyspnea on exertion (climbing stairs)

bull Apprehension anxiety irritability

bull Fatigue weaknessbull Reported weight gain

feeling of puffiness

ASSESSMENTbull Objective data

bull VSbull BP decreasing systolic

narrowing pulse pressurebull Pulse pulsus alternans

(alternating strong-weak-strong cardiac contraction) increased

bull Respirations crackles Cheyne-Stokes

bull Edema dependent pitting (1+ to 4+ mm)

bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

dilated pulmonary vessels lung edema

Left Ventricular Compared with Right Ventricular Heart Failure

LEFT VENTRICULAR

FAILURE

RIGHT VENTRICULAR

FAILURE

Pulmonary crackles Jugular venous distention

Tachypnea Peripheral edema

S3 gallop Perioral and peripheral cyanosis

Cardiac murmurs Congestive hepatomegaly

Paradoxical splitting of S2

Ascites

Hepatojugular reflux

ANALYSIS NURSING DIAGNOSES

bull Decreased cardiac output related to decreased myocardial contractility

bull Activity intolerance related to generalized body weakness and inadequate oxygenation

bull Fatigue related to edema and poor oxygenation

bull Fluid volume excess related to compensatory mechanisms

bull Impaired gas exchange related to pulmonary congestion

bull Anxiety related to shortness of breath

bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

NURSING CARE PLAN

bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

tachycardia dyspnea edema resolved change position frequently pillows for support

bull Rest planned periods limit visitors activity noise Chair and commode privileges

bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

bull Warm fluids if appropriate

NURSING CARE PLAN

bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

NURSING CARE PLANbull Goal 3 provide for special safety

needsbull Skin care

bull Inspect massage lubricate bony prominences

bull Use foot cradle heel protectors sheepskin

bull Side rails up if hypoxic (disoriented)

bull Vital signs monitor for signs of fatigue pulmonary emboli

bull ROM active passive elastic stockings

NURSING CARE PLAN

bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

strict IObull Diet

bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

NURSING CARE PLAN

bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

bull Refer to available community resources for dietary assistance weight reduction exercise program

EVALUATION

bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

distressbull Reduction in dependent edema

DAY 3 OF

CARDIOVASCULARDISEASES

bull hyperlipidemia means high lipid levels

bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

Treatment of Hyperlipidemia

bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

bull SYSTOLIC DYSFUNCTION

HYPERTROPHIC CARDIOMYOPATHY

bull Associated factorsbull 1 Geneticbull 2 Idiopathic

HYPERTROPHIC CARDIOMYOPATHY

bull Pathophysiologybull 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

RESTRICTIVE CARDIOMYOPATHYPathophysiology

bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

CARDIOMYOPATHIES

bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

CARDIOMYOPATHIES

bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

CARDIOMYOPATHIES

bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

relief

CARDIOMYOPATHIES

bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

CARDIOMYOPATHIES

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

Infective endocarditis

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

bull Can be acute or chronic

Infective endocarditis

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

Infective endocarditis

bull Pathophysiologybull 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

bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

Infective endocarditis

bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

retina

Infective endocarditis

bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

Infective endocarditis

bull Preventionbull Antibiotic prophylaxis if patient is

undergoing procedures like dental extractions bronchoscopy surgery etc

Infective endocarditis

bull LABORATORY EXAMbull Blood Cultures to determine the exact

organism

Infective endocarditis

bull Nursing managementbull 1 regular monitoring of temperature heart

soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

Infective endocarditis

bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

B

Infective endocarditis

bull Medical managementbull 2 Surgerybull Valvular replacement

CARDIOGENIC SHOCK

bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

CARDIOGENIC SHOCK

bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

CARDIOGENIC SHOCK

bull LABORATORY FINDINGSIncreased CVP

Normal is 4-10 cmH2O

CARDIOGENIC SHOCK

bull NURSING INTERVENTIONSbull 1 Place patient in a modified

Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

inotropics such as DOPAMINE and DOBUTAMINE

bull 3 Administer O2bull 4 Morphine is administered to

decreased pulmonary congestion and to relieve pain

CARDIOGENIC SHOCK

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

bull 6 Monitor urinary output BP and pulses

bull 7 cautiously administer diuretics and nitrates

CARDIAC TAMPONADE

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

CARDIAC TAMPONADE

bull This condition restricts ventricular filling resulting to decreased cardiac output

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

CARDIAC TAMPONADE

bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

infarctionbull 3 Pericarditisbull 4 Cancer metastasis

CARDIAC TAMPONADE

bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

distention hypotension and distantmuffled heart sound

bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

CARDIAC TAMPONADE

bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

anterior chest

CARDIAC TAMPONADE

bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

CARDIAC TAMPONADE

bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

tamponade

bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

artery rupture dysrhythmias pleural laceration and myocardial trauma

HYPERTENSION

bull 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

bull Types of Hypertensionbull 1 Primary or ESSENTIAL

bull Most common typebull 2 Secondary

bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

Alterations in Blood Flow in the Systemic Circulation

Buergerrsquos Disease

bull Also known as Thromboangiitis obliterans

bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

reaction of the vessel wall

Manifestations

Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

Increased sensitivity to cold (due to impaired circulation

Absentdiminished peripheral pulses

Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

gangrenous changes may arise may necessitate amputation

Diagnosis amp Treatment

bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

emotionsRaynaudrsquos phenomenon ndash associated with

previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

Manifestations bull Period of ischemia (ischemia due to vasospasm)

bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

bull Return to normal colorbull Note although all of the fingers are

affected symmetrically only 1-2digits may be involved

bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

(rare occasions)

Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

Immersion of hand in cold water to initiate attack aids in the Dx

Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

protection from cold Avoidance of emotional stress (anxiety amp

stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

Care Plan for Clients with Altered Cardiovascular Oxygenation

A Assessment

1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

2 vsB Nursing Dx

1 ineffective tissue perfusion (cardiopulmonary)

2 Impaired gas exchange

3 Anxiety due to fear of death (clients with MI or Angina)

C Goals

1 Relief of pain amp symptoms

2 Prevention of further cardiac damage

D Nursing Interventions

1 Pain control

2 Proper medications

3 Decrease clientrsquos anxiety

4 Health teachings (meds activities diet exercise etc)

  • CARDIOVASCULAR DISEASES
  • Slide 2
  • GENERAL CARDIAC ASSESSMENT
  • Pathophysiology
  • Slide 5
  • ASSESSING CHEST PAIN
  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
  • Angina Pectoris Myocardial Ischemia
  • Pathophysiology
  • Types
  • Slide 12
  • Slide 13
  • Slide 14
  • Conthellip
  • Conthellip (2)
  • Drug Therapy
  • Classification
  • Nursing Management
  • Nursing Management (2)
  • Acute Coronary Syndrome
  • Slide 22
  • Conthellip (3)
  • Slide 24
  • Conthellip(MI)
  • Slide 26
  • Pathophysiology (2)
  • Tissue Changes After MI
  • Management of MI
  • Slide 30
  • Slide 31
  • ASSESSMENT
  • ANALYSIS NURSING DIAGNOSES
  • NURSING CARE PLAN
  • NURSING CARE PLAN (2)
  • NURSING CARE PLAN (3)
  • NURSING CARE PLAN (4)
  • NURSING CARE PLAN (5)
  • NURSING CARE PLAN (6)
  • NURSING CARE PLAN (7)
  • NURSING CARE PLAN (8)
  • EVALUATION
  • CONGESTIVE HEART FAILURE
  • PATHOPHYSIOLOGY
  • ASSESSMENT (2)
  • ASSESSMENT (3)
  • Left Ventricular Compared with Right Ventricular Heart Failure
  • ANALYSIS NURSING DIAGNOSES (2)
  • Slide 49
  • NURSING CARE PLAN (9)
  • NURSING CARE PLAN (10)
  • NURSING CARE PLAN (11)
  • NURSING CARE PLAN (12)
  • NURSING CARE PLAN (13)
  • EVALUATION
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Treatment of Hyperlipidemia
  • Slide 62
  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
  • HYPERTROPHIC CARDIOMYOPATHY
  • HYPERTROPHIC CARDIOMYOPATHY (2)
  • RESTRICTIVE CARDIOMYOPATHY
  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
  • CARDIOMYOPATHIES
  • CARDIOMYOPATHIES (2)
  • CARDIOMYOPATHIES (3)
  • CARDIOMYOPATHIES (4)
  • CARDIOMYOPATHIES (5)
  • CARDIOMYOPATHIES (6)
  • Infective endocarditis
  • Infective endocarditis (2)
  • Infective endocarditis (3)
  • Infective endocarditis (4)
  • Infective endocarditis (5)
  • Infective endocarditis (6)
  • Infective endocarditis (7)
  • Infective endocarditis (8)
  • Infective endocarditis (9)
  • Infective endocarditis (10)
  • Infective endocarditis (11)
  • Infective endocarditis (12)
  • CARDIOGENIC SHOCK
  • CARDIOGENIC SHOCK (2)
  • CARDIOGENIC SHOCK (3)
  • CARDIOGENIC SHOCK (4)
  • CARDIOGENIC SHOCK (5)
  • CARDIAC TAMPONADE
  • CARDIAC TAMPONADE (2)
  • CARDIAC TAMPONADE (3)
  • CARDIAC TAMPONADE (4)
  • CARDIAC TAMPONADE (5)
  • CARDIAC TAMPONADE (6)
  • CARDIAC TAMPONADE (7)
  • Slide 100
  • HYPERTENSION
  • HYPERTENSION (2)
  • Slide 103
  • Slide 104
  • Slide 105
  • Alterations in Blood Flow in the Systemic Circulation
  • Buergerrsquos Disease
  • Slide 108
  • Manifestations
  • Slide 110
  • Diagnosis amp Treatment
  • Rynaudrsquos Disease
  • Manifestations (2)
  • Slide 114
  • Diagnosis amp Treatment (2)
  • Slide 116
  • Care Plan for Clients with Altered Cardiovascular Oxygenation
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121

    THE CARDIOVASCULAR SYSTEM

    >

    GENERAL CARDIAC ASSESSMENT

    bull Health historybull Demographic informationbull Familygenetic historybull Culturalsocial factors

    bull Risk factorsbull Modifiable High blood cholesterol

    obesity smoking stress hypertension diabetes mellitus

    bull Nonmodifiable Family history increasing age gender race

    Pathophysiology

    ASSESSING CHEST PAIN

    COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

    Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

    Onset Gradual Sudden Sudden Gradual Sudden

    Gradual Sudden

    Abrupt Gradual Sudden

    Precipitating Factors

    At rest after exercise or emotional stress

    Breathing deeply rotating trunk yawning

    Inflammation of GI parts increased HCL medications

    After exercise emotional stress eating envtrsquol changes

    Hypertension Immobility Prolonged bedrest

    Location Substernal anterior chest rarely back radiates to jawneck

    Precordial rotates to neck left shoulder amp arm

    Xiphoid to umbilicus

    Substernal anterior chest poorly localized

    Site of rupture anterior chest or back between scapula

    Pleural area retrosternal

    Quality Crushing burning stabbing squeezing vicelike

    Pleuritic sharp Aching burning cramplike gnawing

    Squeezing feeling of heavy pressure burning

    Sharp tearing ripping

    Sharp stabbing

    COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

    Characteristic

    MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

    Intensity Asymptomatic to severe increases with time

    Mild to severe Mild to severe Mild to moderate

    Severe unbearable maximal from onset

    Aggravated by breathing

    Duration 30 min to 1-2 hours may wax and wane

    Continuous Periodic 2-10 min ave 3-5 min

    Continuous does not abate once started

    Variable

    Relief Narcotics Sitting up leaning forward

    Physical emotional rest food antacid

    Nitroglycerin rest

    Large repeated doses of narcotics

    02 sitting up morphine

    Associated Symptoms

    Nausea fatigue heartburn equal peripheral pulses

    Fever dyspnea nausea anorexia anxiety

    NV dysphagia anorexia weight loss

    Belching indigestion dizziness

    Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

    Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

    Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

    inadequate to meet the heartrsquos metabolic demands

    Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

    Pathophysiology

    Types

    AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

    (although those with advance atherosclerosis do not develop angina)

    Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

    Pain location precordial or substernal chest area

    Pain characteristics - constricting squeezing or

    suffocating sensation- Usually steady increasing in

    intensity only at the onset amp end of attack

    - May radiate to left shoulder arm jaw or other chest areas

    - Duration lt 15mins- Relieved by rest (preferably sitting

    or standing with support) or by use of NTG

    B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

    Associates in 1659 Cause spasm of coronary

    arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

    be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

    Pain Characteristics occurs during rest or with minimal exercise

    - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

    If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

    Conthellip

    C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

    D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

    E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

    ConthellipDx detailed pain history ECG TST

    angiogram may be used to confirm amp describe type of angina

    Tx directed towards MI prevention- Lifestyle modification (individualized

    regular exercise program smoking cessation)

    - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

    coronary angioplasty) may be indicated if with severe artery occlusion

    Drug Therapy Nitroglycerin (NTGs) ndash

    vasodilators patch (Deponit

    Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

    Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

    Calcium channel blockers Nifedipine (Calcibloc

    Adalat) Diltiazem (Cardizem)

    Lipid lowering agents ndashstatins Simvastatin

    Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

    Classification

    Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

    Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

    Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

    Class IV ndash angina occurs even at rest

    Nursing Management

    Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

    Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

    limitations NTGs ndash max of 3doses at 5-min intervals

    Stinging sensation under the tongue for SL is normal

    Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

    bottles amp change stocks every 6months Inform clients that headache dizziness

    flushed face are common side effects

    Do not discontinue the drug For patches rotate skin sites usually on

    chest wall Instrct on evaluation of effectiveness based

    on pain reliefPropanolols causes bronchospasm amp

    hypoglycemia do not administer to asthmatic amp diabetic clients

    Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

    Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

    Nursing Management

    Acute Coronary Syndrome

    Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

    Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

    Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

    gt20mins)2 New onset exertional angina (increased in

    severity of at least 1 class ndash to at least class III) in lt2months

    3 Recent acceleration of angina to at least class III in lt2months

    Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

    When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

    Conthellip

    ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

    myocardial tissue associated with atherosclerotic disease of coronary arteries

    Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

    Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

    elevation Q wave prolongation T wave inversion

    Conthellip(MI)

    Manifestations chest pain ndash severe crushing

    constricting ldquosomeone sitting on my chestrdquo

    - substernal radiating to left arm neck or jaw

    - prolonged (gt35mins) amp not relieved by rest

    Shortness of breath profuse perspirationFeeling of impending doom

    Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

    profound LV failure from massive MI resulting to low cardiac output

    Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

    Rupture of myocardiumVentricular aneurysms ndash decreases

    pumping efficiency of heart amp increases work of LV

    Pathophysiology

    Causes atherosclerotic heart disease thrombosisembolism

    shock ampor hemorrhage direct traumaMyocardial ischemia

    uarrcellular hypoxia

    darrmyocardial O2 supplydarr myocardial contractility

    darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

    uarrperipheral vasoconstriction

    uarr myocardial contractility

    uarr afterload uarrmyocardial O2 demand

    uarr HR uarrdiastolicfilling

    darrmyocardial tissue perfusion

    Tissue Changes After MI

    Time after Onset Type of Injury amp Gross Tissue Changes

    0-05hrs Reversible injury

    1-2hrs Onset of irreversible injury

    4-12hrs Beginning of coagulation necrosis

    18-24hrs Continued necrosis gross pallor of infected tissue

    1-3days Total necrosis onset of acute inflammatory process

    3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

    7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

    8th week Complete scar tissue replacement

    Management of MI Initial Management OMEN

    - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

    vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

    may be given to limit infarction size amp most effective if given within 4hrs of onset)

    Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

    Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

    bull Surgery 1Revascularization

    bullPTCAbullCoronary stent implantation

    bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

    2Resection ndash aneurysm

    ASSESSMENT

    bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

    bull Objective databull VSbull Diaphoresisbull Emotional restlessness

    ANALYSIS NURSING DIAGNOSES

    bull Decreased cardiac output related to myocardial damage

    bull Impaired gas exchange related to poor perfusion shock

    bull Pain related to myocardial ischemia

    bull Activity intolerance related to pain or inadequate oxygenation

    bull Fear related to possibility of death

    NURSING CARE PLANbull Goal 1 reduce pain discomfort

    bull Narcotics ndash morphine note response Avoid IM

    bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

    bull Position semi-Fowlerrsquos to improve ventilation

    NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

    rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

    thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

    cracklesbull Check labs troponin blood gases electrolytes

    clotting timebull CVP (5-15 cm H2O) increases with heart failure

    bull ROM of lower extremities antiembolic stockings

    NURSING CARE PLAN

    bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

    bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

    bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

    bull Anticipate needs of client call light water Reassurance

    bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

    NURSING CARE PLAN

    bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

    Mg)bull Monitor ECGbull Diet progressive low

    calorie low sodium low cholesterol low fat without caffeine

    NURSING CARE PLAN

    bull Goal 5 facilitate fecal eliminationbull Medications stool

    softeners to prevent Valsalva maneuver mouth breathing during bowel movement

    bull Bedside commode

    NURSING CARE PLAN

    bull Goal 6 provide emotional supportbull Recognize fear of dying

    denial anger withdrawalbull Encourage expression of

    feelings fears concernsbull Discuss rehabilitation lifestyle

    changes prevent cardiac-invalid syndrome by promoting self-care activities independence

    NURSING CARE PLAN

    bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

    activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

    bull Identify need for referral for sexual counselling

    NURSING CARE PLAN

    bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

    meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

    bull Information about sexual activity less fatiguing positions

    bull Support groups Follow-up carebull Medications administration importance untoward

    effects pulse takingbull Control risk factors rest diet exercise no smoking

    weight control stress reduction

    EVALUATION

    bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

    CONGESTIVE HEART FAILURE

    bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

    PATHOPHYSIOLOGY

    Increased cardiac workload

    decreased effective myocardial contractility

    Decreased cardiac output

    LV failure Pulmonary congestion

    RA RV failure

    Systemic congestion

    Peripheral edema

    ASSESSMENTbull Subjective data

    bull Shortness of breathbull Orthopnea (sleeps on two

    or more pillows)bull Paroxysmal nocturnal

    dyspnea (sudden breathlessness during sleep)

    bull Dyspnea on exertion (climbing stairs)

    bull Apprehension anxiety irritability

    bull Fatigue weaknessbull Reported weight gain

    feeling of puffiness

    ASSESSMENTbull Objective data

    bull VSbull BP decreasing systolic

    narrowing pulse pressurebull Pulse pulsus alternans

    (alternating strong-weak-strong cardiac contraction) increased

    bull Respirations crackles Cheyne-Stokes

    bull Edema dependent pitting (1+ to 4+ mm)

    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

    dilated pulmonary vessels lung edema

    Left Ventricular Compared with Right Ventricular Heart Failure

    LEFT VENTRICULAR

    FAILURE

    RIGHT VENTRICULAR

    FAILURE

    Pulmonary crackles Jugular venous distention

    Tachypnea Peripheral edema

    S3 gallop Perioral and peripheral cyanosis

    Cardiac murmurs Congestive hepatomegaly

    Paradoxical splitting of S2

    Ascites

    Hepatojugular reflux

    ANALYSIS NURSING DIAGNOSES

    bull Decreased cardiac output related to decreased myocardial contractility

    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

    bull Fatigue related to edema and poor oxygenation

    bull Fluid volume excess related to compensatory mechanisms

    bull Impaired gas exchange related to pulmonary congestion

    bull Anxiety related to shortness of breath

    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

    NURSING CARE PLAN

    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

    tachycardia dyspnea edema resolved change position frequently pillows for support

    bull Rest planned periods limit visitors activity noise Chair and commode privileges

    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

    bull Warm fluids if appropriate

    NURSING CARE PLAN

    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

    NURSING CARE PLANbull Goal 3 provide for special safety

    needsbull Skin care

    bull Inspect massage lubricate bony prominences

    bull Use foot cradle heel protectors sheepskin

    bull Side rails up if hypoxic (disoriented)

    bull Vital signs monitor for signs of fatigue pulmonary emboli

    bull ROM active passive elastic stockings

    NURSING CARE PLAN

    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

    strict IObull Diet

    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

    NURSING CARE PLAN

    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

    bull Refer to available community resources for dietary assistance weight reduction exercise program

    EVALUATION

    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

    distressbull Reduction in dependent edema

    DAY 3 OF

    CARDIOVASCULARDISEASES

    bull hyperlipidemia means high lipid levels

    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

    Treatment of Hyperlipidemia

    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

    bull SYSTOLIC DYSFUNCTION

    HYPERTROPHIC CARDIOMYOPATHY

    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

    HYPERTROPHIC CARDIOMYOPATHY

    bull Pathophysiologybull 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

    RESTRICTIVE CARDIOMYOPATHYPathophysiology

    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

    CARDIOMYOPATHIES

    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

    CARDIOMYOPATHIES

    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

    CARDIOMYOPATHIES

    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

    relief

    CARDIOMYOPATHIES

    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

    CARDIOMYOPATHIES

    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

    Infective endocarditis

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

    bull Can be acute or chronic

    Infective endocarditis

    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

    Infective endocarditis

    bull Pathophysiologybull 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

    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

    Infective endocarditis

    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

    retina

    Infective endocarditis

    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

    Infective endocarditis

    bull Preventionbull Antibiotic prophylaxis if patient is

    undergoing procedures like dental extractions bronchoscopy surgery etc

    Infective endocarditis

    bull LABORATORY EXAMbull Blood Cultures to determine the exact

    organism

    Infective endocarditis

    bull Nursing managementbull 1 regular monitoring of temperature heart

    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

    Infective endocarditis

    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

    B

    Infective endocarditis

    bull Medical managementbull 2 Surgerybull Valvular replacement

    CARDIOGENIC SHOCK

    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

    CARDIOGENIC SHOCK

    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

    CARDIOGENIC SHOCK

    bull LABORATORY FINDINGSIncreased CVP

    Normal is 4-10 cmH2O

    CARDIOGENIC SHOCK

    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

    inotropics such as DOPAMINE and DOBUTAMINE

    bull 3 Administer O2bull 4 Morphine is administered to

    decreased pulmonary congestion and to relieve pain

    CARDIOGENIC SHOCK

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

    bull 6 Monitor urinary output BP and pulses

    bull 7 cautiously administer diuretics and nitrates

    CARDIAC TAMPONADE

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

    CARDIAC TAMPONADE

    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

    CARDIAC TAMPONADE

    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

    CARDIAC TAMPONADE

    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

    distention hypotension and distantmuffled heart sound

    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

    CARDIAC TAMPONADE

    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

    anterior chest

    CARDIAC TAMPONADE

    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

    CARDIAC TAMPONADE

    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

    tamponade

    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

    artery rupture dysrhythmias pleural laceration and myocardial trauma

    HYPERTENSION

    bull 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

    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

    bull Most common typebull 2 Secondary

    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

    Alterations in Blood Flow in the Systemic Circulation

    Buergerrsquos Disease

    bull Also known as Thromboangiitis obliterans

    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

    reaction of the vessel wall

    Manifestations

    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

    Increased sensitivity to cold (due to impaired circulation

    Absentdiminished peripheral pulses

    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

    gangrenous changes may arise may necessitate amputation

    Diagnosis amp Treatment

    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

    emotionsRaynaudrsquos phenomenon ndash associated with

    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

    Manifestations bull Period of ischemia (ischemia due to vasospasm)

    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

    bull Return to normal colorbull Note although all of the fingers are

    affected symmetrically only 1-2digits may be involved

    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

    (rare occasions)

    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

    Immersion of hand in cold water to initiate attack aids in the Dx

    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

    protection from cold Avoidance of emotional stress (anxiety amp

    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

    Care Plan for Clients with Altered Cardiovascular Oxygenation

    A Assessment

    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

    2 vsB Nursing Dx

    1 ineffective tissue perfusion (cardiopulmonary)

    2 Impaired gas exchange

    3 Anxiety due to fear of death (clients with MI or Angina)

    C Goals

    1 Relief of pain amp symptoms

    2 Prevention of further cardiac damage

    D Nursing Interventions

    1 Pain control

    2 Proper medications

    3 Decrease clientrsquos anxiety

    4 Health teachings (meds activities diet exercise etc)

    • CARDIOVASCULAR DISEASES
    • Slide 2
    • GENERAL CARDIAC ASSESSMENT
    • Pathophysiology
    • Slide 5
    • ASSESSING CHEST PAIN
    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
    • Angina Pectoris Myocardial Ischemia
    • Pathophysiology
    • Types
    • Slide 12
    • Slide 13
    • Slide 14
    • Conthellip
    • Conthellip (2)
    • Drug Therapy
    • Classification
    • Nursing Management
    • Nursing Management (2)
    • Acute Coronary Syndrome
    • Slide 22
    • Conthellip (3)
    • Slide 24
    • Conthellip(MI)
    • Slide 26
    • Pathophysiology (2)
    • Tissue Changes After MI
    • Management of MI
    • Slide 30
    • Slide 31
    • ASSESSMENT
    • ANALYSIS NURSING DIAGNOSES
    • NURSING CARE PLAN
    • NURSING CARE PLAN (2)
    • NURSING CARE PLAN (3)
    • NURSING CARE PLAN (4)
    • NURSING CARE PLAN (5)
    • NURSING CARE PLAN (6)
    • NURSING CARE PLAN (7)
    • NURSING CARE PLAN (8)
    • EVALUATION
    • CONGESTIVE HEART FAILURE
    • PATHOPHYSIOLOGY
    • ASSESSMENT (2)
    • ASSESSMENT (3)
    • Left Ventricular Compared with Right Ventricular Heart Failure
    • ANALYSIS NURSING DIAGNOSES (2)
    • Slide 49
    • NURSING CARE PLAN (9)
    • NURSING CARE PLAN (10)
    • NURSING CARE PLAN (11)
    • NURSING CARE PLAN (12)
    • NURSING CARE PLAN (13)
    • EVALUATION
    • Slide 56
    • Slide 57
    • Slide 58
    • Slide 59
    • Slide 60
    • Treatment of Hyperlipidemia
    • Slide 62
    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
    • HYPERTROPHIC CARDIOMYOPATHY
    • HYPERTROPHIC CARDIOMYOPATHY (2)
    • RESTRICTIVE CARDIOMYOPATHY
    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
    • CARDIOMYOPATHIES
    • CARDIOMYOPATHIES (2)
    • CARDIOMYOPATHIES (3)
    • CARDIOMYOPATHIES (4)
    • CARDIOMYOPATHIES (5)
    • CARDIOMYOPATHIES (6)
    • Infective endocarditis
    • Infective endocarditis (2)
    • Infective endocarditis (3)
    • Infective endocarditis (4)
    • Infective endocarditis (5)
    • Infective endocarditis (6)
    • Infective endocarditis (7)
    • Infective endocarditis (8)
    • Infective endocarditis (9)
    • Infective endocarditis (10)
    • Infective endocarditis (11)
    • Infective endocarditis (12)
    • CARDIOGENIC SHOCK
    • CARDIOGENIC SHOCK (2)
    • CARDIOGENIC SHOCK (3)
    • CARDIOGENIC SHOCK (4)
    • CARDIOGENIC SHOCK (5)
    • CARDIAC TAMPONADE
    • CARDIAC TAMPONADE (2)
    • CARDIAC TAMPONADE (3)
    • CARDIAC TAMPONADE (4)
    • CARDIAC TAMPONADE (5)
    • CARDIAC TAMPONADE (6)
    • CARDIAC TAMPONADE (7)
    • Slide 100
    • HYPERTENSION
    • HYPERTENSION (2)
    • Slide 103
    • Slide 104
    • Slide 105
    • Alterations in Blood Flow in the Systemic Circulation
    • Buergerrsquos Disease
    • Slide 108
    • Manifestations
    • Slide 110
    • Diagnosis amp Treatment
    • Rynaudrsquos Disease
    • Manifestations (2)
    • Slide 114
    • Diagnosis amp Treatment (2)
    • Slide 116
    • Care Plan for Clients with Altered Cardiovascular Oxygenation
    • Slide 118
    • Slide 119
    • Slide 120
    • Slide 121

      GENERAL CARDIAC ASSESSMENT

      bull Health historybull Demographic informationbull Familygenetic historybull Culturalsocial factors

      bull Risk factorsbull Modifiable High blood cholesterol

      obesity smoking stress hypertension diabetes mellitus

      bull Nonmodifiable Family history increasing age gender race

      Pathophysiology

      ASSESSING CHEST PAIN

      COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

      Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

      Onset Gradual Sudden Sudden Gradual Sudden

      Gradual Sudden

      Abrupt Gradual Sudden

      Precipitating Factors

      At rest after exercise or emotional stress

      Breathing deeply rotating trunk yawning

      Inflammation of GI parts increased HCL medications

      After exercise emotional stress eating envtrsquol changes

      Hypertension Immobility Prolonged bedrest

      Location Substernal anterior chest rarely back radiates to jawneck

      Precordial rotates to neck left shoulder amp arm

      Xiphoid to umbilicus

      Substernal anterior chest poorly localized

      Site of rupture anterior chest or back between scapula

      Pleural area retrosternal

      Quality Crushing burning stabbing squeezing vicelike

      Pleuritic sharp Aching burning cramplike gnawing

      Squeezing feeling of heavy pressure burning

      Sharp tearing ripping

      Sharp stabbing

      COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

      Characteristic

      MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

      Intensity Asymptomatic to severe increases with time

      Mild to severe Mild to severe Mild to moderate

      Severe unbearable maximal from onset

      Aggravated by breathing

      Duration 30 min to 1-2 hours may wax and wane

      Continuous Periodic 2-10 min ave 3-5 min

      Continuous does not abate once started

      Variable

      Relief Narcotics Sitting up leaning forward

      Physical emotional rest food antacid

      Nitroglycerin rest

      Large repeated doses of narcotics

      02 sitting up morphine

      Associated Symptoms

      Nausea fatigue heartburn equal peripheral pulses

      Fever dyspnea nausea anorexia anxiety

      NV dysphagia anorexia weight loss

      Belching indigestion dizziness

      Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

      Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

      Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

      inadequate to meet the heartrsquos metabolic demands

      Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

      Pathophysiology

      Types

      AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

      (although those with advance atherosclerosis do not develop angina)

      Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

      Pain location precordial or substernal chest area

      Pain characteristics - constricting squeezing or

      suffocating sensation- Usually steady increasing in

      intensity only at the onset amp end of attack

      - May radiate to left shoulder arm jaw or other chest areas

      - Duration lt 15mins- Relieved by rest (preferably sitting

      or standing with support) or by use of NTG

      B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

      Associates in 1659 Cause spasm of coronary

      arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

      be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

      Pain Characteristics occurs during rest or with minimal exercise

      - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

      If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

      Conthellip

      C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

      D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

      E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

      ConthellipDx detailed pain history ECG TST

      angiogram may be used to confirm amp describe type of angina

      Tx directed towards MI prevention- Lifestyle modification (individualized

      regular exercise program smoking cessation)

      - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

      coronary angioplasty) may be indicated if with severe artery occlusion

      Drug Therapy Nitroglycerin (NTGs) ndash

      vasodilators patch (Deponit

      Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

      Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

      Calcium channel blockers Nifedipine (Calcibloc

      Adalat) Diltiazem (Cardizem)

      Lipid lowering agents ndashstatins Simvastatin

      Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

      Classification

      Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

      Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

      Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

      Class IV ndash angina occurs even at rest

      Nursing Management

      Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

      Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

      limitations NTGs ndash max of 3doses at 5-min intervals

      Stinging sensation under the tongue for SL is normal

      Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

      bottles amp change stocks every 6months Inform clients that headache dizziness

      flushed face are common side effects

      Do not discontinue the drug For patches rotate skin sites usually on

      chest wall Instrct on evaluation of effectiveness based

      on pain reliefPropanolols causes bronchospasm amp

      hypoglycemia do not administer to asthmatic amp diabetic clients

      Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

      Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

      Nursing Management

      Acute Coronary Syndrome

      Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

      Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

      Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

      gt20mins)2 New onset exertional angina (increased in

      severity of at least 1 class ndash to at least class III) in lt2months

      3 Recent acceleration of angina to at least class III in lt2months

      Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

      When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

      Conthellip

      ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

      myocardial tissue associated with atherosclerotic disease of coronary arteries

      Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

      Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

      elevation Q wave prolongation T wave inversion

      Conthellip(MI)

      Manifestations chest pain ndash severe crushing

      constricting ldquosomeone sitting on my chestrdquo

      - substernal radiating to left arm neck or jaw

      - prolonged (gt35mins) amp not relieved by rest

      Shortness of breath profuse perspirationFeeling of impending doom

      Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

      profound LV failure from massive MI resulting to low cardiac output

      Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

      Rupture of myocardiumVentricular aneurysms ndash decreases

      pumping efficiency of heart amp increases work of LV

      Pathophysiology

      Causes atherosclerotic heart disease thrombosisembolism

      shock ampor hemorrhage direct traumaMyocardial ischemia

      uarrcellular hypoxia

      darrmyocardial O2 supplydarr myocardial contractility

      darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

      uarrperipheral vasoconstriction

      uarr myocardial contractility

      uarr afterload uarrmyocardial O2 demand

      uarr HR uarrdiastolicfilling

      darrmyocardial tissue perfusion

      Tissue Changes After MI

      Time after Onset Type of Injury amp Gross Tissue Changes

      0-05hrs Reversible injury

      1-2hrs Onset of irreversible injury

      4-12hrs Beginning of coagulation necrosis

      18-24hrs Continued necrosis gross pallor of infected tissue

      1-3days Total necrosis onset of acute inflammatory process

      3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

      7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

      8th week Complete scar tissue replacement

      Management of MI Initial Management OMEN

      - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

      vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

      may be given to limit infarction size amp most effective if given within 4hrs of onset)

      Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

      Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

      bull Surgery 1Revascularization

      bullPTCAbullCoronary stent implantation

      bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

      2Resection ndash aneurysm

      ASSESSMENT

      bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

      bull Objective databull VSbull Diaphoresisbull Emotional restlessness

      ANALYSIS NURSING DIAGNOSES

      bull Decreased cardiac output related to myocardial damage

      bull Impaired gas exchange related to poor perfusion shock

      bull Pain related to myocardial ischemia

      bull Activity intolerance related to pain or inadequate oxygenation

      bull Fear related to possibility of death

      NURSING CARE PLANbull Goal 1 reduce pain discomfort

      bull Narcotics ndash morphine note response Avoid IM

      bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

      bull Position semi-Fowlerrsquos to improve ventilation

      NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

      rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

      thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

      cracklesbull Check labs troponin blood gases electrolytes

      clotting timebull CVP (5-15 cm H2O) increases with heart failure

      bull ROM of lower extremities antiembolic stockings

      NURSING CARE PLAN

      bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

      bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

      bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

      bull Anticipate needs of client call light water Reassurance

      bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

      NURSING CARE PLAN

      bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

      Mg)bull Monitor ECGbull Diet progressive low

      calorie low sodium low cholesterol low fat without caffeine

      NURSING CARE PLAN

      bull Goal 5 facilitate fecal eliminationbull Medications stool

      softeners to prevent Valsalva maneuver mouth breathing during bowel movement

      bull Bedside commode

      NURSING CARE PLAN

      bull Goal 6 provide emotional supportbull Recognize fear of dying

      denial anger withdrawalbull Encourage expression of

      feelings fears concernsbull Discuss rehabilitation lifestyle

      changes prevent cardiac-invalid syndrome by promoting self-care activities independence

      NURSING CARE PLAN

      bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

      activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

      bull Identify need for referral for sexual counselling

      NURSING CARE PLAN

      bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

      meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

      bull Information about sexual activity less fatiguing positions

      bull Support groups Follow-up carebull Medications administration importance untoward

      effects pulse takingbull Control risk factors rest diet exercise no smoking

      weight control stress reduction

      EVALUATION

      bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

      CONGESTIVE HEART FAILURE

      bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

      PATHOPHYSIOLOGY

      Increased cardiac workload

      decreased effective myocardial contractility

      Decreased cardiac output

      LV failure Pulmonary congestion

      RA RV failure

      Systemic congestion

      Peripheral edema

      ASSESSMENTbull Subjective data

      bull Shortness of breathbull Orthopnea (sleeps on two

      or more pillows)bull Paroxysmal nocturnal

      dyspnea (sudden breathlessness during sleep)

      bull Dyspnea on exertion (climbing stairs)

      bull Apprehension anxiety irritability

      bull Fatigue weaknessbull Reported weight gain

      feeling of puffiness

      ASSESSMENTbull Objective data

      bull VSbull BP decreasing systolic

      narrowing pulse pressurebull Pulse pulsus alternans

      (alternating strong-weak-strong cardiac contraction) increased

      bull Respirations crackles Cheyne-Stokes

      bull Edema dependent pitting (1+ to 4+ mm)

      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

      dilated pulmonary vessels lung edema

      Left Ventricular Compared with Right Ventricular Heart Failure

      LEFT VENTRICULAR

      FAILURE

      RIGHT VENTRICULAR

      FAILURE

      Pulmonary crackles Jugular venous distention

      Tachypnea Peripheral edema

      S3 gallop Perioral and peripheral cyanosis

      Cardiac murmurs Congestive hepatomegaly

      Paradoxical splitting of S2

      Ascites

      Hepatojugular reflux

      ANALYSIS NURSING DIAGNOSES

      bull Decreased cardiac output related to decreased myocardial contractility

      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

      bull Fatigue related to edema and poor oxygenation

      bull Fluid volume excess related to compensatory mechanisms

      bull Impaired gas exchange related to pulmonary congestion

      bull Anxiety related to shortness of breath

      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

      NURSING CARE PLAN

      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

      tachycardia dyspnea edema resolved change position frequently pillows for support

      bull Rest planned periods limit visitors activity noise Chair and commode privileges

      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

      bull Warm fluids if appropriate

      NURSING CARE PLAN

      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

      NURSING CARE PLANbull Goal 3 provide for special safety

      needsbull Skin care

      bull Inspect massage lubricate bony prominences

      bull Use foot cradle heel protectors sheepskin

      bull Side rails up if hypoxic (disoriented)

      bull Vital signs monitor for signs of fatigue pulmonary emboli

      bull ROM active passive elastic stockings

      NURSING CARE PLAN

      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

      strict IObull Diet

      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

      NURSING CARE PLAN

      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

      bull Refer to available community resources for dietary assistance weight reduction exercise program

      EVALUATION

      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

      distressbull Reduction in dependent edema

      DAY 3 OF

      CARDIOVASCULARDISEASES

      bull hyperlipidemia means high lipid levels

      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

      Treatment of Hyperlipidemia

      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

      bull SYSTOLIC DYSFUNCTION

      HYPERTROPHIC CARDIOMYOPATHY

      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

      HYPERTROPHIC CARDIOMYOPATHY

      bull Pathophysiologybull 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

      RESTRICTIVE CARDIOMYOPATHYPathophysiology

      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

      CARDIOMYOPATHIES

      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

      CARDIOMYOPATHIES

      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

      CARDIOMYOPATHIES

      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

      relief

      CARDIOMYOPATHIES

      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

      CARDIOMYOPATHIES

      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

      Infective endocarditis

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

      bull Can be acute or chronic

      Infective endocarditis

      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

      Infective endocarditis

      bull Pathophysiologybull 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

      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

      Infective endocarditis

      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

      retina

      Infective endocarditis

      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

      Infective endocarditis

      bull Preventionbull Antibiotic prophylaxis if patient is

      undergoing procedures like dental extractions bronchoscopy surgery etc

      Infective endocarditis

      bull LABORATORY EXAMbull Blood Cultures to determine the exact

      organism

      Infective endocarditis

      bull Nursing managementbull 1 regular monitoring of temperature heart

      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

      Infective endocarditis

      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

      B

      Infective endocarditis

      bull Medical managementbull 2 Surgerybull Valvular replacement

      CARDIOGENIC SHOCK

      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

      CARDIOGENIC SHOCK

      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

      CARDIOGENIC SHOCK

      bull LABORATORY FINDINGSIncreased CVP

      Normal is 4-10 cmH2O

      CARDIOGENIC SHOCK

      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

      inotropics such as DOPAMINE and DOBUTAMINE

      bull 3 Administer O2bull 4 Morphine is administered to

      decreased pulmonary congestion and to relieve pain

      CARDIOGENIC SHOCK

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

      bull 6 Monitor urinary output BP and pulses

      bull 7 cautiously administer diuretics and nitrates

      CARDIAC TAMPONADE

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

      CARDIAC TAMPONADE

      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

      CARDIAC TAMPONADE

      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

      CARDIAC TAMPONADE

      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

      distention hypotension and distantmuffled heart sound

      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

      CARDIAC TAMPONADE

      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

      anterior chest

      CARDIAC TAMPONADE

      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

      CARDIAC TAMPONADE

      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

      tamponade

      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

      artery rupture dysrhythmias pleural laceration and myocardial trauma

      HYPERTENSION

      bull 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

      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

      bull Most common typebull 2 Secondary

      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

      Alterations in Blood Flow in the Systemic Circulation

      Buergerrsquos Disease

      bull Also known as Thromboangiitis obliterans

      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

      reaction of the vessel wall

      Manifestations

      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

      Increased sensitivity to cold (due to impaired circulation

      Absentdiminished peripheral pulses

      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

      gangrenous changes may arise may necessitate amputation

      Diagnosis amp Treatment

      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

      emotionsRaynaudrsquos phenomenon ndash associated with

      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

      Manifestations bull Period of ischemia (ischemia due to vasospasm)

      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

      bull Return to normal colorbull Note although all of the fingers are

      affected symmetrically only 1-2digits may be involved

      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

      (rare occasions)

      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

      Immersion of hand in cold water to initiate attack aids in the Dx

      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

      protection from cold Avoidance of emotional stress (anxiety amp

      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

      Care Plan for Clients with Altered Cardiovascular Oxygenation

      A Assessment

      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

      2 vsB Nursing Dx

      1 ineffective tissue perfusion (cardiopulmonary)

      2 Impaired gas exchange

      3 Anxiety due to fear of death (clients with MI or Angina)

      C Goals

      1 Relief of pain amp symptoms

      2 Prevention of further cardiac damage

      D Nursing Interventions

      1 Pain control

      2 Proper medications

      3 Decrease clientrsquos anxiety

      4 Health teachings (meds activities diet exercise etc)

      • CARDIOVASCULAR DISEASES
      • Slide 2
      • GENERAL CARDIAC ASSESSMENT
      • Pathophysiology
      • Slide 5
      • ASSESSING CHEST PAIN
      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
      • Angina Pectoris Myocardial Ischemia
      • Pathophysiology
      • Types
      • Slide 12
      • Slide 13
      • Slide 14
      • Conthellip
      • Conthellip (2)
      • Drug Therapy
      • Classification
      • Nursing Management
      • Nursing Management (2)
      • Acute Coronary Syndrome
      • Slide 22
      • Conthellip (3)
      • Slide 24
      • Conthellip(MI)
      • Slide 26
      • Pathophysiology (2)
      • Tissue Changes After MI
      • Management of MI
      • Slide 30
      • Slide 31
      • ASSESSMENT
      • ANALYSIS NURSING DIAGNOSES
      • NURSING CARE PLAN
      • NURSING CARE PLAN (2)
      • NURSING CARE PLAN (3)
      • NURSING CARE PLAN (4)
      • NURSING CARE PLAN (5)
      • NURSING CARE PLAN (6)
      • NURSING CARE PLAN (7)
      • NURSING CARE PLAN (8)
      • EVALUATION
      • CONGESTIVE HEART FAILURE
      • PATHOPHYSIOLOGY
      • ASSESSMENT (2)
      • ASSESSMENT (3)
      • Left Ventricular Compared with Right Ventricular Heart Failure
      • ANALYSIS NURSING DIAGNOSES (2)
      • Slide 49
      • NURSING CARE PLAN (9)
      • NURSING CARE PLAN (10)
      • NURSING CARE PLAN (11)
      • NURSING CARE PLAN (12)
      • NURSING CARE PLAN (13)
      • EVALUATION
      • Slide 56
      • Slide 57
      • Slide 58
      • Slide 59
      • Slide 60
      • Treatment of Hyperlipidemia
      • Slide 62
      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
      • HYPERTROPHIC CARDIOMYOPATHY
      • HYPERTROPHIC CARDIOMYOPATHY (2)
      • RESTRICTIVE CARDIOMYOPATHY
      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
      • CARDIOMYOPATHIES
      • CARDIOMYOPATHIES (2)
      • CARDIOMYOPATHIES (3)
      • CARDIOMYOPATHIES (4)
      • CARDIOMYOPATHIES (5)
      • CARDIOMYOPATHIES (6)
      • Infective endocarditis
      • Infective endocarditis (2)
      • Infective endocarditis (3)
      • Infective endocarditis (4)
      • Infective endocarditis (5)
      • Infective endocarditis (6)
      • Infective endocarditis (7)
      • Infective endocarditis (8)
      • Infective endocarditis (9)
      • Infective endocarditis (10)
      • Infective endocarditis (11)
      • Infective endocarditis (12)
      • CARDIOGENIC SHOCK
      • CARDIOGENIC SHOCK (2)
      • CARDIOGENIC SHOCK (3)
      • CARDIOGENIC SHOCK (4)
      • CARDIOGENIC SHOCK (5)
      • CARDIAC TAMPONADE
      • CARDIAC TAMPONADE (2)
      • CARDIAC TAMPONADE (3)
      • CARDIAC TAMPONADE (4)
      • CARDIAC TAMPONADE (5)
      • CARDIAC TAMPONADE (6)
      • CARDIAC TAMPONADE (7)
      • Slide 100
      • HYPERTENSION
      • HYPERTENSION (2)
      • Slide 103
      • Slide 104
      • Slide 105
      • Alterations in Blood Flow in the Systemic Circulation
      • Buergerrsquos Disease
      • Slide 108
      • Manifestations
      • Slide 110
      • Diagnosis amp Treatment
      • Rynaudrsquos Disease
      • Manifestations (2)
      • Slide 114
      • Diagnosis amp Treatment (2)
      • Slide 116
      • Care Plan for Clients with Altered Cardiovascular Oxygenation
      • Slide 118
      • Slide 119
      • Slide 120
      • Slide 121

        Pathophysiology

        ASSESSING CHEST PAIN

        COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

        Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

        Onset Gradual Sudden Sudden Gradual Sudden

        Gradual Sudden

        Abrupt Gradual Sudden

        Precipitating Factors

        At rest after exercise or emotional stress

        Breathing deeply rotating trunk yawning

        Inflammation of GI parts increased HCL medications

        After exercise emotional stress eating envtrsquol changes

        Hypertension Immobility Prolonged bedrest

        Location Substernal anterior chest rarely back radiates to jawneck

        Precordial rotates to neck left shoulder amp arm

        Xiphoid to umbilicus

        Substernal anterior chest poorly localized

        Site of rupture anterior chest or back between scapula

        Pleural area retrosternal

        Quality Crushing burning stabbing squeezing vicelike

        Pleuritic sharp Aching burning cramplike gnawing

        Squeezing feeling of heavy pressure burning

        Sharp tearing ripping

        Sharp stabbing

        COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

        Characteristic

        MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

        Intensity Asymptomatic to severe increases with time

        Mild to severe Mild to severe Mild to moderate

        Severe unbearable maximal from onset

        Aggravated by breathing

        Duration 30 min to 1-2 hours may wax and wane

        Continuous Periodic 2-10 min ave 3-5 min

        Continuous does not abate once started

        Variable

        Relief Narcotics Sitting up leaning forward

        Physical emotional rest food antacid

        Nitroglycerin rest

        Large repeated doses of narcotics

        02 sitting up morphine

        Associated Symptoms

        Nausea fatigue heartburn equal peripheral pulses

        Fever dyspnea nausea anorexia anxiety

        NV dysphagia anorexia weight loss

        Belching indigestion dizziness

        Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

        Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

        Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

        inadequate to meet the heartrsquos metabolic demands

        Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

        Pathophysiology

        Types

        AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

        (although those with advance atherosclerosis do not develop angina)

        Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

        Pain location precordial or substernal chest area

        Pain characteristics - constricting squeezing or

        suffocating sensation- Usually steady increasing in

        intensity only at the onset amp end of attack

        - May radiate to left shoulder arm jaw or other chest areas

        - Duration lt 15mins- Relieved by rest (preferably sitting

        or standing with support) or by use of NTG

        B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

        Associates in 1659 Cause spasm of coronary

        arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

        be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

        Pain Characteristics occurs during rest or with minimal exercise

        - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

        If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

        Conthellip

        C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

        D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

        E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

        ConthellipDx detailed pain history ECG TST

        angiogram may be used to confirm amp describe type of angina

        Tx directed towards MI prevention- Lifestyle modification (individualized

        regular exercise program smoking cessation)

        - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

        coronary angioplasty) may be indicated if with severe artery occlusion

        Drug Therapy Nitroglycerin (NTGs) ndash

        vasodilators patch (Deponit

        Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

        Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

        Calcium channel blockers Nifedipine (Calcibloc

        Adalat) Diltiazem (Cardizem)

        Lipid lowering agents ndashstatins Simvastatin

        Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

        Classification

        Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

        Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

        Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

        Class IV ndash angina occurs even at rest

        Nursing Management

        Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

        Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

        limitations NTGs ndash max of 3doses at 5-min intervals

        Stinging sensation under the tongue for SL is normal

        Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

        bottles amp change stocks every 6months Inform clients that headache dizziness

        flushed face are common side effects

        Do not discontinue the drug For patches rotate skin sites usually on

        chest wall Instrct on evaluation of effectiveness based

        on pain reliefPropanolols causes bronchospasm amp

        hypoglycemia do not administer to asthmatic amp diabetic clients

        Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

        Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

        Nursing Management

        Acute Coronary Syndrome

        Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

        Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

        Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

        gt20mins)2 New onset exertional angina (increased in

        severity of at least 1 class ndash to at least class III) in lt2months

        3 Recent acceleration of angina to at least class III in lt2months

        Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

        When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

        Conthellip

        ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

        myocardial tissue associated with atherosclerotic disease of coronary arteries

        Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

        Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

        elevation Q wave prolongation T wave inversion

        Conthellip(MI)

        Manifestations chest pain ndash severe crushing

        constricting ldquosomeone sitting on my chestrdquo

        - substernal radiating to left arm neck or jaw

        - prolonged (gt35mins) amp not relieved by rest

        Shortness of breath profuse perspirationFeeling of impending doom

        Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

        profound LV failure from massive MI resulting to low cardiac output

        Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

        Rupture of myocardiumVentricular aneurysms ndash decreases

        pumping efficiency of heart amp increases work of LV

        Pathophysiology

        Causes atherosclerotic heart disease thrombosisembolism

        shock ampor hemorrhage direct traumaMyocardial ischemia

        uarrcellular hypoxia

        darrmyocardial O2 supplydarr myocardial contractility

        darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

        uarrperipheral vasoconstriction

        uarr myocardial contractility

        uarr afterload uarrmyocardial O2 demand

        uarr HR uarrdiastolicfilling

        darrmyocardial tissue perfusion

        Tissue Changes After MI

        Time after Onset Type of Injury amp Gross Tissue Changes

        0-05hrs Reversible injury

        1-2hrs Onset of irreversible injury

        4-12hrs Beginning of coagulation necrosis

        18-24hrs Continued necrosis gross pallor of infected tissue

        1-3days Total necrosis onset of acute inflammatory process

        3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

        7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

        8th week Complete scar tissue replacement

        Management of MI Initial Management OMEN

        - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

        vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

        may be given to limit infarction size amp most effective if given within 4hrs of onset)

        Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

        Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

        bull Surgery 1Revascularization

        bullPTCAbullCoronary stent implantation

        bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

        2Resection ndash aneurysm

        ASSESSMENT

        bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

        bull Objective databull VSbull Diaphoresisbull Emotional restlessness

        ANALYSIS NURSING DIAGNOSES

        bull Decreased cardiac output related to myocardial damage

        bull Impaired gas exchange related to poor perfusion shock

        bull Pain related to myocardial ischemia

        bull Activity intolerance related to pain or inadequate oxygenation

        bull Fear related to possibility of death

        NURSING CARE PLANbull Goal 1 reduce pain discomfort

        bull Narcotics ndash morphine note response Avoid IM

        bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

        bull Position semi-Fowlerrsquos to improve ventilation

        NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

        rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

        thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

        cracklesbull Check labs troponin blood gases electrolytes

        clotting timebull CVP (5-15 cm H2O) increases with heart failure

        bull ROM of lower extremities antiembolic stockings

        NURSING CARE PLAN

        bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

        bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

        bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

        bull Anticipate needs of client call light water Reassurance

        bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

        NURSING CARE PLAN

        bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

        Mg)bull Monitor ECGbull Diet progressive low

        calorie low sodium low cholesterol low fat without caffeine

        NURSING CARE PLAN

        bull Goal 5 facilitate fecal eliminationbull Medications stool

        softeners to prevent Valsalva maneuver mouth breathing during bowel movement

        bull Bedside commode

        NURSING CARE PLAN

        bull Goal 6 provide emotional supportbull Recognize fear of dying

        denial anger withdrawalbull Encourage expression of

        feelings fears concernsbull Discuss rehabilitation lifestyle

        changes prevent cardiac-invalid syndrome by promoting self-care activities independence

        NURSING CARE PLAN

        bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

        activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

        bull Identify need for referral for sexual counselling

        NURSING CARE PLAN

        bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

        meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

        bull Information about sexual activity less fatiguing positions

        bull Support groups Follow-up carebull Medications administration importance untoward

        effects pulse takingbull Control risk factors rest diet exercise no smoking

        weight control stress reduction

        EVALUATION

        bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

        CONGESTIVE HEART FAILURE

        bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

        PATHOPHYSIOLOGY

        Increased cardiac workload

        decreased effective myocardial contractility

        Decreased cardiac output

        LV failure Pulmonary congestion

        RA RV failure

        Systemic congestion

        Peripheral edema

        ASSESSMENTbull Subjective data

        bull Shortness of breathbull Orthopnea (sleeps on two

        or more pillows)bull Paroxysmal nocturnal

        dyspnea (sudden breathlessness during sleep)

        bull Dyspnea on exertion (climbing stairs)

        bull Apprehension anxiety irritability

        bull Fatigue weaknessbull Reported weight gain

        feeling of puffiness

        ASSESSMENTbull Objective data

        bull VSbull BP decreasing systolic

        narrowing pulse pressurebull Pulse pulsus alternans

        (alternating strong-weak-strong cardiac contraction) increased

        bull Respirations crackles Cheyne-Stokes

        bull Edema dependent pitting (1+ to 4+ mm)

        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

        dilated pulmonary vessels lung edema

        Left Ventricular Compared with Right Ventricular Heart Failure

        LEFT VENTRICULAR

        FAILURE

        RIGHT VENTRICULAR

        FAILURE

        Pulmonary crackles Jugular venous distention

        Tachypnea Peripheral edema

        S3 gallop Perioral and peripheral cyanosis

        Cardiac murmurs Congestive hepatomegaly

        Paradoxical splitting of S2

        Ascites

        Hepatojugular reflux

        ANALYSIS NURSING DIAGNOSES

        bull Decreased cardiac output related to decreased myocardial contractility

        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

        bull Fatigue related to edema and poor oxygenation

        bull Fluid volume excess related to compensatory mechanisms

        bull Impaired gas exchange related to pulmonary congestion

        bull Anxiety related to shortness of breath

        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

        NURSING CARE PLAN

        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

        tachycardia dyspnea edema resolved change position frequently pillows for support

        bull Rest planned periods limit visitors activity noise Chair and commode privileges

        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

        bull Warm fluids if appropriate

        NURSING CARE PLAN

        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

        NURSING CARE PLANbull Goal 3 provide for special safety

        needsbull Skin care

        bull Inspect massage lubricate bony prominences

        bull Use foot cradle heel protectors sheepskin

        bull Side rails up if hypoxic (disoriented)

        bull Vital signs monitor for signs of fatigue pulmonary emboli

        bull ROM active passive elastic stockings

        NURSING CARE PLAN

        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

        strict IObull Diet

        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

        NURSING CARE PLAN

        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

        bull Refer to available community resources for dietary assistance weight reduction exercise program

        EVALUATION

        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

        distressbull Reduction in dependent edema

        DAY 3 OF

        CARDIOVASCULARDISEASES

        bull hyperlipidemia means high lipid levels

        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

        Treatment of Hyperlipidemia

        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

        bull SYSTOLIC DYSFUNCTION

        HYPERTROPHIC CARDIOMYOPATHY

        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

        HYPERTROPHIC CARDIOMYOPATHY

        bull Pathophysiologybull 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

        RESTRICTIVE CARDIOMYOPATHYPathophysiology

        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

        CARDIOMYOPATHIES

        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

        CARDIOMYOPATHIES

        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

        CARDIOMYOPATHIES

        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

        relief

        CARDIOMYOPATHIES

        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

        CARDIOMYOPATHIES

        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

        Infective endocarditis

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

        bull Can be acute or chronic

        Infective endocarditis

        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

        Infective endocarditis

        bull Pathophysiologybull 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

        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

        Infective endocarditis

        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

        retina

        Infective endocarditis

        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

        Infective endocarditis

        bull Preventionbull Antibiotic prophylaxis if patient is

        undergoing procedures like dental extractions bronchoscopy surgery etc

        Infective endocarditis

        bull LABORATORY EXAMbull Blood Cultures to determine the exact

        organism

        Infective endocarditis

        bull Nursing managementbull 1 regular monitoring of temperature heart

        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

        Infective endocarditis

        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

        B

        Infective endocarditis

        bull Medical managementbull 2 Surgerybull Valvular replacement

        CARDIOGENIC SHOCK

        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

        CARDIOGENIC SHOCK

        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

        CARDIOGENIC SHOCK

        bull LABORATORY FINDINGSIncreased CVP

        Normal is 4-10 cmH2O

        CARDIOGENIC SHOCK

        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

        inotropics such as DOPAMINE and DOBUTAMINE

        bull 3 Administer O2bull 4 Morphine is administered to

        decreased pulmonary congestion and to relieve pain

        CARDIOGENIC SHOCK

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

        bull 6 Monitor urinary output BP and pulses

        bull 7 cautiously administer diuretics and nitrates

        CARDIAC TAMPONADE

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

        CARDIAC TAMPONADE

        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

        CARDIAC TAMPONADE

        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

        CARDIAC TAMPONADE

        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

        distention hypotension and distantmuffled heart sound

        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

        CARDIAC TAMPONADE

        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

        anterior chest

        CARDIAC TAMPONADE

        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

        CARDIAC TAMPONADE

        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

        tamponade

        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

        artery rupture dysrhythmias pleural laceration and myocardial trauma

        HYPERTENSION

        bull 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

        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

        bull Most common typebull 2 Secondary

        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

        Alterations in Blood Flow in the Systemic Circulation

        Buergerrsquos Disease

        bull Also known as Thromboangiitis obliterans

        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

        reaction of the vessel wall

        Manifestations

        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

        Increased sensitivity to cold (due to impaired circulation

        Absentdiminished peripheral pulses

        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

        gangrenous changes may arise may necessitate amputation

        Diagnosis amp Treatment

        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

        emotionsRaynaudrsquos phenomenon ndash associated with

        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

        Manifestations bull Period of ischemia (ischemia due to vasospasm)

        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

        bull Return to normal colorbull Note although all of the fingers are

        affected symmetrically only 1-2digits may be involved

        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

        (rare occasions)

        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

        Immersion of hand in cold water to initiate attack aids in the Dx

        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

        protection from cold Avoidance of emotional stress (anxiety amp

        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

        Care Plan for Clients with Altered Cardiovascular Oxygenation

        A Assessment

        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

        2 vsB Nursing Dx

        1 ineffective tissue perfusion (cardiopulmonary)

        2 Impaired gas exchange

        3 Anxiety due to fear of death (clients with MI or Angina)

        C Goals

        1 Relief of pain amp symptoms

        2 Prevention of further cardiac damage

        D Nursing Interventions

        1 Pain control

        2 Proper medications

        3 Decrease clientrsquos anxiety

        4 Health teachings (meds activities diet exercise etc)

        • CARDIOVASCULAR DISEASES
        • Slide 2
        • GENERAL CARDIAC ASSESSMENT
        • Pathophysiology
        • Slide 5
        • ASSESSING CHEST PAIN
        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
        • Angina Pectoris Myocardial Ischemia
        • Pathophysiology
        • Types
        • Slide 12
        • Slide 13
        • Slide 14
        • Conthellip
        • Conthellip (2)
        • Drug Therapy
        • Classification
        • Nursing Management
        • Nursing Management (2)
        • Acute Coronary Syndrome
        • Slide 22
        • Conthellip (3)
        • Slide 24
        • Conthellip(MI)
        • Slide 26
        • Pathophysiology (2)
        • Tissue Changes After MI
        • Management of MI
        • Slide 30
        • Slide 31
        • ASSESSMENT
        • ANALYSIS NURSING DIAGNOSES
        • NURSING CARE PLAN
        • NURSING CARE PLAN (2)
        • NURSING CARE PLAN (3)
        • NURSING CARE PLAN (4)
        • NURSING CARE PLAN (5)
        • NURSING CARE PLAN (6)
        • NURSING CARE PLAN (7)
        • NURSING CARE PLAN (8)
        • EVALUATION
        • CONGESTIVE HEART FAILURE
        • PATHOPHYSIOLOGY
        • ASSESSMENT (2)
        • ASSESSMENT (3)
        • Left Ventricular Compared with Right Ventricular Heart Failure
        • ANALYSIS NURSING DIAGNOSES (2)
        • Slide 49
        • NURSING CARE PLAN (9)
        • NURSING CARE PLAN (10)
        • NURSING CARE PLAN (11)
        • NURSING CARE PLAN (12)
        • NURSING CARE PLAN (13)
        • EVALUATION
        • Slide 56
        • Slide 57
        • Slide 58
        • Slide 59
        • Slide 60
        • Treatment of Hyperlipidemia
        • Slide 62
        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
        • HYPERTROPHIC CARDIOMYOPATHY
        • HYPERTROPHIC CARDIOMYOPATHY (2)
        • RESTRICTIVE CARDIOMYOPATHY
        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
        • CARDIOMYOPATHIES
        • CARDIOMYOPATHIES (2)
        • CARDIOMYOPATHIES (3)
        • CARDIOMYOPATHIES (4)
        • CARDIOMYOPATHIES (5)
        • CARDIOMYOPATHIES (6)
        • Infective endocarditis
        • Infective endocarditis (2)
        • Infective endocarditis (3)
        • Infective endocarditis (4)
        • Infective endocarditis (5)
        • Infective endocarditis (6)
        • Infective endocarditis (7)
        • Infective endocarditis (8)
        • Infective endocarditis (9)
        • Infective endocarditis (10)
        • Infective endocarditis (11)
        • Infective endocarditis (12)
        • CARDIOGENIC SHOCK
        • CARDIOGENIC SHOCK (2)
        • CARDIOGENIC SHOCK (3)
        • CARDIOGENIC SHOCK (4)
        • CARDIOGENIC SHOCK (5)
        • CARDIAC TAMPONADE
        • CARDIAC TAMPONADE (2)
        • CARDIAC TAMPONADE (3)
        • CARDIAC TAMPONADE (4)
        • CARDIAC TAMPONADE (5)
        • CARDIAC TAMPONADE (6)
        • CARDIAC TAMPONADE (7)
        • Slide 100
        • HYPERTENSION
        • HYPERTENSION (2)
        • Slide 103
        • Slide 104
        • Slide 105
        • Alterations in Blood Flow in the Systemic Circulation
        • Buergerrsquos Disease
        • Slide 108
        • Manifestations
        • Slide 110
        • Diagnosis amp Treatment
        • Rynaudrsquos Disease
        • Manifestations (2)
        • Slide 114
        • Diagnosis amp Treatment (2)
        • Slide 116
        • Care Plan for Clients with Altered Cardiovascular Oxygenation
        • Slide 118
        • Slide 119
        • Slide 120
        • Slide 121

          ASSESSING CHEST PAIN

          COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

          Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

          Onset Gradual Sudden Sudden Gradual Sudden

          Gradual Sudden

          Abrupt Gradual Sudden

          Precipitating Factors

          At rest after exercise or emotional stress

          Breathing deeply rotating trunk yawning

          Inflammation of GI parts increased HCL medications

          After exercise emotional stress eating envtrsquol changes

          Hypertension Immobility Prolonged bedrest

          Location Substernal anterior chest rarely back radiates to jawneck

          Precordial rotates to neck left shoulder amp arm

          Xiphoid to umbilicus

          Substernal anterior chest poorly localized

          Site of rupture anterior chest or back between scapula

          Pleural area retrosternal

          Quality Crushing burning stabbing squeezing vicelike

          Pleuritic sharp Aching burning cramplike gnawing

          Squeezing feeling of heavy pressure burning

          Sharp tearing ripping

          Sharp stabbing

          COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

          Characteristic

          MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

          Intensity Asymptomatic to severe increases with time

          Mild to severe Mild to severe Mild to moderate

          Severe unbearable maximal from onset

          Aggravated by breathing

          Duration 30 min to 1-2 hours may wax and wane

          Continuous Periodic 2-10 min ave 3-5 min

          Continuous does not abate once started

          Variable

          Relief Narcotics Sitting up leaning forward

          Physical emotional rest food antacid

          Nitroglycerin rest

          Large repeated doses of narcotics

          02 sitting up morphine

          Associated Symptoms

          Nausea fatigue heartburn equal peripheral pulses

          Fever dyspnea nausea anorexia anxiety

          NV dysphagia anorexia weight loss

          Belching indigestion dizziness

          Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

          Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

          Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

          inadequate to meet the heartrsquos metabolic demands

          Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

          Pathophysiology

          Types

          AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

          (although those with advance atherosclerosis do not develop angina)

          Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

          Pain location precordial or substernal chest area

          Pain characteristics - constricting squeezing or

          suffocating sensation- Usually steady increasing in

          intensity only at the onset amp end of attack

          - May radiate to left shoulder arm jaw or other chest areas

          - Duration lt 15mins- Relieved by rest (preferably sitting

          or standing with support) or by use of NTG

          B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

          Associates in 1659 Cause spasm of coronary

          arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

          be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

          Pain Characteristics occurs during rest or with minimal exercise

          - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

          If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

          Conthellip

          C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

          D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

          E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

          ConthellipDx detailed pain history ECG TST

          angiogram may be used to confirm amp describe type of angina

          Tx directed towards MI prevention- Lifestyle modification (individualized

          regular exercise program smoking cessation)

          - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

          coronary angioplasty) may be indicated if with severe artery occlusion

          Drug Therapy Nitroglycerin (NTGs) ndash

          vasodilators patch (Deponit

          Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

          Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

          Calcium channel blockers Nifedipine (Calcibloc

          Adalat) Diltiazem (Cardizem)

          Lipid lowering agents ndashstatins Simvastatin

          Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

          Classification

          Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

          Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

          Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

          Class IV ndash angina occurs even at rest

          Nursing Management

          Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

          Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

          limitations NTGs ndash max of 3doses at 5-min intervals

          Stinging sensation under the tongue for SL is normal

          Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

          bottles amp change stocks every 6months Inform clients that headache dizziness

          flushed face are common side effects

          Do not discontinue the drug For patches rotate skin sites usually on

          chest wall Instrct on evaluation of effectiveness based

          on pain reliefPropanolols causes bronchospasm amp

          hypoglycemia do not administer to asthmatic amp diabetic clients

          Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

          Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

          Nursing Management

          Acute Coronary Syndrome

          Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

          Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

          Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

          gt20mins)2 New onset exertional angina (increased in

          severity of at least 1 class ndash to at least class III) in lt2months

          3 Recent acceleration of angina to at least class III in lt2months

          Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

          When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

          Conthellip

          ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

          myocardial tissue associated with atherosclerotic disease of coronary arteries

          Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

          Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

          elevation Q wave prolongation T wave inversion

          Conthellip(MI)

          Manifestations chest pain ndash severe crushing

          constricting ldquosomeone sitting on my chestrdquo

          - substernal radiating to left arm neck or jaw

          - prolonged (gt35mins) amp not relieved by rest

          Shortness of breath profuse perspirationFeeling of impending doom

          Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

          profound LV failure from massive MI resulting to low cardiac output

          Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

          Rupture of myocardiumVentricular aneurysms ndash decreases

          pumping efficiency of heart amp increases work of LV

          Pathophysiology

          Causes atherosclerotic heart disease thrombosisembolism

          shock ampor hemorrhage direct traumaMyocardial ischemia

          uarrcellular hypoxia

          darrmyocardial O2 supplydarr myocardial contractility

          darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

          uarrperipheral vasoconstriction

          uarr myocardial contractility

          uarr afterload uarrmyocardial O2 demand

          uarr HR uarrdiastolicfilling

          darrmyocardial tissue perfusion

          Tissue Changes After MI

          Time after Onset Type of Injury amp Gross Tissue Changes

          0-05hrs Reversible injury

          1-2hrs Onset of irreversible injury

          4-12hrs Beginning of coagulation necrosis

          18-24hrs Continued necrosis gross pallor of infected tissue

          1-3days Total necrosis onset of acute inflammatory process

          3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

          7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

          8th week Complete scar tissue replacement

          Management of MI Initial Management OMEN

          - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

          vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

          may be given to limit infarction size amp most effective if given within 4hrs of onset)

          Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

          Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

          bull Surgery 1Revascularization

          bullPTCAbullCoronary stent implantation

          bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

          2Resection ndash aneurysm

          ASSESSMENT

          bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

          bull Objective databull VSbull Diaphoresisbull Emotional restlessness

          ANALYSIS NURSING DIAGNOSES

          bull Decreased cardiac output related to myocardial damage

          bull Impaired gas exchange related to poor perfusion shock

          bull Pain related to myocardial ischemia

          bull Activity intolerance related to pain or inadequate oxygenation

          bull Fear related to possibility of death

          NURSING CARE PLANbull Goal 1 reduce pain discomfort

          bull Narcotics ndash morphine note response Avoid IM

          bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

          bull Position semi-Fowlerrsquos to improve ventilation

          NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

          rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

          thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

          cracklesbull Check labs troponin blood gases electrolytes

          clotting timebull CVP (5-15 cm H2O) increases with heart failure

          bull ROM of lower extremities antiembolic stockings

          NURSING CARE PLAN

          bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

          bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

          bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

          bull Anticipate needs of client call light water Reassurance

          bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

          NURSING CARE PLAN

          bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

          Mg)bull Monitor ECGbull Diet progressive low

          calorie low sodium low cholesterol low fat without caffeine

          NURSING CARE PLAN

          bull Goal 5 facilitate fecal eliminationbull Medications stool

          softeners to prevent Valsalva maneuver mouth breathing during bowel movement

          bull Bedside commode

          NURSING CARE PLAN

          bull Goal 6 provide emotional supportbull Recognize fear of dying

          denial anger withdrawalbull Encourage expression of

          feelings fears concernsbull Discuss rehabilitation lifestyle

          changes prevent cardiac-invalid syndrome by promoting self-care activities independence

          NURSING CARE PLAN

          bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

          activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

          bull Identify need for referral for sexual counselling

          NURSING CARE PLAN

          bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

          meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

          bull Information about sexual activity less fatiguing positions

          bull Support groups Follow-up carebull Medications administration importance untoward

          effects pulse takingbull Control risk factors rest diet exercise no smoking

          weight control stress reduction

          EVALUATION

          bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

          CONGESTIVE HEART FAILURE

          bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

          PATHOPHYSIOLOGY

          Increased cardiac workload

          decreased effective myocardial contractility

          Decreased cardiac output

          LV failure Pulmonary congestion

          RA RV failure

          Systemic congestion

          Peripheral edema

          ASSESSMENTbull Subjective data

          bull Shortness of breathbull Orthopnea (sleeps on two

          or more pillows)bull Paroxysmal nocturnal

          dyspnea (sudden breathlessness during sleep)

          bull Dyspnea on exertion (climbing stairs)

          bull Apprehension anxiety irritability

          bull Fatigue weaknessbull Reported weight gain

          feeling of puffiness

          ASSESSMENTbull Objective data

          bull VSbull BP decreasing systolic

          narrowing pulse pressurebull Pulse pulsus alternans

          (alternating strong-weak-strong cardiac contraction) increased

          bull Respirations crackles Cheyne-Stokes

          bull Edema dependent pitting (1+ to 4+ mm)

          bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

          dilated pulmonary vessels lung edema

          Left Ventricular Compared with Right Ventricular Heart Failure

          LEFT VENTRICULAR

          FAILURE

          RIGHT VENTRICULAR

          FAILURE

          Pulmonary crackles Jugular venous distention

          Tachypnea Peripheral edema

          S3 gallop Perioral and peripheral cyanosis

          Cardiac murmurs Congestive hepatomegaly

          Paradoxical splitting of S2

          Ascites

          Hepatojugular reflux

          ANALYSIS NURSING DIAGNOSES

          bull Decreased cardiac output related to decreased myocardial contractility

          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

          bull Fatigue related to edema and poor oxygenation

          bull Fluid volume excess related to compensatory mechanisms

          bull Impaired gas exchange related to pulmonary congestion

          bull Anxiety related to shortness of breath

          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

          NURSING CARE PLAN

          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

          tachycardia dyspnea edema resolved change position frequently pillows for support

          bull Rest planned periods limit visitors activity noise Chair and commode privileges

          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

          bull Warm fluids if appropriate

          NURSING CARE PLAN

          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

          NURSING CARE PLANbull Goal 3 provide for special safety

          needsbull Skin care

          bull Inspect massage lubricate bony prominences

          bull Use foot cradle heel protectors sheepskin

          bull Side rails up if hypoxic (disoriented)

          bull Vital signs monitor for signs of fatigue pulmonary emboli

          bull ROM active passive elastic stockings

          NURSING CARE PLAN

          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

          strict IObull Diet

          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

          NURSING CARE PLAN

          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

          bull Refer to available community resources for dietary assistance weight reduction exercise program

          EVALUATION

          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

          distressbull Reduction in dependent edema

          DAY 3 OF

          CARDIOVASCULARDISEASES

          bull hyperlipidemia means high lipid levels

          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

          Treatment of Hyperlipidemia

          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

          bull SYSTOLIC DYSFUNCTION

          HYPERTROPHIC CARDIOMYOPATHY

          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

          HYPERTROPHIC CARDIOMYOPATHY

          bull Pathophysiologybull 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

          RESTRICTIVE CARDIOMYOPATHYPathophysiology

          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

          CARDIOMYOPATHIES

          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

          CARDIOMYOPATHIES

          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

          CARDIOMYOPATHIES

          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

          relief

          CARDIOMYOPATHIES

          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

          CARDIOMYOPATHIES

          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

          Infective endocarditis

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

          bull Can be acute or chronic

          Infective endocarditis

          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

          Infective endocarditis

          bull Pathophysiologybull 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

          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

          Infective endocarditis

          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

          retina

          Infective endocarditis

          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

          Infective endocarditis

          bull Preventionbull Antibiotic prophylaxis if patient is

          undergoing procedures like dental extractions bronchoscopy surgery etc

          Infective endocarditis

          bull LABORATORY EXAMbull Blood Cultures to determine the exact

          organism

          Infective endocarditis

          bull Nursing managementbull 1 regular monitoring of temperature heart

          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

          Infective endocarditis

          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

          B

          Infective endocarditis

          bull Medical managementbull 2 Surgerybull Valvular replacement

          CARDIOGENIC SHOCK

          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

          CARDIOGENIC SHOCK

          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

          CARDIOGENIC SHOCK

          bull LABORATORY FINDINGSIncreased CVP

          Normal is 4-10 cmH2O

          CARDIOGENIC SHOCK

          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

          inotropics such as DOPAMINE and DOBUTAMINE

          bull 3 Administer O2bull 4 Morphine is administered to

          decreased pulmonary congestion and to relieve pain

          CARDIOGENIC SHOCK

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

          bull 6 Monitor urinary output BP and pulses

          bull 7 cautiously administer diuretics and nitrates

          CARDIAC TAMPONADE

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

          CARDIAC TAMPONADE

          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

          CARDIAC TAMPONADE

          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

          CARDIAC TAMPONADE

          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

          distention hypotension and distantmuffled heart sound

          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

          CARDIAC TAMPONADE

          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

          anterior chest

          CARDIAC TAMPONADE

          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

          CARDIAC TAMPONADE

          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

          tamponade

          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

          artery rupture dysrhythmias pleural laceration and myocardial trauma

          HYPERTENSION

          bull 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

          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

          bull Most common typebull 2 Secondary

          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

          Alterations in Blood Flow in the Systemic Circulation

          Buergerrsquos Disease

          bull Also known as Thromboangiitis obliterans

          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

          reaction of the vessel wall

          Manifestations

          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

          Increased sensitivity to cold (due to impaired circulation

          Absentdiminished peripheral pulses

          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

          gangrenous changes may arise may necessitate amputation

          Diagnosis amp Treatment

          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

          emotionsRaynaudrsquos phenomenon ndash associated with

          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

          Manifestations bull Period of ischemia (ischemia due to vasospasm)

          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

          bull Return to normal colorbull Note although all of the fingers are

          affected symmetrically only 1-2digits may be involved

          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

          (rare occasions)

          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

          Immersion of hand in cold water to initiate attack aids in the Dx

          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

          protection from cold Avoidance of emotional stress (anxiety amp

          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

          Care Plan for Clients with Altered Cardiovascular Oxygenation

          A Assessment

          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

          2 vsB Nursing Dx

          1 ineffective tissue perfusion (cardiopulmonary)

          2 Impaired gas exchange

          3 Anxiety due to fear of death (clients with MI or Angina)

          C Goals

          1 Relief of pain amp symptoms

          2 Prevention of further cardiac damage

          D Nursing Interventions

          1 Pain control

          2 Proper medications

          3 Decrease clientrsquos anxiety

          4 Health teachings (meds activities diet exercise etc)

          • CARDIOVASCULAR DISEASES
          • Slide 2
          • GENERAL CARDIAC ASSESSMENT
          • Pathophysiology
          • Slide 5
          • ASSESSING CHEST PAIN
          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
          • Angina Pectoris Myocardial Ischemia
          • Pathophysiology
          • Types
          • Slide 12
          • Slide 13
          • Slide 14
          • Conthellip
          • Conthellip (2)
          • Drug Therapy
          • Classification
          • Nursing Management
          • Nursing Management (2)
          • Acute Coronary Syndrome
          • Slide 22
          • Conthellip (3)
          • Slide 24
          • Conthellip(MI)
          • Slide 26
          • Pathophysiology (2)
          • Tissue Changes After MI
          • Management of MI
          • Slide 30
          • Slide 31
          • ASSESSMENT
          • ANALYSIS NURSING DIAGNOSES
          • NURSING CARE PLAN
          • NURSING CARE PLAN (2)
          • NURSING CARE PLAN (3)
          • NURSING CARE PLAN (4)
          • NURSING CARE PLAN (5)
          • NURSING CARE PLAN (6)
          • NURSING CARE PLAN (7)
          • NURSING CARE PLAN (8)
          • EVALUATION
          • CONGESTIVE HEART FAILURE
          • PATHOPHYSIOLOGY
          • ASSESSMENT (2)
          • ASSESSMENT (3)
          • Left Ventricular Compared with Right Ventricular Heart Failure
          • ANALYSIS NURSING DIAGNOSES (2)
          • Slide 49
          • NURSING CARE PLAN (9)
          • NURSING CARE PLAN (10)
          • NURSING CARE PLAN (11)
          • NURSING CARE PLAN (12)
          • NURSING CARE PLAN (13)
          • EVALUATION
          • Slide 56
          • Slide 57
          • Slide 58
          • Slide 59
          • Slide 60
          • Treatment of Hyperlipidemia
          • Slide 62
          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
          • HYPERTROPHIC CARDIOMYOPATHY
          • HYPERTROPHIC CARDIOMYOPATHY (2)
          • RESTRICTIVE CARDIOMYOPATHY
          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
          • CARDIOMYOPATHIES
          • CARDIOMYOPATHIES (2)
          • CARDIOMYOPATHIES (3)
          • CARDIOMYOPATHIES (4)
          • CARDIOMYOPATHIES (5)
          • CARDIOMYOPATHIES (6)
          • Infective endocarditis
          • Infective endocarditis (2)
          • Infective endocarditis (3)
          • Infective endocarditis (4)
          • Infective endocarditis (5)
          • Infective endocarditis (6)
          • Infective endocarditis (7)
          • Infective endocarditis (8)
          • Infective endocarditis (9)
          • Infective endocarditis (10)
          • Infective endocarditis (11)
          • Infective endocarditis (12)
          • CARDIOGENIC SHOCK
          • CARDIOGENIC SHOCK (2)
          • CARDIOGENIC SHOCK (3)
          • CARDIOGENIC SHOCK (4)
          • CARDIOGENIC SHOCK (5)
          • CARDIAC TAMPONADE
          • CARDIAC TAMPONADE (2)
          • CARDIAC TAMPONADE (3)
          • CARDIAC TAMPONADE (4)
          • CARDIAC TAMPONADE (5)
          • CARDIAC TAMPONADE (6)
          • CARDIAC TAMPONADE (7)
          • Slide 100
          • HYPERTENSION
          • HYPERTENSION (2)
          • Slide 103
          • Slide 104
          • Slide 105
          • Alterations in Blood Flow in the Systemic Circulation
          • Buergerrsquos Disease
          • Slide 108
          • Manifestations
          • Slide 110
          • Diagnosis amp Treatment
          • Rynaudrsquos Disease
          • Manifestations (2)
          • Slide 114
          • Diagnosis amp Treatment (2)
          • Slide 116
          • Care Plan for Clients with Altered Cardiovascular Oxygenation
          • Slide 118
          • Slide 119
          • Slide 120
          • Slide 121

            COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

            Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

            Onset Gradual Sudden Sudden Gradual Sudden

            Gradual Sudden

            Abrupt Gradual Sudden

            Precipitating Factors

            At rest after exercise or emotional stress

            Breathing deeply rotating trunk yawning

            Inflammation of GI parts increased HCL medications

            After exercise emotional stress eating envtrsquol changes

            Hypertension Immobility Prolonged bedrest

            Location Substernal anterior chest rarely back radiates to jawneck

            Precordial rotates to neck left shoulder amp arm

            Xiphoid to umbilicus

            Substernal anterior chest poorly localized

            Site of rupture anterior chest or back between scapula

            Pleural area retrosternal

            Quality Crushing burning stabbing squeezing vicelike

            Pleuritic sharp Aching burning cramplike gnawing

            Squeezing feeling of heavy pressure burning

            Sharp tearing ripping

            Sharp stabbing

            COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

            Characteristic

            MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

            Intensity Asymptomatic to severe increases with time

            Mild to severe Mild to severe Mild to moderate

            Severe unbearable maximal from onset

            Aggravated by breathing

            Duration 30 min to 1-2 hours may wax and wane

            Continuous Periodic 2-10 min ave 3-5 min

            Continuous does not abate once started

            Variable

            Relief Narcotics Sitting up leaning forward

            Physical emotional rest food antacid

            Nitroglycerin rest

            Large repeated doses of narcotics

            02 sitting up morphine

            Associated Symptoms

            Nausea fatigue heartburn equal peripheral pulses

            Fever dyspnea nausea anorexia anxiety

            NV dysphagia anorexia weight loss

            Belching indigestion dizziness

            Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

            Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

            Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

            inadequate to meet the heartrsquos metabolic demands

            Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

            Pathophysiology

            Types

            AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

            (although those with advance atherosclerosis do not develop angina)

            Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

            Pain location precordial or substernal chest area

            Pain characteristics - constricting squeezing or

            suffocating sensation- Usually steady increasing in

            intensity only at the onset amp end of attack

            - May radiate to left shoulder arm jaw or other chest areas

            - Duration lt 15mins- Relieved by rest (preferably sitting

            or standing with support) or by use of NTG

            B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

            Associates in 1659 Cause spasm of coronary

            arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

            be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

            Pain Characteristics occurs during rest or with minimal exercise

            - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

            If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

            Conthellip

            C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

            D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

            E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

            ConthellipDx detailed pain history ECG TST

            angiogram may be used to confirm amp describe type of angina

            Tx directed towards MI prevention- Lifestyle modification (individualized

            regular exercise program smoking cessation)

            - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

            coronary angioplasty) may be indicated if with severe artery occlusion

            Drug Therapy Nitroglycerin (NTGs) ndash

            vasodilators patch (Deponit

            Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

            Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

            Calcium channel blockers Nifedipine (Calcibloc

            Adalat) Diltiazem (Cardizem)

            Lipid lowering agents ndashstatins Simvastatin

            Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

            Classification

            Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

            Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

            Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

            Class IV ndash angina occurs even at rest

            Nursing Management

            Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

            Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

            limitations NTGs ndash max of 3doses at 5-min intervals

            Stinging sensation under the tongue for SL is normal

            Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

            bottles amp change stocks every 6months Inform clients that headache dizziness

            flushed face are common side effects

            Do not discontinue the drug For patches rotate skin sites usually on

            chest wall Instrct on evaluation of effectiveness based

            on pain reliefPropanolols causes bronchospasm amp

            hypoglycemia do not administer to asthmatic amp diabetic clients

            Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

            Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

            Nursing Management

            Acute Coronary Syndrome

            Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

            Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

            Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

            gt20mins)2 New onset exertional angina (increased in

            severity of at least 1 class ndash to at least class III) in lt2months

            3 Recent acceleration of angina to at least class III in lt2months

            Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

            When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

            Conthellip

            ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

            myocardial tissue associated with atherosclerotic disease of coronary arteries

            Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

            Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

            elevation Q wave prolongation T wave inversion

            Conthellip(MI)

            Manifestations chest pain ndash severe crushing

            constricting ldquosomeone sitting on my chestrdquo

            - substernal radiating to left arm neck or jaw

            - prolonged (gt35mins) amp not relieved by rest

            Shortness of breath profuse perspirationFeeling of impending doom

            Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

            profound LV failure from massive MI resulting to low cardiac output

            Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

            Rupture of myocardiumVentricular aneurysms ndash decreases

            pumping efficiency of heart amp increases work of LV

            Pathophysiology

            Causes atherosclerotic heart disease thrombosisembolism

            shock ampor hemorrhage direct traumaMyocardial ischemia

            uarrcellular hypoxia

            darrmyocardial O2 supplydarr myocardial contractility

            darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

            uarrperipheral vasoconstriction

            uarr myocardial contractility

            uarr afterload uarrmyocardial O2 demand

            uarr HR uarrdiastolicfilling

            darrmyocardial tissue perfusion

            Tissue Changes After MI

            Time after Onset Type of Injury amp Gross Tissue Changes

            0-05hrs Reversible injury

            1-2hrs Onset of irreversible injury

            4-12hrs Beginning of coagulation necrosis

            18-24hrs Continued necrosis gross pallor of infected tissue

            1-3days Total necrosis onset of acute inflammatory process

            3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

            7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

            8th week Complete scar tissue replacement

            Management of MI Initial Management OMEN

            - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

            vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

            may be given to limit infarction size amp most effective if given within 4hrs of onset)

            Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

            Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

            bull Surgery 1Revascularization

            bullPTCAbullCoronary stent implantation

            bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

            2Resection ndash aneurysm

            ASSESSMENT

            bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

            bull Objective databull VSbull Diaphoresisbull Emotional restlessness

            ANALYSIS NURSING DIAGNOSES

            bull Decreased cardiac output related to myocardial damage

            bull Impaired gas exchange related to poor perfusion shock

            bull Pain related to myocardial ischemia

            bull Activity intolerance related to pain or inadequate oxygenation

            bull Fear related to possibility of death

            NURSING CARE PLANbull Goal 1 reduce pain discomfort

            bull Narcotics ndash morphine note response Avoid IM

            bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

            bull Position semi-Fowlerrsquos to improve ventilation

            NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

            rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

            thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

            cracklesbull Check labs troponin blood gases electrolytes

            clotting timebull CVP (5-15 cm H2O) increases with heart failure

            bull ROM of lower extremities antiembolic stockings

            NURSING CARE PLAN

            bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

            bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

            bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

            bull Anticipate needs of client call light water Reassurance

            bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

            NURSING CARE PLAN

            bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

            Mg)bull Monitor ECGbull Diet progressive low

            calorie low sodium low cholesterol low fat without caffeine

            NURSING CARE PLAN

            bull Goal 5 facilitate fecal eliminationbull Medications stool

            softeners to prevent Valsalva maneuver mouth breathing during bowel movement

            bull Bedside commode

            NURSING CARE PLAN

            bull Goal 6 provide emotional supportbull Recognize fear of dying

            denial anger withdrawalbull Encourage expression of

            feelings fears concernsbull Discuss rehabilitation lifestyle

            changes prevent cardiac-invalid syndrome by promoting self-care activities independence

            NURSING CARE PLAN

            bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

            activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

            bull Identify need for referral for sexual counselling

            NURSING CARE PLAN

            bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

            meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

            bull Information about sexual activity less fatiguing positions

            bull Support groups Follow-up carebull Medications administration importance untoward

            effects pulse takingbull Control risk factors rest diet exercise no smoking

            weight control stress reduction

            EVALUATION

            bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

            CONGESTIVE HEART FAILURE

            bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

            PATHOPHYSIOLOGY

            Increased cardiac workload

            decreased effective myocardial contractility

            Decreased cardiac output

            LV failure Pulmonary congestion

            RA RV failure

            Systemic congestion

            Peripheral edema

            ASSESSMENTbull Subjective data

            bull Shortness of breathbull Orthopnea (sleeps on two

            or more pillows)bull Paroxysmal nocturnal

            dyspnea (sudden breathlessness during sleep)

            bull Dyspnea on exertion (climbing stairs)

            bull Apprehension anxiety irritability

            bull Fatigue weaknessbull Reported weight gain

            feeling of puffiness

            ASSESSMENTbull Objective data

            bull VSbull BP decreasing systolic

            narrowing pulse pressurebull Pulse pulsus alternans

            (alternating strong-weak-strong cardiac contraction) increased

            bull Respirations crackles Cheyne-Stokes

            bull Edema dependent pitting (1+ to 4+ mm)

            bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

            dilated pulmonary vessels lung edema

            Left Ventricular Compared with Right Ventricular Heart Failure

            LEFT VENTRICULAR

            FAILURE

            RIGHT VENTRICULAR

            FAILURE

            Pulmonary crackles Jugular venous distention

            Tachypnea Peripheral edema

            S3 gallop Perioral and peripheral cyanosis

            Cardiac murmurs Congestive hepatomegaly

            Paradoxical splitting of S2

            Ascites

            Hepatojugular reflux

            ANALYSIS NURSING DIAGNOSES

            bull Decreased cardiac output related to decreased myocardial contractility

            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

            bull Fatigue related to edema and poor oxygenation

            bull Fluid volume excess related to compensatory mechanisms

            bull Impaired gas exchange related to pulmonary congestion

            bull Anxiety related to shortness of breath

            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

            NURSING CARE PLAN

            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

            tachycardia dyspnea edema resolved change position frequently pillows for support

            bull Rest planned periods limit visitors activity noise Chair and commode privileges

            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

            bull Warm fluids if appropriate

            NURSING CARE PLAN

            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

            NURSING CARE PLANbull Goal 3 provide for special safety

            needsbull Skin care

            bull Inspect massage lubricate bony prominences

            bull Use foot cradle heel protectors sheepskin

            bull Side rails up if hypoxic (disoriented)

            bull Vital signs monitor for signs of fatigue pulmonary emboli

            bull ROM active passive elastic stockings

            NURSING CARE PLAN

            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

            strict IObull Diet

            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

            NURSING CARE PLAN

            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

            bull Refer to available community resources for dietary assistance weight reduction exercise program

            EVALUATION

            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

            distressbull Reduction in dependent edema

            DAY 3 OF

            CARDIOVASCULARDISEASES

            bull hyperlipidemia means high lipid levels

            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

            Treatment of Hyperlipidemia

            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

            bull SYSTOLIC DYSFUNCTION

            HYPERTROPHIC CARDIOMYOPATHY

            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

            HYPERTROPHIC CARDIOMYOPATHY

            bull Pathophysiologybull 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

            RESTRICTIVE CARDIOMYOPATHYPathophysiology

            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

            CARDIOMYOPATHIES

            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

            CARDIOMYOPATHIES

            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

            CARDIOMYOPATHIES

            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

            relief

            CARDIOMYOPATHIES

            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

            CARDIOMYOPATHIES

            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

            Infective endocarditis

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

            bull Can be acute or chronic

            Infective endocarditis

            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

            Infective endocarditis

            bull Pathophysiologybull 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

            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

            Infective endocarditis

            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

            retina

            Infective endocarditis

            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

            Infective endocarditis

            bull Preventionbull Antibiotic prophylaxis if patient is

            undergoing procedures like dental extractions bronchoscopy surgery etc

            Infective endocarditis

            bull LABORATORY EXAMbull Blood Cultures to determine the exact

            organism

            Infective endocarditis

            bull Nursing managementbull 1 regular monitoring of temperature heart

            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

            Infective endocarditis

            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

            B

            Infective endocarditis

            bull Medical managementbull 2 Surgerybull Valvular replacement

            CARDIOGENIC SHOCK

            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

            CARDIOGENIC SHOCK

            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

            CARDIOGENIC SHOCK

            bull LABORATORY FINDINGSIncreased CVP

            Normal is 4-10 cmH2O

            CARDIOGENIC SHOCK

            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

            inotropics such as DOPAMINE and DOBUTAMINE

            bull 3 Administer O2bull 4 Morphine is administered to

            decreased pulmonary congestion and to relieve pain

            CARDIOGENIC SHOCK

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

            bull 6 Monitor urinary output BP and pulses

            bull 7 cautiously administer diuretics and nitrates

            CARDIAC TAMPONADE

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

            CARDIAC TAMPONADE

            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

            CARDIAC TAMPONADE

            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

            CARDIAC TAMPONADE

            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

            distention hypotension and distantmuffled heart sound

            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

            CARDIAC TAMPONADE

            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

            anterior chest

            CARDIAC TAMPONADE

            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

            CARDIAC TAMPONADE

            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

            tamponade

            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

            artery rupture dysrhythmias pleural laceration and myocardial trauma

            HYPERTENSION

            bull 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

            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

            bull Most common typebull 2 Secondary

            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

            Alterations in Blood Flow in the Systemic Circulation

            Buergerrsquos Disease

            bull Also known as Thromboangiitis obliterans

            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

            reaction of the vessel wall

            Manifestations

            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

            Increased sensitivity to cold (due to impaired circulation

            Absentdiminished peripheral pulses

            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

            gangrenous changes may arise may necessitate amputation

            Diagnosis amp Treatment

            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

            emotionsRaynaudrsquos phenomenon ndash associated with

            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

            Manifestations bull Period of ischemia (ischemia due to vasospasm)

            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

            bull Return to normal colorbull Note although all of the fingers are

            affected symmetrically only 1-2digits may be involved

            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

            (rare occasions)

            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

            Immersion of hand in cold water to initiate attack aids in the Dx

            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

            protection from cold Avoidance of emotional stress (anxiety amp

            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

            Care Plan for Clients with Altered Cardiovascular Oxygenation

            A Assessment

            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

            2 vsB Nursing Dx

            1 ineffective tissue perfusion (cardiopulmonary)

            2 Impaired gas exchange

            3 Anxiety due to fear of death (clients with MI or Angina)

            C Goals

            1 Relief of pain amp symptoms

            2 Prevention of further cardiac damage

            D Nursing Interventions

            1 Pain control

            2 Proper medications

            3 Decrease clientrsquos anxiety

            4 Health teachings (meds activities diet exercise etc)

            • CARDIOVASCULAR DISEASES
            • Slide 2
            • GENERAL CARDIAC ASSESSMENT
            • Pathophysiology
            • Slide 5
            • ASSESSING CHEST PAIN
            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
            • Angina Pectoris Myocardial Ischemia
            • Pathophysiology
            • Types
            • Slide 12
            • Slide 13
            • Slide 14
            • Conthellip
            • Conthellip (2)
            • Drug Therapy
            • Classification
            • Nursing Management
            • Nursing Management (2)
            • Acute Coronary Syndrome
            • Slide 22
            • Conthellip (3)
            • Slide 24
            • Conthellip(MI)
            • Slide 26
            • Pathophysiology (2)
            • Tissue Changes After MI
            • Management of MI
            • Slide 30
            • Slide 31
            • ASSESSMENT
            • ANALYSIS NURSING DIAGNOSES
            • NURSING CARE PLAN
            • NURSING CARE PLAN (2)
            • NURSING CARE PLAN (3)
            • NURSING CARE PLAN (4)
            • NURSING CARE PLAN (5)
            • NURSING CARE PLAN (6)
            • NURSING CARE PLAN (7)
            • NURSING CARE PLAN (8)
            • EVALUATION
            • CONGESTIVE HEART FAILURE
            • PATHOPHYSIOLOGY
            • ASSESSMENT (2)
            • ASSESSMENT (3)
            • Left Ventricular Compared with Right Ventricular Heart Failure
            • ANALYSIS NURSING DIAGNOSES (2)
            • Slide 49
            • NURSING CARE PLAN (9)
            • NURSING CARE PLAN (10)
            • NURSING CARE PLAN (11)
            • NURSING CARE PLAN (12)
            • NURSING CARE PLAN (13)
            • EVALUATION
            • Slide 56
            • Slide 57
            • Slide 58
            • Slide 59
            • Slide 60
            • Treatment of Hyperlipidemia
            • Slide 62
            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
            • HYPERTROPHIC CARDIOMYOPATHY
            • HYPERTROPHIC CARDIOMYOPATHY (2)
            • RESTRICTIVE CARDIOMYOPATHY
            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
            • CARDIOMYOPATHIES
            • CARDIOMYOPATHIES (2)
            • CARDIOMYOPATHIES (3)
            • CARDIOMYOPATHIES (4)
            • CARDIOMYOPATHIES (5)
            • CARDIOMYOPATHIES (6)
            • Infective endocarditis
            • Infective endocarditis (2)
            • Infective endocarditis (3)
            • Infective endocarditis (4)
            • Infective endocarditis (5)
            • Infective endocarditis (6)
            • Infective endocarditis (7)
            • Infective endocarditis (8)
            • Infective endocarditis (9)
            • Infective endocarditis (10)
            • Infective endocarditis (11)
            • Infective endocarditis (12)
            • CARDIOGENIC SHOCK
            • CARDIOGENIC SHOCK (2)
            • CARDIOGENIC SHOCK (3)
            • CARDIOGENIC SHOCK (4)
            • CARDIOGENIC SHOCK (5)
            • CARDIAC TAMPONADE
            • CARDIAC TAMPONADE (2)
            • CARDIAC TAMPONADE (3)
            • CARDIAC TAMPONADE (4)
            • CARDIAC TAMPONADE (5)
            • CARDIAC TAMPONADE (6)
            • CARDIAC TAMPONADE (7)
            • Slide 100
            • HYPERTENSION
            • HYPERTENSION (2)
            • Slide 103
            • Slide 104
            • Slide 105
            • Alterations in Blood Flow in the Systemic Circulation
            • Buergerrsquos Disease
            • Slide 108
            • Manifestations
            • Slide 110
            • Diagnosis amp Treatment
            • Rynaudrsquos Disease
            • Manifestations (2)
            • Slide 114
            • Diagnosis amp Treatment (2)
            • Slide 116
            • Care Plan for Clients with Altered Cardiovascular Oxygenation
            • Slide 118
            • Slide 119
            • Slide 120
            • Slide 121

              COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN

              Characteristic

              MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism

              Intensity Asymptomatic to severe increases with time

              Mild to severe Mild to severe Mild to moderate

              Severe unbearable maximal from onset

              Aggravated by breathing

              Duration 30 min to 1-2 hours may wax and wane

              Continuous Periodic 2-10 min ave 3-5 min

              Continuous does not abate once started

              Variable

              Relief Narcotics Sitting up leaning forward

              Physical emotional rest food antacid

              Nitroglycerin rest

              Large repeated doses of narcotics

              02 sitting up morphine

              Associated Symptoms

              Nausea fatigue heartburn equal peripheral pulses

              Fever dyspnea nausea anorexia anxiety

              NV dysphagia anorexia weight loss

              Belching indigestion dizziness

              Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses

              Dyspnea tachypnea diaphoresis hemoptysis cough apprehension

              Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

              inadequate to meet the heartrsquos metabolic demands

              Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

              Pathophysiology

              Types

              AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

              (although those with advance atherosclerosis do not develop angina)

              Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

              Pain location precordial or substernal chest area

              Pain characteristics - constricting squeezing or

              suffocating sensation- Usually steady increasing in

              intensity only at the onset amp end of attack

              - May radiate to left shoulder arm jaw or other chest areas

              - Duration lt 15mins- Relieved by rest (preferably sitting

              or standing with support) or by use of NTG

              B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

              Associates in 1659 Cause spasm of coronary

              arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

              be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

              Pain Characteristics occurs during rest or with minimal exercise

              - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

              If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

              Conthellip

              C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

              D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

              E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

              ConthellipDx detailed pain history ECG TST

              angiogram may be used to confirm amp describe type of angina

              Tx directed towards MI prevention- Lifestyle modification (individualized

              regular exercise program smoking cessation)

              - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

              coronary angioplasty) may be indicated if with severe artery occlusion

              Drug Therapy Nitroglycerin (NTGs) ndash

              vasodilators patch (Deponit

              Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

              Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

              Calcium channel blockers Nifedipine (Calcibloc

              Adalat) Diltiazem (Cardizem)

              Lipid lowering agents ndashstatins Simvastatin

              Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

              Classification

              Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

              Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

              Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

              Class IV ndash angina occurs even at rest

              Nursing Management

              Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

              Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

              limitations NTGs ndash max of 3doses at 5-min intervals

              Stinging sensation under the tongue for SL is normal

              Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

              bottles amp change stocks every 6months Inform clients that headache dizziness

              flushed face are common side effects

              Do not discontinue the drug For patches rotate skin sites usually on

              chest wall Instrct on evaluation of effectiveness based

              on pain reliefPropanolols causes bronchospasm amp

              hypoglycemia do not administer to asthmatic amp diabetic clients

              Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

              Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

              Nursing Management

              Acute Coronary Syndrome

              Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

              Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

              Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

              gt20mins)2 New onset exertional angina (increased in

              severity of at least 1 class ndash to at least class III) in lt2months

              3 Recent acceleration of angina to at least class III in lt2months

              Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

              When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

              Conthellip

              ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

              myocardial tissue associated with atherosclerotic disease of coronary arteries

              Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

              Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

              elevation Q wave prolongation T wave inversion

              Conthellip(MI)

              Manifestations chest pain ndash severe crushing

              constricting ldquosomeone sitting on my chestrdquo

              - substernal radiating to left arm neck or jaw

              - prolonged (gt35mins) amp not relieved by rest

              Shortness of breath profuse perspirationFeeling of impending doom

              Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

              profound LV failure from massive MI resulting to low cardiac output

              Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

              Rupture of myocardiumVentricular aneurysms ndash decreases

              pumping efficiency of heart amp increases work of LV

              Pathophysiology

              Causes atherosclerotic heart disease thrombosisembolism

              shock ampor hemorrhage direct traumaMyocardial ischemia

              uarrcellular hypoxia

              darrmyocardial O2 supplydarr myocardial contractility

              darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

              uarrperipheral vasoconstriction

              uarr myocardial contractility

              uarr afterload uarrmyocardial O2 demand

              uarr HR uarrdiastolicfilling

              darrmyocardial tissue perfusion

              Tissue Changes After MI

              Time after Onset Type of Injury amp Gross Tissue Changes

              0-05hrs Reversible injury

              1-2hrs Onset of irreversible injury

              4-12hrs Beginning of coagulation necrosis

              18-24hrs Continued necrosis gross pallor of infected tissue

              1-3days Total necrosis onset of acute inflammatory process

              3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

              7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

              8th week Complete scar tissue replacement

              Management of MI Initial Management OMEN

              - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

              vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

              may be given to limit infarction size amp most effective if given within 4hrs of onset)

              Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

              Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

              bull Surgery 1Revascularization

              bullPTCAbullCoronary stent implantation

              bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

              2Resection ndash aneurysm

              ASSESSMENT

              bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

              bull Objective databull VSbull Diaphoresisbull Emotional restlessness

              ANALYSIS NURSING DIAGNOSES

              bull Decreased cardiac output related to myocardial damage

              bull Impaired gas exchange related to poor perfusion shock

              bull Pain related to myocardial ischemia

              bull Activity intolerance related to pain or inadequate oxygenation

              bull Fear related to possibility of death

              NURSING CARE PLANbull Goal 1 reduce pain discomfort

              bull Narcotics ndash morphine note response Avoid IM

              bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

              bull Position semi-Fowlerrsquos to improve ventilation

              NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

              rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

              thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

              cracklesbull Check labs troponin blood gases electrolytes

              clotting timebull CVP (5-15 cm H2O) increases with heart failure

              bull ROM of lower extremities antiembolic stockings

              NURSING CARE PLAN

              bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

              bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

              bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

              bull Anticipate needs of client call light water Reassurance

              bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

              NURSING CARE PLAN

              bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

              Mg)bull Monitor ECGbull Diet progressive low

              calorie low sodium low cholesterol low fat without caffeine

              NURSING CARE PLAN

              bull Goal 5 facilitate fecal eliminationbull Medications stool

              softeners to prevent Valsalva maneuver mouth breathing during bowel movement

              bull Bedside commode

              NURSING CARE PLAN

              bull Goal 6 provide emotional supportbull Recognize fear of dying

              denial anger withdrawalbull Encourage expression of

              feelings fears concernsbull Discuss rehabilitation lifestyle

              changes prevent cardiac-invalid syndrome by promoting self-care activities independence

              NURSING CARE PLAN

              bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

              activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

              bull Identify need for referral for sexual counselling

              NURSING CARE PLAN

              bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

              meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

              bull Information about sexual activity less fatiguing positions

              bull Support groups Follow-up carebull Medications administration importance untoward

              effects pulse takingbull Control risk factors rest diet exercise no smoking

              weight control stress reduction

              EVALUATION

              bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

              CONGESTIVE HEART FAILURE

              bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

              PATHOPHYSIOLOGY

              Increased cardiac workload

              decreased effective myocardial contractility

              Decreased cardiac output

              LV failure Pulmonary congestion

              RA RV failure

              Systemic congestion

              Peripheral edema

              ASSESSMENTbull Subjective data

              bull Shortness of breathbull Orthopnea (sleeps on two

              or more pillows)bull Paroxysmal nocturnal

              dyspnea (sudden breathlessness during sleep)

              bull Dyspnea on exertion (climbing stairs)

              bull Apprehension anxiety irritability

              bull Fatigue weaknessbull Reported weight gain

              feeling of puffiness

              ASSESSMENTbull Objective data

              bull VSbull BP decreasing systolic

              narrowing pulse pressurebull Pulse pulsus alternans

              (alternating strong-weak-strong cardiac contraction) increased

              bull Respirations crackles Cheyne-Stokes

              bull Edema dependent pitting (1+ to 4+ mm)

              bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

              dilated pulmonary vessels lung edema

              Left Ventricular Compared with Right Ventricular Heart Failure

              LEFT VENTRICULAR

              FAILURE

              RIGHT VENTRICULAR

              FAILURE

              Pulmonary crackles Jugular venous distention

              Tachypnea Peripheral edema

              S3 gallop Perioral and peripheral cyanosis

              Cardiac murmurs Congestive hepatomegaly

              Paradoxical splitting of S2

              Ascites

              Hepatojugular reflux

              ANALYSIS NURSING DIAGNOSES

              bull Decreased cardiac output related to decreased myocardial contractility

              bull Activity intolerance related to generalized body weakness and inadequate oxygenation

              bull Fatigue related to edema and poor oxygenation

              bull Fluid volume excess related to compensatory mechanisms

              bull Impaired gas exchange related to pulmonary congestion

              bull Anxiety related to shortness of breath

              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

              NURSING CARE PLAN

              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

              tachycardia dyspnea edema resolved change position frequently pillows for support

              bull Rest planned periods limit visitors activity noise Chair and commode privileges

              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

              bull Warm fluids if appropriate

              NURSING CARE PLAN

              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

              NURSING CARE PLANbull Goal 3 provide for special safety

              needsbull Skin care

              bull Inspect massage lubricate bony prominences

              bull Use foot cradle heel protectors sheepskin

              bull Side rails up if hypoxic (disoriented)

              bull Vital signs monitor for signs of fatigue pulmonary emboli

              bull ROM active passive elastic stockings

              NURSING CARE PLAN

              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

              strict IObull Diet

              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

              NURSING CARE PLAN

              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

              bull Refer to available community resources for dietary assistance weight reduction exercise program

              EVALUATION

              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

              distressbull Reduction in dependent edema

              DAY 3 OF

              CARDIOVASCULARDISEASES

              bull hyperlipidemia means high lipid levels

              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

              Treatment of Hyperlipidemia

              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

              bull SYSTOLIC DYSFUNCTION

              HYPERTROPHIC CARDIOMYOPATHY

              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

              HYPERTROPHIC CARDIOMYOPATHY

              bull Pathophysiologybull 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

              RESTRICTIVE CARDIOMYOPATHYPathophysiology

              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

              CARDIOMYOPATHIES

              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

              CARDIOMYOPATHIES

              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

              CARDIOMYOPATHIES

              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

              relief

              CARDIOMYOPATHIES

              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

              CARDIOMYOPATHIES

              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

              Infective endocarditis

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

              bull Can be acute or chronic

              Infective endocarditis

              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

              Infective endocarditis

              bull Pathophysiologybull 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

              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

              Infective endocarditis

              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

              retina

              Infective endocarditis

              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

              Infective endocarditis

              bull Preventionbull Antibiotic prophylaxis if patient is

              undergoing procedures like dental extractions bronchoscopy surgery etc

              Infective endocarditis

              bull LABORATORY EXAMbull Blood Cultures to determine the exact

              organism

              Infective endocarditis

              bull Nursing managementbull 1 regular monitoring of temperature heart

              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

              Infective endocarditis

              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

              B

              Infective endocarditis

              bull Medical managementbull 2 Surgerybull Valvular replacement

              CARDIOGENIC SHOCK

              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

              CARDIOGENIC SHOCK

              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

              CARDIOGENIC SHOCK

              bull LABORATORY FINDINGSIncreased CVP

              Normal is 4-10 cmH2O

              CARDIOGENIC SHOCK

              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

              inotropics such as DOPAMINE and DOBUTAMINE

              bull 3 Administer O2bull 4 Morphine is administered to

              decreased pulmonary congestion and to relieve pain

              CARDIOGENIC SHOCK

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

              bull 6 Monitor urinary output BP and pulses

              bull 7 cautiously administer diuretics and nitrates

              CARDIAC TAMPONADE

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

              CARDIAC TAMPONADE

              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

              CARDIAC TAMPONADE

              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

              CARDIAC TAMPONADE

              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

              distention hypotension and distantmuffled heart sound

              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

              CARDIAC TAMPONADE

              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

              anterior chest

              CARDIAC TAMPONADE

              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

              CARDIAC TAMPONADE

              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

              tamponade

              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

              artery rupture dysrhythmias pleural laceration and myocardial trauma

              HYPERTENSION

              bull 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

              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

              bull Most common typebull 2 Secondary

              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

              Alterations in Blood Flow in the Systemic Circulation

              Buergerrsquos Disease

              bull Also known as Thromboangiitis obliterans

              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

              reaction of the vessel wall

              Manifestations

              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

              Increased sensitivity to cold (due to impaired circulation

              Absentdiminished peripheral pulses

              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

              gangrenous changes may arise may necessitate amputation

              Diagnosis amp Treatment

              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

              emotionsRaynaudrsquos phenomenon ndash associated with

              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

              Manifestations bull Period of ischemia (ischemia due to vasospasm)

              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

              bull Return to normal colorbull Note although all of the fingers are

              affected symmetrically only 1-2digits may be involved

              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

              (rare occasions)

              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

              Immersion of hand in cold water to initiate attack aids in the Dx

              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

              protection from cold Avoidance of emotional stress (anxiety amp

              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

              Care Plan for Clients with Altered Cardiovascular Oxygenation

              A Assessment

              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

              2 vsB Nursing Dx

              1 ineffective tissue perfusion (cardiopulmonary)

              2 Impaired gas exchange

              3 Anxiety due to fear of death (clients with MI or Angina)

              C Goals

              1 Relief of pain amp symptoms

              2 Prevention of further cardiac damage

              D Nursing Interventions

              1 Pain control

              2 Proper medications

              3 Decrease clientrsquos anxiety

              4 Health teachings (meds activities diet exercise etc)

              • CARDIOVASCULAR DISEASES
              • Slide 2
              • GENERAL CARDIAC ASSESSMENT
              • Pathophysiology
              • Slide 5
              • ASSESSING CHEST PAIN
              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
              • Angina Pectoris Myocardial Ischemia
              • Pathophysiology
              • Types
              • Slide 12
              • Slide 13
              • Slide 14
              • Conthellip
              • Conthellip (2)
              • Drug Therapy
              • Classification
              • Nursing Management
              • Nursing Management (2)
              • Acute Coronary Syndrome
              • Slide 22
              • Conthellip (3)
              • Slide 24
              • Conthellip(MI)
              • Slide 26
              • Pathophysiology (2)
              • Tissue Changes After MI
              • Management of MI
              • Slide 30
              • Slide 31
              • ASSESSMENT
              • ANALYSIS NURSING DIAGNOSES
              • NURSING CARE PLAN
              • NURSING CARE PLAN (2)
              • NURSING CARE PLAN (3)
              • NURSING CARE PLAN (4)
              • NURSING CARE PLAN (5)
              • NURSING CARE PLAN (6)
              • NURSING CARE PLAN (7)
              • NURSING CARE PLAN (8)
              • EVALUATION
              • CONGESTIVE HEART FAILURE
              • PATHOPHYSIOLOGY
              • ASSESSMENT (2)
              • ASSESSMENT (3)
              • Left Ventricular Compared with Right Ventricular Heart Failure
              • ANALYSIS NURSING DIAGNOSES (2)
              • Slide 49
              • NURSING CARE PLAN (9)
              • NURSING CARE PLAN (10)
              • NURSING CARE PLAN (11)
              • NURSING CARE PLAN (12)
              • NURSING CARE PLAN (13)
              • EVALUATION
              • Slide 56
              • Slide 57
              • Slide 58
              • Slide 59
              • Slide 60
              • Treatment of Hyperlipidemia
              • Slide 62
              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
              • HYPERTROPHIC CARDIOMYOPATHY
              • HYPERTROPHIC CARDIOMYOPATHY (2)
              • RESTRICTIVE CARDIOMYOPATHY
              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
              • CARDIOMYOPATHIES
              • CARDIOMYOPATHIES (2)
              • CARDIOMYOPATHIES (3)
              • CARDIOMYOPATHIES (4)
              • CARDIOMYOPATHIES (5)
              • CARDIOMYOPATHIES (6)
              • Infective endocarditis
              • Infective endocarditis (2)
              • Infective endocarditis (3)
              • Infective endocarditis (4)
              • Infective endocarditis (5)
              • Infective endocarditis (6)
              • Infective endocarditis (7)
              • Infective endocarditis (8)
              • Infective endocarditis (9)
              • Infective endocarditis (10)
              • Infective endocarditis (11)
              • Infective endocarditis (12)
              • CARDIOGENIC SHOCK
              • CARDIOGENIC SHOCK (2)
              • CARDIOGENIC SHOCK (3)
              • CARDIOGENIC SHOCK (4)
              • CARDIOGENIC SHOCK (5)
              • CARDIAC TAMPONADE
              • CARDIAC TAMPONADE (2)
              • CARDIAC TAMPONADE (3)
              • CARDIAC TAMPONADE (4)
              • CARDIAC TAMPONADE (5)
              • CARDIAC TAMPONADE (6)
              • CARDIAC TAMPONADE (7)
              • Slide 100
              • HYPERTENSION
              • HYPERTENSION (2)
              • Slide 103
              • Slide 104
              • Slide 105
              • Alterations in Blood Flow in the Systemic Circulation
              • Buergerrsquos Disease
              • Slide 108
              • Manifestations
              • Slide 110
              • Diagnosis amp Treatment
              • Rynaudrsquos Disease
              • Manifestations (2)
              • Slide 114
              • Diagnosis amp Treatment (2)
              • Slide 116
              • Care Plan for Clients with Altered Cardiovascular Oxygenation
              • Slide 118
              • Slide 119
              • Slide 120
              • Slide 121

                Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is

                inadequate to meet the heartrsquos metabolic demands

                Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia

                Pathophysiology

                Types

                AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

                (although those with advance atherosclerosis do not develop angina)

                Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

                Pain location precordial or substernal chest area

                Pain characteristics - constricting squeezing or

                suffocating sensation- Usually steady increasing in

                intensity only at the onset amp end of attack

                - May radiate to left shoulder arm jaw or other chest areas

                - Duration lt 15mins- Relieved by rest (preferably sitting

                or standing with support) or by use of NTG

                B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

                Associates in 1659 Cause spasm of coronary

                arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

                be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

                Pain Characteristics occurs during rest or with minimal exercise

                - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                Conthellip

                C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                ConthellipDx detailed pain history ECG TST

                angiogram may be used to confirm amp describe type of angina

                Tx directed towards MI prevention- Lifestyle modification (individualized

                regular exercise program smoking cessation)

                - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                coronary angioplasty) may be indicated if with severe artery occlusion

                Drug Therapy Nitroglycerin (NTGs) ndash

                vasodilators patch (Deponit

                Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                Calcium channel blockers Nifedipine (Calcibloc

                Adalat) Diltiazem (Cardizem)

                Lipid lowering agents ndashstatins Simvastatin

                Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                Classification

                Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                Class IV ndash angina occurs even at rest

                Nursing Management

                Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                limitations NTGs ndash max of 3doses at 5-min intervals

                Stinging sensation under the tongue for SL is normal

                Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                bottles amp change stocks every 6months Inform clients that headache dizziness

                flushed face are common side effects

                Do not discontinue the drug For patches rotate skin sites usually on

                chest wall Instrct on evaluation of effectiveness based

                on pain reliefPropanolols causes bronchospasm amp

                hypoglycemia do not administer to asthmatic amp diabetic clients

                Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                Nursing Management

                Acute Coronary Syndrome

                Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                gt20mins)2 New onset exertional angina (increased in

                severity of at least 1 class ndash to at least class III) in lt2months

                3 Recent acceleration of angina to at least class III in lt2months

                Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                Conthellip

                ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                myocardial tissue associated with atherosclerotic disease of coronary arteries

                Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                elevation Q wave prolongation T wave inversion

                Conthellip(MI)

                Manifestations chest pain ndash severe crushing

                constricting ldquosomeone sitting on my chestrdquo

                - substernal radiating to left arm neck or jaw

                - prolonged (gt35mins) amp not relieved by rest

                Shortness of breath profuse perspirationFeeling of impending doom

                Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                profound LV failure from massive MI resulting to low cardiac output

                Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                Rupture of myocardiumVentricular aneurysms ndash decreases

                pumping efficiency of heart amp increases work of LV

                Pathophysiology

                Causes atherosclerotic heart disease thrombosisembolism

                shock ampor hemorrhage direct traumaMyocardial ischemia

                uarrcellular hypoxia

                darrmyocardial O2 supplydarr myocardial contractility

                darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                uarrperipheral vasoconstriction

                uarr myocardial contractility

                uarr afterload uarrmyocardial O2 demand

                uarr HR uarrdiastolicfilling

                darrmyocardial tissue perfusion

                Tissue Changes After MI

                Time after Onset Type of Injury amp Gross Tissue Changes

                0-05hrs Reversible injury

                1-2hrs Onset of irreversible injury

                4-12hrs Beginning of coagulation necrosis

                18-24hrs Continued necrosis gross pallor of infected tissue

                1-3days Total necrosis onset of acute inflammatory process

                3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                8th week Complete scar tissue replacement

                Management of MI Initial Management OMEN

                - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                may be given to limit infarction size amp most effective if given within 4hrs of onset)

                Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                bull Surgery 1Revascularization

                bullPTCAbullCoronary stent implantation

                bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                2Resection ndash aneurysm

                ASSESSMENT

                bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                ANALYSIS NURSING DIAGNOSES

                bull Decreased cardiac output related to myocardial damage

                bull Impaired gas exchange related to poor perfusion shock

                bull Pain related to myocardial ischemia

                bull Activity intolerance related to pain or inadequate oxygenation

                bull Fear related to possibility of death

                NURSING CARE PLANbull Goal 1 reduce pain discomfort

                bull Narcotics ndash morphine note response Avoid IM

                bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                bull Position semi-Fowlerrsquos to improve ventilation

                NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                cracklesbull Check labs troponin blood gases electrolytes

                clotting timebull CVP (5-15 cm H2O) increases with heart failure

                bull ROM of lower extremities antiembolic stockings

                NURSING CARE PLAN

                bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                bull Anticipate needs of client call light water Reassurance

                bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                NURSING CARE PLAN

                bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                Mg)bull Monitor ECGbull Diet progressive low

                calorie low sodium low cholesterol low fat without caffeine

                NURSING CARE PLAN

                bull Goal 5 facilitate fecal eliminationbull Medications stool

                softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                bull Bedside commode

                NURSING CARE PLAN

                bull Goal 6 provide emotional supportbull Recognize fear of dying

                denial anger withdrawalbull Encourage expression of

                feelings fears concernsbull Discuss rehabilitation lifestyle

                changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                NURSING CARE PLAN

                bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                bull Identify need for referral for sexual counselling

                NURSING CARE PLAN

                bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                bull Information about sexual activity less fatiguing positions

                bull Support groups Follow-up carebull Medications administration importance untoward

                effects pulse takingbull Control risk factors rest diet exercise no smoking

                weight control stress reduction

                EVALUATION

                bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                CONGESTIVE HEART FAILURE

                bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                PATHOPHYSIOLOGY

                Increased cardiac workload

                decreased effective myocardial contractility

                Decreased cardiac output

                LV failure Pulmonary congestion

                RA RV failure

                Systemic congestion

                Peripheral edema

                ASSESSMENTbull Subjective data

                bull Shortness of breathbull Orthopnea (sleeps on two

                or more pillows)bull Paroxysmal nocturnal

                dyspnea (sudden breathlessness during sleep)

                bull Dyspnea on exertion (climbing stairs)

                bull Apprehension anxiety irritability

                bull Fatigue weaknessbull Reported weight gain

                feeling of puffiness

                ASSESSMENTbull Objective data

                bull VSbull BP decreasing systolic

                narrowing pulse pressurebull Pulse pulsus alternans

                (alternating strong-weak-strong cardiac contraction) increased

                bull Respirations crackles Cheyne-Stokes

                bull Edema dependent pitting (1+ to 4+ mm)

                bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                dilated pulmonary vessels lung edema

                Left Ventricular Compared with Right Ventricular Heart Failure

                LEFT VENTRICULAR

                FAILURE

                RIGHT VENTRICULAR

                FAILURE

                Pulmonary crackles Jugular venous distention

                Tachypnea Peripheral edema

                S3 gallop Perioral and peripheral cyanosis

                Cardiac murmurs Congestive hepatomegaly

                Paradoxical splitting of S2

                Ascites

                Hepatojugular reflux

                ANALYSIS NURSING DIAGNOSES

                bull Decreased cardiac output related to decreased myocardial contractility

                bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                bull Fatigue related to edema and poor oxygenation

                bull Fluid volume excess related to compensatory mechanisms

                bull Impaired gas exchange related to pulmonary congestion

                bull Anxiety related to shortness of breath

                bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                NURSING CARE PLAN

                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                tachycardia dyspnea edema resolved change position frequently pillows for support

                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                bull Warm fluids if appropriate

                NURSING CARE PLAN

                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                NURSING CARE PLANbull Goal 3 provide for special safety

                needsbull Skin care

                bull Inspect massage lubricate bony prominences

                bull Use foot cradle heel protectors sheepskin

                bull Side rails up if hypoxic (disoriented)

                bull Vital signs monitor for signs of fatigue pulmonary emboli

                bull ROM active passive elastic stockings

                NURSING CARE PLAN

                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                strict IObull Diet

                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                NURSING CARE PLAN

                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                bull Refer to available community resources for dietary assistance weight reduction exercise program

                EVALUATION

                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                distressbull Reduction in dependent edema

                DAY 3 OF

                CARDIOVASCULARDISEASES

                bull hyperlipidemia means high lipid levels

                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                Treatment of Hyperlipidemia

                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                bull SYSTOLIC DYSFUNCTION

                HYPERTROPHIC CARDIOMYOPATHY

                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                HYPERTROPHIC CARDIOMYOPATHY

                bull Pathophysiologybull 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

                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                CARDIOMYOPATHIES

                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                CARDIOMYOPATHIES

                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                CARDIOMYOPATHIES

                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                relief

                CARDIOMYOPATHIES

                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                CARDIOMYOPATHIES

                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

                Infective endocarditis

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

                bull Can be acute or chronic

                Infective endocarditis

                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

                Infective endocarditis

                bull Pathophysiologybull 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

                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                Infective endocarditis

                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                retina

                Infective endocarditis

                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                Infective endocarditis

                bull Preventionbull Antibiotic prophylaxis if patient is

                undergoing procedures like dental extractions bronchoscopy surgery etc

                Infective endocarditis

                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                organism

                Infective endocarditis

                bull Nursing managementbull 1 regular monitoring of temperature heart

                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                Infective endocarditis

                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                B

                Infective endocarditis

                bull Medical managementbull 2 Surgerybull Valvular replacement

                CARDIOGENIC SHOCK

                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                CARDIOGENIC SHOCK

                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                CARDIOGENIC SHOCK

                bull LABORATORY FINDINGSIncreased CVP

                Normal is 4-10 cmH2O

                CARDIOGENIC SHOCK

                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                inotropics such as DOPAMINE and DOBUTAMINE

                bull 3 Administer O2bull 4 Morphine is administered to

                decreased pulmonary congestion and to relieve pain

                CARDIOGENIC SHOCK

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

                bull 6 Monitor urinary output BP and pulses

                bull 7 cautiously administer diuretics and nitrates

                CARDIAC TAMPONADE

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

                CARDIAC TAMPONADE

                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                CARDIAC TAMPONADE

                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                CARDIAC TAMPONADE

                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                distention hypotension and distantmuffled heart sound

                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                CARDIAC TAMPONADE

                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                anterior chest

                CARDIAC TAMPONADE

                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                CARDIAC TAMPONADE

                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                tamponade

                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                artery rupture dysrhythmias pleural laceration and myocardial trauma

                HYPERTENSION

                bull 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

                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                bull Most common typebull 2 Secondary

                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                Alterations in Blood Flow in the Systemic Circulation

                Buergerrsquos Disease

                bull Also known as Thromboangiitis obliterans

                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                reaction of the vessel wall

                Manifestations

                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                Increased sensitivity to cold (due to impaired circulation

                Absentdiminished peripheral pulses

                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                gangrenous changes may arise may necessitate amputation

                Diagnosis amp Treatment

                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                emotionsRaynaudrsquos phenomenon ndash associated with

                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                bull Return to normal colorbull Note although all of the fingers are

                affected symmetrically only 1-2digits may be involved

                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                (rare occasions)

                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                Immersion of hand in cold water to initiate attack aids in the Dx

                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                protection from cold Avoidance of emotional stress (anxiety amp

                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                Care Plan for Clients with Altered Cardiovascular Oxygenation

                A Assessment

                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                2 vsB Nursing Dx

                1 ineffective tissue perfusion (cardiopulmonary)

                2 Impaired gas exchange

                3 Anxiety due to fear of death (clients with MI or Angina)

                C Goals

                1 Relief of pain amp symptoms

                2 Prevention of further cardiac damage

                D Nursing Interventions

                1 Pain control

                2 Proper medications

                3 Decrease clientrsquos anxiety

                4 Health teachings (meds activities diet exercise etc)

                • CARDIOVASCULAR DISEASES
                • Slide 2
                • GENERAL CARDIAC ASSESSMENT
                • Pathophysiology
                • Slide 5
                • ASSESSING CHEST PAIN
                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                • Angina Pectoris Myocardial Ischemia
                • Pathophysiology
                • Types
                • Slide 12
                • Slide 13
                • Slide 14
                • Conthellip
                • Conthellip (2)
                • Drug Therapy
                • Classification
                • Nursing Management
                • Nursing Management (2)
                • Acute Coronary Syndrome
                • Slide 22
                • Conthellip (3)
                • Slide 24
                • Conthellip(MI)
                • Slide 26
                • Pathophysiology (2)
                • Tissue Changes After MI
                • Management of MI
                • Slide 30
                • Slide 31
                • ASSESSMENT
                • ANALYSIS NURSING DIAGNOSES
                • NURSING CARE PLAN
                • NURSING CARE PLAN (2)
                • NURSING CARE PLAN (3)
                • NURSING CARE PLAN (4)
                • NURSING CARE PLAN (5)
                • NURSING CARE PLAN (6)
                • NURSING CARE PLAN (7)
                • NURSING CARE PLAN (8)
                • EVALUATION
                • CONGESTIVE HEART FAILURE
                • PATHOPHYSIOLOGY
                • ASSESSMENT (2)
                • ASSESSMENT (3)
                • Left Ventricular Compared with Right Ventricular Heart Failure
                • ANALYSIS NURSING DIAGNOSES (2)
                • Slide 49
                • NURSING CARE PLAN (9)
                • NURSING CARE PLAN (10)
                • NURSING CARE PLAN (11)
                • NURSING CARE PLAN (12)
                • NURSING CARE PLAN (13)
                • EVALUATION
                • Slide 56
                • Slide 57
                • Slide 58
                • Slide 59
                • Slide 60
                • Treatment of Hyperlipidemia
                • Slide 62
                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                • HYPERTROPHIC CARDIOMYOPATHY
                • HYPERTROPHIC CARDIOMYOPATHY (2)
                • RESTRICTIVE CARDIOMYOPATHY
                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                • CARDIOMYOPATHIES
                • CARDIOMYOPATHIES (2)
                • CARDIOMYOPATHIES (3)
                • CARDIOMYOPATHIES (4)
                • CARDIOMYOPATHIES (5)
                • CARDIOMYOPATHIES (6)
                • Infective endocarditis
                • Infective endocarditis (2)
                • Infective endocarditis (3)
                • Infective endocarditis (4)
                • Infective endocarditis (5)
                • Infective endocarditis (6)
                • Infective endocarditis (7)
                • Infective endocarditis (8)
                • Infective endocarditis (9)
                • Infective endocarditis (10)
                • Infective endocarditis (11)
                • Infective endocarditis (12)
                • CARDIOGENIC SHOCK
                • CARDIOGENIC SHOCK (2)
                • CARDIOGENIC SHOCK (3)
                • CARDIOGENIC SHOCK (4)
                • CARDIOGENIC SHOCK (5)
                • CARDIAC TAMPONADE
                • CARDIAC TAMPONADE (2)
                • CARDIAC TAMPONADE (3)
                • CARDIAC TAMPONADE (4)
                • CARDIAC TAMPONADE (5)
                • CARDIAC TAMPONADE (6)
                • CARDIAC TAMPONADE (7)
                • Slide 100
                • HYPERTENSION
                • HYPERTENSION (2)
                • Slide 103
                • Slide 104
                • Slide 105
                • Alterations in Blood Flow in the Systemic Circulation
                • Buergerrsquos Disease
                • Slide 108
                • Manifestations
                • Slide 110
                • Diagnosis amp Treatment
                • Rynaudrsquos Disease
                • Manifestations (2)
                • Slide 114
                • Diagnosis amp Treatment (2)
                • Slide 116
                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                • Slide 118
                • Slide 119
                • Slide 120
                • Slide 121

                  Pathophysiology

                  Types

                  AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

                  (although those with advance atherosclerosis do not develop angina)

                  Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

                  Pain location precordial or substernal chest area

                  Pain characteristics - constricting squeezing or

                  suffocating sensation- Usually steady increasing in

                  intensity only at the onset amp end of attack

                  - May radiate to left shoulder arm jaw or other chest areas

                  - Duration lt 15mins- Relieved by rest (preferably sitting

                  or standing with support) or by use of NTG

                  B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

                  Associates in 1659 Cause spasm of coronary

                  arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

                  be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

                  Pain Characteristics occurs during rest or with minimal exercise

                  - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                  If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                  Conthellip

                  C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                  D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                  E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                  ConthellipDx detailed pain history ECG TST

                  angiogram may be used to confirm amp describe type of angina

                  Tx directed towards MI prevention- Lifestyle modification (individualized

                  regular exercise program smoking cessation)

                  - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                  coronary angioplasty) may be indicated if with severe artery occlusion

                  Drug Therapy Nitroglycerin (NTGs) ndash

                  vasodilators patch (Deponit

                  Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                  Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                  Calcium channel blockers Nifedipine (Calcibloc

                  Adalat) Diltiazem (Cardizem)

                  Lipid lowering agents ndashstatins Simvastatin

                  Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                  Classification

                  Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                  Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                  Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                  Class IV ndash angina occurs even at rest

                  Nursing Management

                  Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                  Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                  limitations NTGs ndash max of 3doses at 5-min intervals

                  Stinging sensation under the tongue for SL is normal

                  Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                  bottles amp change stocks every 6months Inform clients that headache dizziness

                  flushed face are common side effects

                  Do not discontinue the drug For patches rotate skin sites usually on

                  chest wall Instrct on evaluation of effectiveness based

                  on pain reliefPropanolols causes bronchospasm amp

                  hypoglycemia do not administer to asthmatic amp diabetic clients

                  Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                  Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                  Nursing Management

                  Acute Coronary Syndrome

                  Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                  Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                  Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                  gt20mins)2 New onset exertional angina (increased in

                  severity of at least 1 class ndash to at least class III) in lt2months

                  3 Recent acceleration of angina to at least class III in lt2months

                  Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                  When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                  Conthellip

                  ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                  myocardial tissue associated with atherosclerotic disease of coronary arteries

                  Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                  Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                  elevation Q wave prolongation T wave inversion

                  Conthellip(MI)

                  Manifestations chest pain ndash severe crushing

                  constricting ldquosomeone sitting on my chestrdquo

                  - substernal radiating to left arm neck or jaw

                  - prolonged (gt35mins) amp not relieved by rest

                  Shortness of breath profuse perspirationFeeling of impending doom

                  Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                  profound LV failure from massive MI resulting to low cardiac output

                  Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                  Rupture of myocardiumVentricular aneurysms ndash decreases

                  pumping efficiency of heart amp increases work of LV

                  Pathophysiology

                  Causes atherosclerotic heart disease thrombosisembolism

                  shock ampor hemorrhage direct traumaMyocardial ischemia

                  uarrcellular hypoxia

                  darrmyocardial O2 supplydarr myocardial contractility

                  darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                  uarrperipheral vasoconstriction

                  uarr myocardial contractility

                  uarr afterload uarrmyocardial O2 demand

                  uarr HR uarrdiastolicfilling

                  darrmyocardial tissue perfusion

                  Tissue Changes After MI

                  Time after Onset Type of Injury amp Gross Tissue Changes

                  0-05hrs Reversible injury

                  1-2hrs Onset of irreversible injury

                  4-12hrs Beginning of coagulation necrosis

                  18-24hrs Continued necrosis gross pallor of infected tissue

                  1-3days Total necrosis onset of acute inflammatory process

                  3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                  7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                  8th week Complete scar tissue replacement

                  Management of MI Initial Management OMEN

                  - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                  vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                  may be given to limit infarction size amp most effective if given within 4hrs of onset)

                  Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                  Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                  bull Surgery 1Revascularization

                  bullPTCAbullCoronary stent implantation

                  bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                  2Resection ndash aneurysm

                  ASSESSMENT

                  bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                  bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                  ANALYSIS NURSING DIAGNOSES

                  bull Decreased cardiac output related to myocardial damage

                  bull Impaired gas exchange related to poor perfusion shock

                  bull Pain related to myocardial ischemia

                  bull Activity intolerance related to pain or inadequate oxygenation

                  bull Fear related to possibility of death

                  NURSING CARE PLANbull Goal 1 reduce pain discomfort

                  bull Narcotics ndash morphine note response Avoid IM

                  bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                  bull Position semi-Fowlerrsquos to improve ventilation

                  NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                  rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                  thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                  cracklesbull Check labs troponin blood gases electrolytes

                  clotting timebull CVP (5-15 cm H2O) increases with heart failure

                  bull ROM of lower extremities antiembolic stockings

                  NURSING CARE PLAN

                  bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                  bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                  bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                  bull Anticipate needs of client call light water Reassurance

                  bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                  NURSING CARE PLAN

                  bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                  Mg)bull Monitor ECGbull Diet progressive low

                  calorie low sodium low cholesterol low fat without caffeine

                  NURSING CARE PLAN

                  bull Goal 5 facilitate fecal eliminationbull Medications stool

                  softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                  bull Bedside commode

                  NURSING CARE PLAN

                  bull Goal 6 provide emotional supportbull Recognize fear of dying

                  denial anger withdrawalbull Encourage expression of

                  feelings fears concernsbull Discuss rehabilitation lifestyle

                  changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                  NURSING CARE PLAN

                  bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                  activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                  bull Identify need for referral for sexual counselling

                  NURSING CARE PLAN

                  bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                  meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                  bull Information about sexual activity less fatiguing positions

                  bull Support groups Follow-up carebull Medications administration importance untoward

                  effects pulse takingbull Control risk factors rest diet exercise no smoking

                  weight control stress reduction

                  EVALUATION

                  bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                  CONGESTIVE HEART FAILURE

                  bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                  PATHOPHYSIOLOGY

                  Increased cardiac workload

                  decreased effective myocardial contractility

                  Decreased cardiac output

                  LV failure Pulmonary congestion

                  RA RV failure

                  Systemic congestion

                  Peripheral edema

                  ASSESSMENTbull Subjective data

                  bull Shortness of breathbull Orthopnea (sleeps on two

                  or more pillows)bull Paroxysmal nocturnal

                  dyspnea (sudden breathlessness during sleep)

                  bull Dyspnea on exertion (climbing stairs)

                  bull Apprehension anxiety irritability

                  bull Fatigue weaknessbull Reported weight gain

                  feeling of puffiness

                  ASSESSMENTbull Objective data

                  bull VSbull BP decreasing systolic

                  narrowing pulse pressurebull Pulse pulsus alternans

                  (alternating strong-weak-strong cardiac contraction) increased

                  bull Respirations crackles Cheyne-Stokes

                  bull Edema dependent pitting (1+ to 4+ mm)

                  bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                  dilated pulmonary vessels lung edema

                  Left Ventricular Compared with Right Ventricular Heart Failure

                  LEFT VENTRICULAR

                  FAILURE

                  RIGHT VENTRICULAR

                  FAILURE

                  Pulmonary crackles Jugular venous distention

                  Tachypnea Peripheral edema

                  S3 gallop Perioral and peripheral cyanosis

                  Cardiac murmurs Congestive hepatomegaly

                  Paradoxical splitting of S2

                  Ascites

                  Hepatojugular reflux

                  ANALYSIS NURSING DIAGNOSES

                  bull Decreased cardiac output related to decreased myocardial contractility

                  bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                  bull Fatigue related to edema and poor oxygenation

                  bull Fluid volume excess related to compensatory mechanisms

                  bull Impaired gas exchange related to pulmonary congestion

                  bull Anxiety related to shortness of breath

                  bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                  NURSING CARE PLAN

                  bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                  tachycardia dyspnea edema resolved change position frequently pillows for support

                  bull Rest planned periods limit visitors activity noise Chair and commode privileges

                  bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                  bull Warm fluids if appropriate

                  NURSING CARE PLAN

                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                  NURSING CARE PLANbull Goal 3 provide for special safety

                  needsbull Skin care

                  bull Inspect massage lubricate bony prominences

                  bull Use foot cradle heel protectors sheepskin

                  bull Side rails up if hypoxic (disoriented)

                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                  bull ROM active passive elastic stockings

                  NURSING CARE PLAN

                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                  strict IObull Diet

                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                  NURSING CARE PLAN

                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                  EVALUATION

                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                  distressbull Reduction in dependent edema

                  DAY 3 OF

                  CARDIOVASCULARDISEASES

                  bull hyperlipidemia means high lipid levels

                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                  Treatment of Hyperlipidemia

                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                  bull SYSTOLIC DYSFUNCTION

                  HYPERTROPHIC CARDIOMYOPATHY

                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                  HYPERTROPHIC CARDIOMYOPATHY

                  bull Pathophysiologybull 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

                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                  CARDIOMYOPATHIES

                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                  CARDIOMYOPATHIES

                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                  CARDIOMYOPATHIES

                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                  relief

                  CARDIOMYOPATHIES

                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                  CARDIOMYOPATHIES

                  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

                  Infective endocarditis

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

                  bull Can be acute or chronic

                  Infective endocarditis

                  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

                  Infective endocarditis

                  bull Pathophysiologybull 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

                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                  Infective endocarditis

                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                  retina

                  Infective endocarditis

                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                  Infective endocarditis

                  bull Preventionbull Antibiotic prophylaxis if patient is

                  undergoing procedures like dental extractions bronchoscopy surgery etc

                  Infective endocarditis

                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                  organism

                  Infective endocarditis

                  bull Nursing managementbull 1 regular monitoring of temperature heart

                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                  Infective endocarditis

                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                  B

                  Infective endocarditis

                  bull Medical managementbull 2 Surgerybull Valvular replacement

                  CARDIOGENIC SHOCK

                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                  CARDIOGENIC SHOCK

                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                  CARDIOGENIC SHOCK

                  bull LABORATORY FINDINGSIncreased CVP

                  Normal is 4-10 cmH2O

                  CARDIOGENIC SHOCK

                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                  inotropics such as DOPAMINE and DOBUTAMINE

                  bull 3 Administer O2bull 4 Morphine is administered to

                  decreased pulmonary congestion and to relieve pain

                  CARDIOGENIC SHOCK

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

                  bull 6 Monitor urinary output BP and pulses

                  bull 7 cautiously administer diuretics and nitrates

                  CARDIAC TAMPONADE

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

                  CARDIAC TAMPONADE

                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                  CARDIAC TAMPONADE

                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                  CARDIAC TAMPONADE

                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                  distention hypotension and distantmuffled heart sound

                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                  CARDIAC TAMPONADE

                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                  anterior chest

                  CARDIAC TAMPONADE

                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                  CARDIAC TAMPONADE

                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                  tamponade

                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                  HYPERTENSION

                  bull 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

                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                  bull Most common typebull 2 Secondary

                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                  Alterations in Blood Flow in the Systemic Circulation

                  Buergerrsquos Disease

                  bull Also known as Thromboangiitis obliterans

                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                  reaction of the vessel wall

                  Manifestations

                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                  Increased sensitivity to cold (due to impaired circulation

                  Absentdiminished peripheral pulses

                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                  gangrenous changes may arise may necessitate amputation

                  Diagnosis amp Treatment

                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                  emotionsRaynaudrsquos phenomenon ndash associated with

                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                  bull Return to normal colorbull Note although all of the fingers are

                  affected symmetrically only 1-2digits may be involved

                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                  (rare occasions)

                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                  Immersion of hand in cold water to initiate attack aids in the Dx

                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                  protection from cold Avoidance of emotional stress (anxiety amp

                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                  A Assessment

                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                  2 vsB Nursing Dx

                  1 ineffective tissue perfusion (cardiopulmonary)

                  2 Impaired gas exchange

                  3 Anxiety due to fear of death (clients with MI or Angina)

                  C Goals

                  1 Relief of pain amp symptoms

                  2 Prevention of further cardiac damage

                  D Nursing Interventions

                  1 Pain control

                  2 Proper medications

                  3 Decrease clientrsquos anxiety

                  4 Health teachings (meds activities diet exercise etc)

                  • CARDIOVASCULAR DISEASES
                  • Slide 2
                  • GENERAL CARDIAC ASSESSMENT
                  • Pathophysiology
                  • Slide 5
                  • ASSESSING CHEST PAIN
                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                  • Angina Pectoris Myocardial Ischemia
                  • Pathophysiology
                  • Types
                  • Slide 12
                  • Slide 13
                  • Slide 14
                  • Conthellip
                  • Conthellip (2)
                  • Drug Therapy
                  • Classification
                  • Nursing Management
                  • Nursing Management (2)
                  • Acute Coronary Syndrome
                  • Slide 22
                  • Conthellip (3)
                  • Slide 24
                  • Conthellip(MI)
                  • Slide 26
                  • Pathophysiology (2)
                  • Tissue Changes After MI
                  • Management of MI
                  • Slide 30
                  • Slide 31
                  • ASSESSMENT
                  • ANALYSIS NURSING DIAGNOSES
                  • NURSING CARE PLAN
                  • NURSING CARE PLAN (2)
                  • NURSING CARE PLAN (3)
                  • NURSING CARE PLAN (4)
                  • NURSING CARE PLAN (5)
                  • NURSING CARE PLAN (6)
                  • NURSING CARE PLAN (7)
                  • NURSING CARE PLAN (8)
                  • EVALUATION
                  • CONGESTIVE HEART FAILURE
                  • PATHOPHYSIOLOGY
                  • ASSESSMENT (2)
                  • ASSESSMENT (3)
                  • Left Ventricular Compared with Right Ventricular Heart Failure
                  • ANALYSIS NURSING DIAGNOSES (2)
                  • Slide 49
                  • NURSING CARE PLAN (9)
                  • NURSING CARE PLAN (10)
                  • NURSING CARE PLAN (11)
                  • NURSING CARE PLAN (12)
                  • NURSING CARE PLAN (13)
                  • EVALUATION
                  • Slide 56
                  • Slide 57
                  • Slide 58
                  • Slide 59
                  • Slide 60
                  • Treatment of Hyperlipidemia
                  • Slide 62
                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                  • HYPERTROPHIC CARDIOMYOPATHY
                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                  • RESTRICTIVE CARDIOMYOPATHY
                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                  • CARDIOMYOPATHIES
                  • CARDIOMYOPATHIES (2)
                  • CARDIOMYOPATHIES (3)
                  • CARDIOMYOPATHIES (4)
                  • CARDIOMYOPATHIES (5)
                  • CARDIOMYOPATHIES (6)
                  • Infective endocarditis
                  • Infective endocarditis (2)
                  • Infective endocarditis (3)
                  • Infective endocarditis (4)
                  • Infective endocarditis (5)
                  • Infective endocarditis (6)
                  • Infective endocarditis (7)
                  • Infective endocarditis (8)
                  • Infective endocarditis (9)
                  • Infective endocarditis (10)
                  • Infective endocarditis (11)
                  • Infective endocarditis (12)
                  • CARDIOGENIC SHOCK
                  • CARDIOGENIC SHOCK (2)
                  • CARDIOGENIC SHOCK (3)
                  • CARDIOGENIC SHOCK (4)
                  • CARDIOGENIC SHOCK (5)
                  • CARDIAC TAMPONADE
                  • CARDIAC TAMPONADE (2)
                  • CARDIAC TAMPONADE (3)
                  • CARDIAC TAMPONADE (4)
                  • CARDIAC TAMPONADE (5)
                  • CARDIAC TAMPONADE (6)
                  • CARDIAC TAMPONADE (7)
                  • Slide 100
                  • HYPERTENSION
                  • HYPERTENSION (2)
                  • Slide 103
                  • Slide 104
                  • Slide 105
                  • Alterations in Blood Flow in the Systemic Circulation
                  • Buergerrsquos Disease
                  • Slide 108
                  • Manifestations
                  • Slide 110
                  • Diagnosis amp Treatment
                  • Rynaudrsquos Disease
                  • Manifestations (2)
                  • Slide 114
                  • Diagnosis amp Treatment (2)
                  • Slide 116
                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                  • Slide 118
                  • Slide 119
                  • Slide 120
                  • Slide 121

                    Types

                    AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis

                    (although those with advance atherosclerosis do not develop angina)

                    Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)

                    Pain location precordial or substernal chest area

                    Pain characteristics - constricting squeezing or

                    suffocating sensation- Usually steady increasing in

                    intensity only at the onset amp end of attack

                    - May radiate to left shoulder arm jaw or other chest areas

                    - Duration lt 15mins- Relieved by rest (preferably sitting

                    or standing with support) or by use of NTG

                    B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

                    Associates in 1659 Cause spasm of coronary

                    arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

                    be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

                    Pain Characteristics occurs during rest or with minimal exercise

                    - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                    If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                    Conthellip

                    C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                    D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                    E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                    ConthellipDx detailed pain history ECG TST

                    angiogram may be used to confirm amp describe type of angina

                    Tx directed towards MI prevention- Lifestyle modification (individualized

                    regular exercise program smoking cessation)

                    - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                    coronary angioplasty) may be indicated if with severe artery occlusion

                    Drug Therapy Nitroglycerin (NTGs) ndash

                    vasodilators patch (Deponit

                    Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                    Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                    Calcium channel blockers Nifedipine (Calcibloc

                    Adalat) Diltiazem (Cardizem)

                    Lipid lowering agents ndashstatins Simvastatin

                    Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                    Classification

                    Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                    Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                    Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                    Class IV ndash angina occurs even at rest

                    Nursing Management

                    Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                    Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                    limitations NTGs ndash max of 3doses at 5-min intervals

                    Stinging sensation under the tongue for SL is normal

                    Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                    bottles amp change stocks every 6months Inform clients that headache dizziness

                    flushed face are common side effects

                    Do not discontinue the drug For patches rotate skin sites usually on

                    chest wall Instrct on evaluation of effectiveness based

                    on pain reliefPropanolols causes bronchospasm amp

                    hypoglycemia do not administer to asthmatic amp diabetic clients

                    Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                    Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                    Nursing Management

                    Acute Coronary Syndrome

                    Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                    Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                    Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                    gt20mins)2 New onset exertional angina (increased in

                    severity of at least 1 class ndash to at least class III) in lt2months

                    3 Recent acceleration of angina to at least class III in lt2months

                    Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                    When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                    Conthellip

                    ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                    myocardial tissue associated with atherosclerotic disease of coronary arteries

                    Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                    Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                    elevation Q wave prolongation T wave inversion

                    Conthellip(MI)

                    Manifestations chest pain ndash severe crushing

                    constricting ldquosomeone sitting on my chestrdquo

                    - substernal radiating to left arm neck or jaw

                    - prolonged (gt35mins) amp not relieved by rest

                    Shortness of breath profuse perspirationFeeling of impending doom

                    Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                    profound LV failure from massive MI resulting to low cardiac output

                    Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                    Rupture of myocardiumVentricular aneurysms ndash decreases

                    pumping efficiency of heart amp increases work of LV

                    Pathophysiology

                    Causes atherosclerotic heart disease thrombosisembolism

                    shock ampor hemorrhage direct traumaMyocardial ischemia

                    uarrcellular hypoxia

                    darrmyocardial O2 supplydarr myocardial contractility

                    darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                    uarrperipheral vasoconstriction

                    uarr myocardial contractility

                    uarr afterload uarrmyocardial O2 demand

                    uarr HR uarrdiastolicfilling

                    darrmyocardial tissue perfusion

                    Tissue Changes After MI

                    Time after Onset Type of Injury amp Gross Tissue Changes

                    0-05hrs Reversible injury

                    1-2hrs Onset of irreversible injury

                    4-12hrs Beginning of coagulation necrosis

                    18-24hrs Continued necrosis gross pallor of infected tissue

                    1-3days Total necrosis onset of acute inflammatory process

                    3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                    7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                    8th week Complete scar tissue replacement

                    Management of MI Initial Management OMEN

                    - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                    vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                    may be given to limit infarction size amp most effective if given within 4hrs of onset)

                    Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                    Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                    bull Surgery 1Revascularization

                    bullPTCAbullCoronary stent implantation

                    bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                    2Resection ndash aneurysm

                    ASSESSMENT

                    bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                    bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                    ANALYSIS NURSING DIAGNOSES

                    bull Decreased cardiac output related to myocardial damage

                    bull Impaired gas exchange related to poor perfusion shock

                    bull Pain related to myocardial ischemia

                    bull Activity intolerance related to pain or inadequate oxygenation

                    bull Fear related to possibility of death

                    NURSING CARE PLANbull Goal 1 reduce pain discomfort

                    bull Narcotics ndash morphine note response Avoid IM

                    bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                    bull Position semi-Fowlerrsquos to improve ventilation

                    NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                    rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                    thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                    cracklesbull Check labs troponin blood gases electrolytes

                    clotting timebull CVP (5-15 cm H2O) increases with heart failure

                    bull ROM of lower extremities antiembolic stockings

                    NURSING CARE PLAN

                    bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                    bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                    bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                    bull Anticipate needs of client call light water Reassurance

                    bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                    NURSING CARE PLAN

                    bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                    Mg)bull Monitor ECGbull Diet progressive low

                    calorie low sodium low cholesterol low fat without caffeine

                    NURSING CARE PLAN

                    bull Goal 5 facilitate fecal eliminationbull Medications stool

                    softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                    bull Bedside commode

                    NURSING CARE PLAN

                    bull Goal 6 provide emotional supportbull Recognize fear of dying

                    denial anger withdrawalbull Encourage expression of

                    feelings fears concernsbull Discuss rehabilitation lifestyle

                    changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                    NURSING CARE PLAN

                    bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                    activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                    bull Identify need for referral for sexual counselling

                    NURSING CARE PLAN

                    bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                    meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                    bull Information about sexual activity less fatiguing positions

                    bull Support groups Follow-up carebull Medications administration importance untoward

                    effects pulse takingbull Control risk factors rest diet exercise no smoking

                    weight control stress reduction

                    EVALUATION

                    bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                    CONGESTIVE HEART FAILURE

                    bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                    PATHOPHYSIOLOGY

                    Increased cardiac workload

                    decreased effective myocardial contractility

                    Decreased cardiac output

                    LV failure Pulmonary congestion

                    RA RV failure

                    Systemic congestion

                    Peripheral edema

                    ASSESSMENTbull Subjective data

                    bull Shortness of breathbull Orthopnea (sleeps on two

                    or more pillows)bull Paroxysmal nocturnal

                    dyspnea (sudden breathlessness during sleep)

                    bull Dyspnea on exertion (climbing stairs)

                    bull Apprehension anxiety irritability

                    bull Fatigue weaknessbull Reported weight gain

                    feeling of puffiness

                    ASSESSMENTbull Objective data

                    bull VSbull BP decreasing systolic

                    narrowing pulse pressurebull Pulse pulsus alternans

                    (alternating strong-weak-strong cardiac contraction) increased

                    bull Respirations crackles Cheyne-Stokes

                    bull Edema dependent pitting (1+ to 4+ mm)

                    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                    dilated pulmonary vessels lung edema

                    Left Ventricular Compared with Right Ventricular Heart Failure

                    LEFT VENTRICULAR

                    FAILURE

                    RIGHT VENTRICULAR

                    FAILURE

                    Pulmonary crackles Jugular venous distention

                    Tachypnea Peripheral edema

                    S3 gallop Perioral and peripheral cyanosis

                    Cardiac murmurs Congestive hepatomegaly

                    Paradoxical splitting of S2

                    Ascites

                    Hepatojugular reflux

                    ANALYSIS NURSING DIAGNOSES

                    bull Decreased cardiac output related to decreased myocardial contractility

                    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                    bull Fatigue related to edema and poor oxygenation

                    bull Fluid volume excess related to compensatory mechanisms

                    bull Impaired gas exchange related to pulmonary congestion

                    bull Anxiety related to shortness of breath

                    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                    NURSING CARE PLAN

                    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                    tachycardia dyspnea edema resolved change position frequently pillows for support

                    bull Rest planned periods limit visitors activity noise Chair and commode privileges

                    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                    bull Warm fluids if appropriate

                    NURSING CARE PLAN

                    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                    NURSING CARE PLANbull Goal 3 provide for special safety

                    needsbull Skin care

                    bull Inspect massage lubricate bony prominences

                    bull Use foot cradle heel protectors sheepskin

                    bull Side rails up if hypoxic (disoriented)

                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                    bull ROM active passive elastic stockings

                    NURSING CARE PLAN

                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                    strict IObull Diet

                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                    NURSING CARE PLAN

                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                    EVALUATION

                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                    distressbull Reduction in dependent edema

                    DAY 3 OF

                    CARDIOVASCULARDISEASES

                    bull hyperlipidemia means high lipid levels

                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                    Treatment of Hyperlipidemia

                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                    bull SYSTOLIC DYSFUNCTION

                    HYPERTROPHIC CARDIOMYOPATHY

                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                    HYPERTROPHIC CARDIOMYOPATHY

                    bull Pathophysiologybull 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

                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                    CARDIOMYOPATHIES

                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                    CARDIOMYOPATHIES

                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                    CARDIOMYOPATHIES

                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                    relief

                    CARDIOMYOPATHIES

                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                    CARDIOMYOPATHIES

                    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

                    Infective endocarditis

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

                    bull Can be acute or chronic

                    Infective endocarditis

                    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

                    Infective endocarditis

                    bull Pathophysiologybull 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

                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                    Infective endocarditis

                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                    retina

                    Infective endocarditis

                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                    Infective endocarditis

                    bull Preventionbull Antibiotic prophylaxis if patient is

                    undergoing procedures like dental extractions bronchoscopy surgery etc

                    Infective endocarditis

                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                    organism

                    Infective endocarditis

                    bull Nursing managementbull 1 regular monitoring of temperature heart

                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                    Infective endocarditis

                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                    B

                    Infective endocarditis

                    bull Medical managementbull 2 Surgerybull Valvular replacement

                    CARDIOGENIC SHOCK

                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                    CARDIOGENIC SHOCK

                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                    CARDIOGENIC SHOCK

                    bull LABORATORY FINDINGSIncreased CVP

                    Normal is 4-10 cmH2O

                    CARDIOGENIC SHOCK

                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                    inotropics such as DOPAMINE and DOBUTAMINE

                    bull 3 Administer O2bull 4 Morphine is administered to

                    decreased pulmonary congestion and to relieve pain

                    CARDIOGENIC SHOCK

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

                    bull 6 Monitor urinary output BP and pulses

                    bull 7 cautiously administer diuretics and nitrates

                    CARDIAC TAMPONADE

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

                    CARDIAC TAMPONADE

                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                    CARDIAC TAMPONADE

                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                    CARDIAC TAMPONADE

                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                    distention hypotension and distantmuffled heart sound

                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                    CARDIAC TAMPONADE

                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                    anterior chest

                    CARDIAC TAMPONADE

                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                    CARDIAC TAMPONADE

                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                    tamponade

                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                    HYPERTENSION

                    bull 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

                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                    bull Most common typebull 2 Secondary

                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                    Alterations in Blood Flow in the Systemic Circulation

                    Buergerrsquos Disease

                    bull Also known as Thromboangiitis obliterans

                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                    reaction of the vessel wall

                    Manifestations

                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                    Increased sensitivity to cold (due to impaired circulation

                    Absentdiminished peripheral pulses

                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                    gangrenous changes may arise may necessitate amputation

                    Diagnosis amp Treatment

                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                    emotionsRaynaudrsquos phenomenon ndash associated with

                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                    bull Return to normal colorbull Note although all of the fingers are

                    affected symmetrically only 1-2digits may be involved

                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                    (rare occasions)

                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                    Immersion of hand in cold water to initiate attack aids in the Dx

                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                    protection from cold Avoidance of emotional stress (anxiety amp

                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                    A Assessment

                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                    2 vsB Nursing Dx

                    1 ineffective tissue perfusion (cardiopulmonary)

                    2 Impaired gas exchange

                    3 Anxiety due to fear of death (clients with MI or Angina)

                    C Goals

                    1 Relief of pain amp symptoms

                    2 Prevention of further cardiac damage

                    D Nursing Interventions

                    1 Pain control

                    2 Proper medications

                    3 Decrease clientrsquos anxiety

                    4 Health teachings (meds activities diet exercise etc)

                    • CARDIOVASCULAR DISEASES
                    • Slide 2
                    • GENERAL CARDIAC ASSESSMENT
                    • Pathophysiology
                    • Slide 5
                    • ASSESSING CHEST PAIN
                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                    • Angina Pectoris Myocardial Ischemia
                    • Pathophysiology
                    • Types
                    • Slide 12
                    • Slide 13
                    • Slide 14
                    • Conthellip
                    • Conthellip (2)
                    • Drug Therapy
                    • Classification
                    • Nursing Management
                    • Nursing Management (2)
                    • Acute Coronary Syndrome
                    • Slide 22
                    • Conthellip (3)
                    • Slide 24
                    • Conthellip(MI)
                    • Slide 26
                    • Pathophysiology (2)
                    • Tissue Changes After MI
                    • Management of MI
                    • Slide 30
                    • Slide 31
                    • ASSESSMENT
                    • ANALYSIS NURSING DIAGNOSES
                    • NURSING CARE PLAN
                    • NURSING CARE PLAN (2)
                    • NURSING CARE PLAN (3)
                    • NURSING CARE PLAN (4)
                    • NURSING CARE PLAN (5)
                    • NURSING CARE PLAN (6)
                    • NURSING CARE PLAN (7)
                    • NURSING CARE PLAN (8)
                    • EVALUATION
                    • CONGESTIVE HEART FAILURE
                    • PATHOPHYSIOLOGY
                    • ASSESSMENT (2)
                    • ASSESSMENT (3)
                    • Left Ventricular Compared with Right Ventricular Heart Failure
                    • ANALYSIS NURSING DIAGNOSES (2)
                    • Slide 49
                    • NURSING CARE PLAN (9)
                    • NURSING CARE PLAN (10)
                    • NURSING CARE PLAN (11)
                    • NURSING CARE PLAN (12)
                    • NURSING CARE PLAN (13)
                    • EVALUATION
                    • Slide 56
                    • Slide 57
                    • Slide 58
                    • Slide 59
                    • Slide 60
                    • Treatment of Hyperlipidemia
                    • Slide 62
                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                    • HYPERTROPHIC CARDIOMYOPATHY
                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                    • RESTRICTIVE CARDIOMYOPATHY
                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                    • CARDIOMYOPATHIES
                    • CARDIOMYOPATHIES (2)
                    • CARDIOMYOPATHIES (3)
                    • CARDIOMYOPATHIES (4)
                    • CARDIOMYOPATHIES (5)
                    • CARDIOMYOPATHIES (6)
                    • Infective endocarditis
                    • Infective endocarditis (2)
                    • Infective endocarditis (3)
                    • Infective endocarditis (4)
                    • Infective endocarditis (5)
                    • Infective endocarditis (6)
                    • Infective endocarditis (7)
                    • Infective endocarditis (8)
                    • Infective endocarditis (9)
                    • Infective endocarditis (10)
                    • Infective endocarditis (11)
                    • Infective endocarditis (12)
                    • CARDIOGENIC SHOCK
                    • CARDIOGENIC SHOCK (2)
                    • CARDIOGENIC SHOCK (3)
                    • CARDIOGENIC SHOCK (4)
                    • CARDIOGENIC SHOCK (5)
                    • CARDIAC TAMPONADE
                    • CARDIAC TAMPONADE (2)
                    • CARDIAC TAMPONADE (3)
                    • CARDIAC TAMPONADE (4)
                    • CARDIAC TAMPONADE (5)
                    • CARDIAC TAMPONADE (6)
                    • CARDIAC TAMPONADE (7)
                    • Slide 100
                    • HYPERTENSION
                    • HYPERTENSION (2)
                    • Slide 103
                    • Slide 104
                    • Slide 105
                    • Alterations in Blood Flow in the Systemic Circulation
                    • Buergerrsquos Disease
                    • Slide 108
                    • Manifestations
                    • Slide 110
                    • Diagnosis amp Treatment
                    • Rynaudrsquos Disease
                    • Manifestations (2)
                    • Slide 114
                    • Diagnosis amp Treatment (2)
                    • Slide 116
                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                    • Slide 118
                    • Slide 119
                    • Slide 120
                    • Slide 121

                      Pain characteristics - constricting squeezing or

                      suffocating sensation- Usually steady increasing in

                      intensity only at the onset amp end of attack

                      - May radiate to left shoulder arm jaw or other chest areas

                      - Duration lt 15mins- Relieved by rest (preferably sitting

                      or standing with support) or by use of NTG

                      B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

                      Associates in 1659 Cause spasm of coronary

                      arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

                      be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

                      Pain Characteristics occurs during rest or with minimal exercise

                      - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                      If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                      Conthellip

                      C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                      D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                      E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                      ConthellipDx detailed pain history ECG TST

                      angiogram may be used to confirm amp describe type of angina

                      Tx directed towards MI prevention- Lifestyle modification (individualized

                      regular exercise program smoking cessation)

                      - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                      coronary angioplasty) may be indicated if with severe artery occlusion

                      Drug Therapy Nitroglycerin (NTGs) ndash

                      vasodilators patch (Deponit

                      Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                      Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                      Calcium channel blockers Nifedipine (Calcibloc

                      Adalat) Diltiazem (Cardizem)

                      Lipid lowering agents ndashstatins Simvastatin

                      Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                      Classification

                      Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                      Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                      Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                      Class IV ndash angina occurs even at rest

                      Nursing Management

                      Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                      Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                      limitations NTGs ndash max of 3doses at 5-min intervals

                      Stinging sensation under the tongue for SL is normal

                      Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                      bottles amp change stocks every 6months Inform clients that headache dizziness

                      flushed face are common side effects

                      Do not discontinue the drug For patches rotate skin sites usually on

                      chest wall Instrct on evaluation of effectiveness based

                      on pain reliefPropanolols causes bronchospasm amp

                      hypoglycemia do not administer to asthmatic amp diabetic clients

                      Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                      Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                      Nursing Management

                      Acute Coronary Syndrome

                      Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                      Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                      Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                      gt20mins)2 New onset exertional angina (increased in

                      severity of at least 1 class ndash to at least class III) in lt2months

                      3 Recent acceleration of angina to at least class III in lt2months

                      Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                      When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                      Conthellip

                      ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                      myocardial tissue associated with atherosclerotic disease of coronary arteries

                      Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                      Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                      elevation Q wave prolongation T wave inversion

                      Conthellip(MI)

                      Manifestations chest pain ndash severe crushing

                      constricting ldquosomeone sitting on my chestrdquo

                      - substernal radiating to left arm neck or jaw

                      - prolonged (gt35mins) amp not relieved by rest

                      Shortness of breath profuse perspirationFeeling of impending doom

                      Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                      profound LV failure from massive MI resulting to low cardiac output

                      Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                      Rupture of myocardiumVentricular aneurysms ndash decreases

                      pumping efficiency of heart amp increases work of LV

                      Pathophysiology

                      Causes atherosclerotic heart disease thrombosisembolism

                      shock ampor hemorrhage direct traumaMyocardial ischemia

                      uarrcellular hypoxia

                      darrmyocardial O2 supplydarr myocardial contractility

                      darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                      uarrperipheral vasoconstriction

                      uarr myocardial contractility

                      uarr afterload uarrmyocardial O2 demand

                      uarr HR uarrdiastolicfilling

                      darrmyocardial tissue perfusion

                      Tissue Changes After MI

                      Time after Onset Type of Injury amp Gross Tissue Changes

                      0-05hrs Reversible injury

                      1-2hrs Onset of irreversible injury

                      4-12hrs Beginning of coagulation necrosis

                      18-24hrs Continued necrosis gross pallor of infected tissue

                      1-3days Total necrosis onset of acute inflammatory process

                      3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                      7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                      8th week Complete scar tissue replacement

                      Management of MI Initial Management OMEN

                      - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                      vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                      may be given to limit infarction size amp most effective if given within 4hrs of onset)

                      Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                      Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                      bull Surgery 1Revascularization

                      bullPTCAbullCoronary stent implantation

                      bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                      2Resection ndash aneurysm

                      ASSESSMENT

                      bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                      bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                      ANALYSIS NURSING DIAGNOSES

                      bull Decreased cardiac output related to myocardial damage

                      bull Impaired gas exchange related to poor perfusion shock

                      bull Pain related to myocardial ischemia

                      bull Activity intolerance related to pain or inadequate oxygenation

                      bull Fear related to possibility of death

                      NURSING CARE PLANbull Goal 1 reduce pain discomfort

                      bull Narcotics ndash morphine note response Avoid IM

                      bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                      bull Position semi-Fowlerrsquos to improve ventilation

                      NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                      rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                      thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                      cracklesbull Check labs troponin blood gases electrolytes

                      clotting timebull CVP (5-15 cm H2O) increases with heart failure

                      bull ROM of lower extremities antiembolic stockings

                      NURSING CARE PLAN

                      bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                      bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                      bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                      bull Anticipate needs of client call light water Reassurance

                      bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                      NURSING CARE PLAN

                      bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                      Mg)bull Monitor ECGbull Diet progressive low

                      calorie low sodium low cholesterol low fat without caffeine

                      NURSING CARE PLAN

                      bull Goal 5 facilitate fecal eliminationbull Medications stool

                      softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                      bull Bedside commode

                      NURSING CARE PLAN

                      bull Goal 6 provide emotional supportbull Recognize fear of dying

                      denial anger withdrawalbull Encourage expression of

                      feelings fears concernsbull Discuss rehabilitation lifestyle

                      changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                      NURSING CARE PLAN

                      bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                      activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                      bull Identify need for referral for sexual counselling

                      NURSING CARE PLAN

                      bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                      meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                      bull Information about sexual activity less fatiguing positions

                      bull Support groups Follow-up carebull Medications administration importance untoward

                      effects pulse takingbull Control risk factors rest diet exercise no smoking

                      weight control stress reduction

                      EVALUATION

                      bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                      CONGESTIVE HEART FAILURE

                      bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                      PATHOPHYSIOLOGY

                      Increased cardiac workload

                      decreased effective myocardial contractility

                      Decreased cardiac output

                      LV failure Pulmonary congestion

                      RA RV failure

                      Systemic congestion

                      Peripheral edema

                      ASSESSMENTbull Subjective data

                      bull Shortness of breathbull Orthopnea (sleeps on two

                      or more pillows)bull Paroxysmal nocturnal

                      dyspnea (sudden breathlessness during sleep)

                      bull Dyspnea on exertion (climbing stairs)

                      bull Apprehension anxiety irritability

                      bull Fatigue weaknessbull Reported weight gain

                      feeling of puffiness

                      ASSESSMENTbull Objective data

                      bull VSbull BP decreasing systolic

                      narrowing pulse pressurebull Pulse pulsus alternans

                      (alternating strong-weak-strong cardiac contraction) increased

                      bull Respirations crackles Cheyne-Stokes

                      bull Edema dependent pitting (1+ to 4+ mm)

                      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                      dilated pulmonary vessels lung edema

                      Left Ventricular Compared with Right Ventricular Heart Failure

                      LEFT VENTRICULAR

                      FAILURE

                      RIGHT VENTRICULAR

                      FAILURE

                      Pulmonary crackles Jugular venous distention

                      Tachypnea Peripheral edema

                      S3 gallop Perioral and peripheral cyanosis

                      Cardiac murmurs Congestive hepatomegaly

                      Paradoxical splitting of S2

                      Ascites

                      Hepatojugular reflux

                      ANALYSIS NURSING DIAGNOSES

                      bull Decreased cardiac output related to decreased myocardial contractility

                      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                      bull Fatigue related to edema and poor oxygenation

                      bull Fluid volume excess related to compensatory mechanisms

                      bull Impaired gas exchange related to pulmonary congestion

                      bull Anxiety related to shortness of breath

                      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                      NURSING CARE PLAN

                      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                      tachycardia dyspnea edema resolved change position frequently pillows for support

                      bull Rest planned periods limit visitors activity noise Chair and commode privileges

                      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                      bull Warm fluids if appropriate

                      NURSING CARE PLAN

                      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                      NURSING CARE PLANbull Goal 3 provide for special safety

                      needsbull Skin care

                      bull Inspect massage lubricate bony prominences

                      bull Use foot cradle heel protectors sheepskin

                      bull Side rails up if hypoxic (disoriented)

                      bull Vital signs monitor for signs of fatigue pulmonary emboli

                      bull ROM active passive elastic stockings

                      NURSING CARE PLAN

                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                      strict IObull Diet

                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                      NURSING CARE PLAN

                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                      EVALUATION

                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                      distressbull Reduction in dependent edema

                      DAY 3 OF

                      CARDIOVASCULARDISEASES

                      bull hyperlipidemia means high lipid levels

                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                      Treatment of Hyperlipidemia

                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                      bull SYSTOLIC DYSFUNCTION

                      HYPERTROPHIC CARDIOMYOPATHY

                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                      HYPERTROPHIC CARDIOMYOPATHY

                      bull Pathophysiologybull 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

                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                      CARDIOMYOPATHIES

                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                      CARDIOMYOPATHIES

                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                      CARDIOMYOPATHIES

                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                      relief

                      CARDIOMYOPATHIES

                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                      CARDIOMYOPATHIES

                      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

                      Infective endocarditis

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

                      bull Can be acute or chronic

                      Infective endocarditis

                      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

                      Infective endocarditis

                      bull Pathophysiologybull 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

                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                      Infective endocarditis

                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                      retina

                      Infective endocarditis

                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                      Infective endocarditis

                      bull Preventionbull Antibiotic prophylaxis if patient is

                      undergoing procedures like dental extractions bronchoscopy surgery etc

                      Infective endocarditis

                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                      organism

                      Infective endocarditis

                      bull Nursing managementbull 1 regular monitoring of temperature heart

                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                      Infective endocarditis

                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                      B

                      Infective endocarditis

                      bull Medical managementbull 2 Surgerybull Valvular replacement

                      CARDIOGENIC SHOCK

                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                      CARDIOGENIC SHOCK

                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                      CARDIOGENIC SHOCK

                      bull LABORATORY FINDINGSIncreased CVP

                      Normal is 4-10 cmH2O

                      CARDIOGENIC SHOCK

                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                      inotropics such as DOPAMINE and DOBUTAMINE

                      bull 3 Administer O2bull 4 Morphine is administered to

                      decreased pulmonary congestion and to relieve pain

                      CARDIOGENIC SHOCK

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

                      bull 6 Monitor urinary output BP and pulses

                      bull 7 cautiously administer diuretics and nitrates

                      CARDIAC TAMPONADE

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

                      CARDIAC TAMPONADE

                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                      CARDIAC TAMPONADE

                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                      CARDIAC TAMPONADE

                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                      distention hypotension and distantmuffled heart sound

                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                      CARDIAC TAMPONADE

                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                      anterior chest

                      CARDIAC TAMPONADE

                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                      CARDIAC TAMPONADE

                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                      tamponade

                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                      HYPERTENSION

                      bull 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

                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                      bull Most common typebull 2 Secondary

                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                      Alterations in Blood Flow in the Systemic Circulation

                      Buergerrsquos Disease

                      bull Also known as Thromboangiitis obliterans

                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                      reaction of the vessel wall

                      Manifestations

                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                      Increased sensitivity to cold (due to impaired circulation

                      Absentdiminished peripheral pulses

                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                      gangrenous changes may arise may necessitate amputation

                      Diagnosis amp Treatment

                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                      emotionsRaynaudrsquos phenomenon ndash associated with

                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                      bull Return to normal colorbull Note although all of the fingers are

                      affected symmetrically only 1-2digits may be involved

                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                      (rare occasions)

                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                      Immersion of hand in cold water to initiate attack aids in the Dx

                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                      protection from cold Avoidance of emotional stress (anxiety amp

                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                      A Assessment

                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                      2 vsB Nursing Dx

                      1 ineffective tissue perfusion (cardiopulmonary)

                      2 Impaired gas exchange

                      3 Anxiety due to fear of death (clients with MI or Angina)

                      C Goals

                      1 Relief of pain amp symptoms

                      2 Prevention of further cardiac damage

                      D Nursing Interventions

                      1 Pain control

                      2 Proper medications

                      3 Decrease clientrsquos anxiety

                      4 Health teachings (meds activities diet exercise etc)

                      • CARDIOVASCULAR DISEASES
                      • Slide 2
                      • GENERAL CARDIAC ASSESSMENT
                      • Pathophysiology
                      • Slide 5
                      • ASSESSING CHEST PAIN
                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                      • Angina Pectoris Myocardial Ischemia
                      • Pathophysiology
                      • Types
                      • Slide 12
                      • Slide 13
                      • Slide 14
                      • Conthellip
                      • Conthellip (2)
                      • Drug Therapy
                      • Classification
                      • Nursing Management
                      • Nursing Management (2)
                      • Acute Coronary Syndrome
                      • Slide 22
                      • Conthellip (3)
                      • Slide 24
                      • Conthellip(MI)
                      • Slide 26
                      • Pathophysiology (2)
                      • Tissue Changes After MI
                      • Management of MI
                      • Slide 30
                      • Slide 31
                      • ASSESSMENT
                      • ANALYSIS NURSING DIAGNOSES
                      • NURSING CARE PLAN
                      • NURSING CARE PLAN (2)
                      • NURSING CARE PLAN (3)
                      • NURSING CARE PLAN (4)
                      • NURSING CARE PLAN (5)
                      • NURSING CARE PLAN (6)
                      • NURSING CARE PLAN (7)
                      • NURSING CARE PLAN (8)
                      • EVALUATION
                      • CONGESTIVE HEART FAILURE
                      • PATHOPHYSIOLOGY
                      • ASSESSMENT (2)
                      • ASSESSMENT (3)
                      • Left Ventricular Compared with Right Ventricular Heart Failure
                      • ANALYSIS NURSING DIAGNOSES (2)
                      • Slide 49
                      • NURSING CARE PLAN (9)
                      • NURSING CARE PLAN (10)
                      • NURSING CARE PLAN (11)
                      • NURSING CARE PLAN (12)
                      • NURSING CARE PLAN (13)
                      • EVALUATION
                      • Slide 56
                      • Slide 57
                      • Slide 58
                      • Slide 59
                      • Slide 60
                      • Treatment of Hyperlipidemia
                      • Slide 62
                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                      • HYPERTROPHIC CARDIOMYOPATHY
                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                      • RESTRICTIVE CARDIOMYOPATHY
                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                      • CARDIOMYOPATHIES
                      • CARDIOMYOPATHIES (2)
                      • CARDIOMYOPATHIES (3)
                      • CARDIOMYOPATHIES (4)
                      • CARDIOMYOPATHIES (5)
                      • CARDIOMYOPATHIES (6)
                      • Infective endocarditis
                      • Infective endocarditis (2)
                      • Infective endocarditis (3)
                      • Infective endocarditis (4)
                      • Infective endocarditis (5)
                      • Infective endocarditis (6)
                      • Infective endocarditis (7)
                      • Infective endocarditis (8)
                      • Infective endocarditis (9)
                      • Infective endocarditis (10)
                      • Infective endocarditis (11)
                      • Infective endocarditis (12)
                      • CARDIOGENIC SHOCK
                      • CARDIOGENIC SHOCK (2)
                      • CARDIOGENIC SHOCK (3)
                      • CARDIOGENIC SHOCK (4)
                      • CARDIOGENIC SHOCK (5)
                      • CARDIAC TAMPONADE
                      • CARDIAC TAMPONADE (2)
                      • CARDIAC TAMPONADE (3)
                      • CARDIAC TAMPONADE (4)
                      • CARDIAC TAMPONADE (5)
                      • CARDIAC TAMPONADE (6)
                      • CARDIAC TAMPONADE (7)
                      • Slide 100
                      • HYPERTENSION
                      • HYPERTENSION (2)
                      • Slide 103
                      • Slide 104
                      • Slide 105
                      • Alterations in Blood Flow in the Systemic Circulation
                      • Buergerrsquos Disease
                      • Slide 108
                      • Manifestations
                      • Slide 110
                      • Diagnosis amp Treatment
                      • Rynaudrsquos Disease
                      • Manifestations (2)
                      • Slide 114
                      • Diagnosis amp Treatment (2)
                      • Slide 116
                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                      • Slide 118
                      • Slide 119
                      • Slide 120
                      • Slide 121

                        B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp

                        Associates in 1659 Cause spasm of coronary

                        arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may

                        be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)

                        Pain Characteristics occurs during rest or with minimal exercise

                        - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                        If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                        Conthellip

                        C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                        D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                        E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                        ConthellipDx detailed pain history ECG TST

                        angiogram may be used to confirm amp describe type of angina

                        Tx directed towards MI prevention- Lifestyle modification (individualized

                        regular exercise program smoking cessation)

                        - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                        coronary angioplasty) may be indicated if with severe artery occlusion

                        Drug Therapy Nitroglycerin (NTGs) ndash

                        vasodilators patch (Deponit

                        Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                        Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                        Calcium channel blockers Nifedipine (Calcibloc

                        Adalat) Diltiazem (Cardizem)

                        Lipid lowering agents ndashstatins Simvastatin

                        Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                        Classification

                        Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                        Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                        Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                        Class IV ndash angina occurs even at rest

                        Nursing Management

                        Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                        Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                        limitations NTGs ndash max of 3doses at 5-min intervals

                        Stinging sensation under the tongue for SL is normal

                        Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                        bottles amp change stocks every 6months Inform clients that headache dizziness

                        flushed face are common side effects

                        Do not discontinue the drug For patches rotate skin sites usually on

                        chest wall Instrct on evaluation of effectiveness based

                        on pain reliefPropanolols causes bronchospasm amp

                        hypoglycemia do not administer to asthmatic amp diabetic clients

                        Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                        Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                        Nursing Management

                        Acute Coronary Syndrome

                        Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                        Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                        Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                        gt20mins)2 New onset exertional angina (increased in

                        severity of at least 1 class ndash to at least class III) in lt2months

                        3 Recent acceleration of angina to at least class III in lt2months

                        Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                        When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                        Conthellip

                        ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                        myocardial tissue associated with atherosclerotic disease of coronary arteries

                        Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                        Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                        elevation Q wave prolongation T wave inversion

                        Conthellip(MI)

                        Manifestations chest pain ndash severe crushing

                        constricting ldquosomeone sitting on my chestrdquo

                        - substernal radiating to left arm neck or jaw

                        - prolonged (gt35mins) amp not relieved by rest

                        Shortness of breath profuse perspirationFeeling of impending doom

                        Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                        profound LV failure from massive MI resulting to low cardiac output

                        Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                        Rupture of myocardiumVentricular aneurysms ndash decreases

                        pumping efficiency of heart amp increases work of LV

                        Pathophysiology

                        Causes atherosclerotic heart disease thrombosisembolism

                        shock ampor hemorrhage direct traumaMyocardial ischemia

                        uarrcellular hypoxia

                        darrmyocardial O2 supplydarr myocardial contractility

                        darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                        uarrperipheral vasoconstriction

                        uarr myocardial contractility

                        uarr afterload uarrmyocardial O2 demand

                        uarr HR uarrdiastolicfilling

                        darrmyocardial tissue perfusion

                        Tissue Changes After MI

                        Time after Onset Type of Injury amp Gross Tissue Changes

                        0-05hrs Reversible injury

                        1-2hrs Onset of irreversible injury

                        4-12hrs Beginning of coagulation necrosis

                        18-24hrs Continued necrosis gross pallor of infected tissue

                        1-3days Total necrosis onset of acute inflammatory process

                        3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                        7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                        8th week Complete scar tissue replacement

                        Management of MI Initial Management OMEN

                        - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                        vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                        may be given to limit infarction size amp most effective if given within 4hrs of onset)

                        Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                        Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                        bull Surgery 1Revascularization

                        bullPTCAbullCoronary stent implantation

                        bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                        2Resection ndash aneurysm

                        ASSESSMENT

                        bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                        bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                        ANALYSIS NURSING DIAGNOSES

                        bull Decreased cardiac output related to myocardial damage

                        bull Impaired gas exchange related to poor perfusion shock

                        bull Pain related to myocardial ischemia

                        bull Activity intolerance related to pain or inadequate oxygenation

                        bull Fear related to possibility of death

                        NURSING CARE PLANbull Goal 1 reduce pain discomfort

                        bull Narcotics ndash morphine note response Avoid IM

                        bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                        bull Position semi-Fowlerrsquos to improve ventilation

                        NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                        rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                        thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                        cracklesbull Check labs troponin blood gases electrolytes

                        clotting timebull CVP (5-15 cm H2O) increases with heart failure

                        bull ROM of lower extremities antiembolic stockings

                        NURSING CARE PLAN

                        bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                        bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                        bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                        bull Anticipate needs of client call light water Reassurance

                        bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                        NURSING CARE PLAN

                        bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                        Mg)bull Monitor ECGbull Diet progressive low

                        calorie low sodium low cholesterol low fat without caffeine

                        NURSING CARE PLAN

                        bull Goal 5 facilitate fecal eliminationbull Medications stool

                        softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                        bull Bedside commode

                        NURSING CARE PLAN

                        bull Goal 6 provide emotional supportbull Recognize fear of dying

                        denial anger withdrawalbull Encourage expression of

                        feelings fears concernsbull Discuss rehabilitation lifestyle

                        changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                        NURSING CARE PLAN

                        bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                        activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                        bull Identify need for referral for sexual counselling

                        NURSING CARE PLAN

                        bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                        meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                        bull Information about sexual activity less fatiguing positions

                        bull Support groups Follow-up carebull Medications administration importance untoward

                        effects pulse takingbull Control risk factors rest diet exercise no smoking

                        weight control stress reduction

                        EVALUATION

                        bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                        CONGESTIVE HEART FAILURE

                        bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                        PATHOPHYSIOLOGY

                        Increased cardiac workload

                        decreased effective myocardial contractility

                        Decreased cardiac output

                        LV failure Pulmonary congestion

                        RA RV failure

                        Systemic congestion

                        Peripheral edema

                        ASSESSMENTbull Subjective data

                        bull Shortness of breathbull Orthopnea (sleeps on two

                        or more pillows)bull Paroxysmal nocturnal

                        dyspnea (sudden breathlessness during sleep)

                        bull Dyspnea on exertion (climbing stairs)

                        bull Apprehension anxiety irritability

                        bull Fatigue weaknessbull Reported weight gain

                        feeling of puffiness

                        ASSESSMENTbull Objective data

                        bull VSbull BP decreasing systolic

                        narrowing pulse pressurebull Pulse pulsus alternans

                        (alternating strong-weak-strong cardiac contraction) increased

                        bull Respirations crackles Cheyne-Stokes

                        bull Edema dependent pitting (1+ to 4+ mm)

                        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                        dilated pulmonary vessels lung edema

                        Left Ventricular Compared with Right Ventricular Heart Failure

                        LEFT VENTRICULAR

                        FAILURE

                        RIGHT VENTRICULAR

                        FAILURE

                        Pulmonary crackles Jugular venous distention

                        Tachypnea Peripheral edema

                        S3 gallop Perioral and peripheral cyanosis

                        Cardiac murmurs Congestive hepatomegaly

                        Paradoxical splitting of S2

                        Ascites

                        Hepatojugular reflux

                        ANALYSIS NURSING DIAGNOSES

                        bull Decreased cardiac output related to decreased myocardial contractility

                        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                        bull Fatigue related to edema and poor oxygenation

                        bull Fluid volume excess related to compensatory mechanisms

                        bull Impaired gas exchange related to pulmonary congestion

                        bull Anxiety related to shortness of breath

                        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                        NURSING CARE PLAN

                        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                        tachycardia dyspnea edema resolved change position frequently pillows for support

                        bull Rest planned periods limit visitors activity noise Chair and commode privileges

                        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                        bull Warm fluids if appropriate

                        NURSING CARE PLAN

                        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                        NURSING CARE PLANbull Goal 3 provide for special safety

                        needsbull Skin care

                        bull Inspect massage lubricate bony prominences

                        bull Use foot cradle heel protectors sheepskin

                        bull Side rails up if hypoxic (disoriented)

                        bull Vital signs monitor for signs of fatigue pulmonary emboli

                        bull ROM active passive elastic stockings

                        NURSING CARE PLAN

                        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                        strict IObull Diet

                        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                        NURSING CARE PLAN

                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                        EVALUATION

                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                        distressbull Reduction in dependent edema

                        DAY 3 OF

                        CARDIOVASCULARDISEASES

                        bull hyperlipidemia means high lipid levels

                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                        Treatment of Hyperlipidemia

                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                        bull SYSTOLIC DYSFUNCTION

                        HYPERTROPHIC CARDIOMYOPATHY

                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                        HYPERTROPHIC CARDIOMYOPATHY

                        bull Pathophysiologybull 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

                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                        CARDIOMYOPATHIES

                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                        CARDIOMYOPATHIES

                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                        CARDIOMYOPATHIES

                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                        relief

                        CARDIOMYOPATHIES

                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                        CARDIOMYOPATHIES

                        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

                        Infective endocarditis

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

                        bull Can be acute or chronic

                        Infective endocarditis

                        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

                        Infective endocarditis

                        bull Pathophysiologybull 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

                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                        Infective endocarditis

                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                        retina

                        Infective endocarditis

                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                        Infective endocarditis

                        bull Preventionbull Antibiotic prophylaxis if patient is

                        undergoing procedures like dental extractions bronchoscopy surgery etc

                        Infective endocarditis

                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                        organism

                        Infective endocarditis

                        bull Nursing managementbull 1 regular monitoring of temperature heart

                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                        Infective endocarditis

                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                        B

                        Infective endocarditis

                        bull Medical managementbull 2 Surgerybull Valvular replacement

                        CARDIOGENIC SHOCK

                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                        CARDIOGENIC SHOCK

                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                        CARDIOGENIC SHOCK

                        bull LABORATORY FINDINGSIncreased CVP

                        Normal is 4-10 cmH2O

                        CARDIOGENIC SHOCK

                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                        inotropics such as DOPAMINE and DOBUTAMINE

                        bull 3 Administer O2bull 4 Morphine is administered to

                        decreased pulmonary congestion and to relieve pain

                        CARDIOGENIC SHOCK

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

                        bull 6 Monitor urinary output BP and pulses

                        bull 7 cautiously administer diuretics and nitrates

                        CARDIAC TAMPONADE

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

                        CARDIAC TAMPONADE

                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                        CARDIAC TAMPONADE

                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                        CARDIAC TAMPONADE

                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                        distention hypotension and distantmuffled heart sound

                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                        CARDIAC TAMPONADE

                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                        anterior chest

                        CARDIAC TAMPONADE

                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                        CARDIAC TAMPONADE

                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                        tamponade

                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                        HYPERTENSION

                        bull 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

                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                        bull Most common typebull 2 Secondary

                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                        Alterations in Blood Flow in the Systemic Circulation

                        Buergerrsquos Disease

                        bull Also known as Thromboangiitis obliterans

                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                        reaction of the vessel wall

                        Manifestations

                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                        Increased sensitivity to cold (due to impaired circulation

                        Absentdiminished peripheral pulses

                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                        gangrenous changes may arise may necessitate amputation

                        Diagnosis amp Treatment

                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                        emotionsRaynaudrsquos phenomenon ndash associated with

                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                        bull Return to normal colorbull Note although all of the fingers are

                        affected symmetrically only 1-2digits may be involved

                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                        (rare occasions)

                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                        Immersion of hand in cold water to initiate attack aids in the Dx

                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                        protection from cold Avoidance of emotional stress (anxiety amp

                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                        A Assessment

                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                        2 vsB Nursing Dx

                        1 ineffective tissue perfusion (cardiopulmonary)

                        2 Impaired gas exchange

                        3 Anxiety due to fear of death (clients with MI or Angina)

                        C Goals

                        1 Relief of pain amp symptoms

                        2 Prevention of further cardiac damage

                        D Nursing Interventions

                        1 Pain control

                        2 Proper medications

                        3 Decrease clientrsquos anxiety

                        4 Health teachings (meds activities diet exercise etc)

                        • CARDIOVASCULAR DISEASES
                        • Slide 2
                        • GENERAL CARDIAC ASSESSMENT
                        • Pathophysiology
                        • Slide 5
                        • ASSESSING CHEST PAIN
                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                        • Angina Pectoris Myocardial Ischemia
                        • Pathophysiology
                        • Types
                        • Slide 12
                        • Slide 13
                        • Slide 14
                        • Conthellip
                        • Conthellip (2)
                        • Drug Therapy
                        • Classification
                        • Nursing Management
                        • Nursing Management (2)
                        • Acute Coronary Syndrome
                        • Slide 22
                        • Conthellip (3)
                        • Slide 24
                        • Conthellip(MI)
                        • Slide 26
                        • Pathophysiology (2)
                        • Tissue Changes After MI
                        • Management of MI
                        • Slide 30
                        • Slide 31
                        • ASSESSMENT
                        • ANALYSIS NURSING DIAGNOSES
                        • NURSING CARE PLAN
                        • NURSING CARE PLAN (2)
                        • NURSING CARE PLAN (3)
                        • NURSING CARE PLAN (4)
                        • NURSING CARE PLAN (5)
                        • NURSING CARE PLAN (6)
                        • NURSING CARE PLAN (7)
                        • NURSING CARE PLAN (8)
                        • EVALUATION
                        • CONGESTIVE HEART FAILURE
                        • PATHOPHYSIOLOGY
                        • ASSESSMENT (2)
                        • ASSESSMENT (3)
                        • Left Ventricular Compared with Right Ventricular Heart Failure
                        • ANALYSIS NURSING DIAGNOSES (2)
                        • Slide 49
                        • NURSING CARE PLAN (9)
                        • NURSING CARE PLAN (10)
                        • NURSING CARE PLAN (11)
                        • NURSING CARE PLAN (12)
                        • NURSING CARE PLAN (13)
                        • EVALUATION
                        • Slide 56
                        • Slide 57
                        • Slide 58
                        • Slide 59
                        • Slide 60
                        • Treatment of Hyperlipidemia
                        • Slide 62
                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                        • HYPERTROPHIC CARDIOMYOPATHY
                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                        • RESTRICTIVE CARDIOMYOPATHY
                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                        • CARDIOMYOPATHIES
                        • CARDIOMYOPATHIES (2)
                        • CARDIOMYOPATHIES (3)
                        • CARDIOMYOPATHIES (4)
                        • CARDIOMYOPATHIES (5)
                        • CARDIOMYOPATHIES (6)
                        • Infective endocarditis
                        • Infective endocarditis (2)
                        • Infective endocarditis (3)
                        • Infective endocarditis (4)
                        • Infective endocarditis (5)
                        • Infective endocarditis (6)
                        • Infective endocarditis (7)
                        • Infective endocarditis (8)
                        • Infective endocarditis (9)
                        • Infective endocarditis (10)
                        • Infective endocarditis (11)
                        • Infective endocarditis (12)
                        • CARDIOGENIC SHOCK
                        • CARDIOGENIC SHOCK (2)
                        • CARDIOGENIC SHOCK (3)
                        • CARDIOGENIC SHOCK (4)
                        • CARDIOGENIC SHOCK (5)
                        • CARDIAC TAMPONADE
                        • CARDIAC TAMPONADE (2)
                        • CARDIAC TAMPONADE (3)
                        • CARDIAC TAMPONADE (4)
                        • CARDIAC TAMPONADE (5)
                        • CARDIAC TAMPONADE (6)
                        • CARDIAC TAMPONADE (7)
                        • Slide 100
                        • HYPERTENSION
                        • HYPERTENSION (2)
                        • Slide 103
                        • Slide 104
                        • Slide 105
                        • Alterations in Blood Flow in the Systemic Circulation
                        • Buergerrsquos Disease
                        • Slide 108
                        • Manifestations
                        • Slide 110
                        • Diagnosis amp Treatment
                        • Rynaudrsquos Disease
                        • Manifestations (2)
                        • Slide 114
                        • Diagnosis amp Treatment (2)
                        • Slide 116
                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                        • Slide 118
                        • Slide 119
                        • Slide 120
                        • Slide 121

                          Pain Characteristics occurs during rest or with minimal exercise

                          - commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)

                          If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm

                          Conthellip

                          C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                          D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                          E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                          ConthellipDx detailed pain history ECG TST

                          angiogram may be used to confirm amp describe type of angina

                          Tx directed towards MI prevention- Lifestyle modification (individualized

                          regular exercise program smoking cessation)

                          - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                          coronary angioplasty) may be indicated if with severe artery occlusion

                          Drug Therapy Nitroglycerin (NTGs) ndash

                          vasodilators patch (Deponit

                          Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                          Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                          Calcium channel blockers Nifedipine (Calcibloc

                          Adalat) Diltiazem (Cardizem)

                          Lipid lowering agents ndashstatins Simvastatin

                          Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                          Classification

                          Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                          Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                          Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                          Class IV ndash angina occurs even at rest

                          Nursing Management

                          Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                          Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                          limitations NTGs ndash max of 3doses at 5-min intervals

                          Stinging sensation under the tongue for SL is normal

                          Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                          bottles amp change stocks every 6months Inform clients that headache dizziness

                          flushed face are common side effects

                          Do not discontinue the drug For patches rotate skin sites usually on

                          chest wall Instrct on evaluation of effectiveness based

                          on pain reliefPropanolols causes bronchospasm amp

                          hypoglycemia do not administer to asthmatic amp diabetic clients

                          Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                          Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                          Nursing Management

                          Acute Coronary Syndrome

                          Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                          Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                          Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                          gt20mins)2 New onset exertional angina (increased in

                          severity of at least 1 class ndash to at least class III) in lt2months

                          3 Recent acceleration of angina to at least class III in lt2months

                          Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                          When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                          Conthellip

                          ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                          myocardial tissue associated with atherosclerotic disease of coronary arteries

                          Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                          Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                          elevation Q wave prolongation T wave inversion

                          Conthellip(MI)

                          Manifestations chest pain ndash severe crushing

                          constricting ldquosomeone sitting on my chestrdquo

                          - substernal radiating to left arm neck or jaw

                          - prolonged (gt35mins) amp not relieved by rest

                          Shortness of breath profuse perspirationFeeling of impending doom

                          Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                          profound LV failure from massive MI resulting to low cardiac output

                          Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                          Rupture of myocardiumVentricular aneurysms ndash decreases

                          pumping efficiency of heart amp increases work of LV

                          Pathophysiology

                          Causes atherosclerotic heart disease thrombosisembolism

                          shock ampor hemorrhage direct traumaMyocardial ischemia

                          uarrcellular hypoxia

                          darrmyocardial O2 supplydarr myocardial contractility

                          darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                          uarrperipheral vasoconstriction

                          uarr myocardial contractility

                          uarr afterload uarrmyocardial O2 demand

                          uarr HR uarrdiastolicfilling

                          darrmyocardial tissue perfusion

                          Tissue Changes After MI

                          Time after Onset Type of Injury amp Gross Tissue Changes

                          0-05hrs Reversible injury

                          1-2hrs Onset of irreversible injury

                          4-12hrs Beginning of coagulation necrosis

                          18-24hrs Continued necrosis gross pallor of infected tissue

                          1-3days Total necrosis onset of acute inflammatory process

                          3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                          7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                          8th week Complete scar tissue replacement

                          Management of MI Initial Management OMEN

                          - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                          vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                          may be given to limit infarction size amp most effective if given within 4hrs of onset)

                          Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                          Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                          bull Surgery 1Revascularization

                          bullPTCAbullCoronary stent implantation

                          bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                          2Resection ndash aneurysm

                          ASSESSMENT

                          bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                          bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                          ANALYSIS NURSING DIAGNOSES

                          bull Decreased cardiac output related to myocardial damage

                          bull Impaired gas exchange related to poor perfusion shock

                          bull Pain related to myocardial ischemia

                          bull Activity intolerance related to pain or inadequate oxygenation

                          bull Fear related to possibility of death

                          NURSING CARE PLANbull Goal 1 reduce pain discomfort

                          bull Narcotics ndash morphine note response Avoid IM

                          bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                          bull Position semi-Fowlerrsquos to improve ventilation

                          NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                          rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                          thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                          cracklesbull Check labs troponin blood gases electrolytes

                          clotting timebull CVP (5-15 cm H2O) increases with heart failure

                          bull ROM of lower extremities antiembolic stockings

                          NURSING CARE PLAN

                          bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                          bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                          bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                          bull Anticipate needs of client call light water Reassurance

                          bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                          NURSING CARE PLAN

                          bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                          Mg)bull Monitor ECGbull Diet progressive low

                          calorie low sodium low cholesterol low fat without caffeine

                          NURSING CARE PLAN

                          bull Goal 5 facilitate fecal eliminationbull Medications stool

                          softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                          bull Bedside commode

                          NURSING CARE PLAN

                          bull Goal 6 provide emotional supportbull Recognize fear of dying

                          denial anger withdrawalbull Encourage expression of

                          feelings fears concernsbull Discuss rehabilitation lifestyle

                          changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                          NURSING CARE PLAN

                          bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                          activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                          bull Identify need for referral for sexual counselling

                          NURSING CARE PLAN

                          bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                          meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                          bull Information about sexual activity less fatiguing positions

                          bull Support groups Follow-up carebull Medications administration importance untoward

                          effects pulse takingbull Control risk factors rest diet exercise no smoking

                          weight control stress reduction

                          EVALUATION

                          bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                          CONGESTIVE HEART FAILURE

                          bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                          PATHOPHYSIOLOGY

                          Increased cardiac workload

                          decreased effective myocardial contractility

                          Decreased cardiac output

                          LV failure Pulmonary congestion

                          RA RV failure

                          Systemic congestion

                          Peripheral edema

                          ASSESSMENTbull Subjective data

                          bull Shortness of breathbull Orthopnea (sleeps on two

                          or more pillows)bull Paroxysmal nocturnal

                          dyspnea (sudden breathlessness during sleep)

                          bull Dyspnea on exertion (climbing stairs)

                          bull Apprehension anxiety irritability

                          bull Fatigue weaknessbull Reported weight gain

                          feeling of puffiness

                          ASSESSMENTbull Objective data

                          bull VSbull BP decreasing systolic

                          narrowing pulse pressurebull Pulse pulsus alternans

                          (alternating strong-weak-strong cardiac contraction) increased

                          bull Respirations crackles Cheyne-Stokes

                          bull Edema dependent pitting (1+ to 4+ mm)

                          bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                          dilated pulmonary vessels lung edema

                          Left Ventricular Compared with Right Ventricular Heart Failure

                          LEFT VENTRICULAR

                          FAILURE

                          RIGHT VENTRICULAR

                          FAILURE

                          Pulmonary crackles Jugular venous distention

                          Tachypnea Peripheral edema

                          S3 gallop Perioral and peripheral cyanosis

                          Cardiac murmurs Congestive hepatomegaly

                          Paradoxical splitting of S2

                          Ascites

                          Hepatojugular reflux

                          ANALYSIS NURSING DIAGNOSES

                          bull Decreased cardiac output related to decreased myocardial contractility

                          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                          bull Fatigue related to edema and poor oxygenation

                          bull Fluid volume excess related to compensatory mechanisms

                          bull Impaired gas exchange related to pulmonary congestion

                          bull Anxiety related to shortness of breath

                          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                          NURSING CARE PLAN

                          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                          tachycardia dyspnea edema resolved change position frequently pillows for support

                          bull Rest planned periods limit visitors activity noise Chair and commode privileges

                          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                          bull Warm fluids if appropriate

                          NURSING CARE PLAN

                          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                          NURSING CARE PLANbull Goal 3 provide for special safety

                          needsbull Skin care

                          bull Inspect massage lubricate bony prominences

                          bull Use foot cradle heel protectors sheepskin

                          bull Side rails up if hypoxic (disoriented)

                          bull Vital signs monitor for signs of fatigue pulmonary emboli

                          bull ROM active passive elastic stockings

                          NURSING CARE PLAN

                          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                          strict IObull Diet

                          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                          NURSING CARE PLAN

                          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                          bull Refer to available community resources for dietary assistance weight reduction exercise program

                          EVALUATION

                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                          distressbull Reduction in dependent edema

                          DAY 3 OF

                          CARDIOVASCULARDISEASES

                          bull hyperlipidemia means high lipid levels

                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                          Treatment of Hyperlipidemia

                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                          bull SYSTOLIC DYSFUNCTION

                          HYPERTROPHIC CARDIOMYOPATHY

                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                          HYPERTROPHIC CARDIOMYOPATHY

                          bull Pathophysiologybull 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

                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                          CARDIOMYOPATHIES

                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                          CARDIOMYOPATHIES

                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                          CARDIOMYOPATHIES

                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                          relief

                          CARDIOMYOPATHIES

                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                          CARDIOMYOPATHIES

                          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

                          Infective endocarditis

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

                          bull Can be acute or chronic

                          Infective endocarditis

                          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

                          Infective endocarditis

                          bull Pathophysiologybull 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

                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                          Infective endocarditis

                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                          retina

                          Infective endocarditis

                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                          Infective endocarditis

                          bull Preventionbull Antibiotic prophylaxis if patient is

                          undergoing procedures like dental extractions bronchoscopy surgery etc

                          Infective endocarditis

                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                          organism

                          Infective endocarditis

                          bull Nursing managementbull 1 regular monitoring of temperature heart

                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                          Infective endocarditis

                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                          B

                          Infective endocarditis

                          bull Medical managementbull 2 Surgerybull Valvular replacement

                          CARDIOGENIC SHOCK

                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                          CARDIOGENIC SHOCK

                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                          CARDIOGENIC SHOCK

                          bull LABORATORY FINDINGSIncreased CVP

                          Normal is 4-10 cmH2O

                          CARDIOGENIC SHOCK

                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                          inotropics such as DOPAMINE and DOBUTAMINE

                          bull 3 Administer O2bull 4 Morphine is administered to

                          decreased pulmonary congestion and to relieve pain

                          CARDIOGENIC SHOCK

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

                          bull 6 Monitor urinary output BP and pulses

                          bull 7 cautiously administer diuretics and nitrates

                          CARDIAC TAMPONADE

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

                          CARDIAC TAMPONADE

                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                          CARDIAC TAMPONADE

                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                          CARDIAC TAMPONADE

                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                          distention hypotension and distantmuffled heart sound

                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                          CARDIAC TAMPONADE

                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                          anterior chest

                          CARDIAC TAMPONADE

                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                          CARDIAC TAMPONADE

                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                          tamponade

                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                          HYPERTENSION

                          bull 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

                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                          bull Most common typebull 2 Secondary

                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                          Alterations in Blood Flow in the Systemic Circulation

                          Buergerrsquos Disease

                          bull Also known as Thromboangiitis obliterans

                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                          reaction of the vessel wall

                          Manifestations

                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                          Increased sensitivity to cold (due to impaired circulation

                          Absentdiminished peripheral pulses

                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                          gangrenous changes may arise may necessitate amputation

                          Diagnosis amp Treatment

                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                          emotionsRaynaudrsquos phenomenon ndash associated with

                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                          bull Return to normal colorbull Note although all of the fingers are

                          affected symmetrically only 1-2digits may be involved

                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                          (rare occasions)

                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                          Immersion of hand in cold water to initiate attack aids in the Dx

                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                          protection from cold Avoidance of emotional stress (anxiety amp

                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                          A Assessment

                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                          2 vsB Nursing Dx

                          1 ineffective tissue perfusion (cardiopulmonary)

                          2 Impaired gas exchange

                          3 Anxiety due to fear of death (clients with MI or Angina)

                          C Goals

                          1 Relief of pain amp symptoms

                          2 Prevention of further cardiac damage

                          D Nursing Interventions

                          1 Pain control

                          2 Proper medications

                          3 Decrease clientrsquos anxiety

                          4 Health teachings (meds activities diet exercise etc)

                          • CARDIOVASCULAR DISEASES
                          • Slide 2
                          • GENERAL CARDIAC ASSESSMENT
                          • Pathophysiology
                          • Slide 5
                          • ASSESSING CHEST PAIN
                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                          • Angina Pectoris Myocardial Ischemia
                          • Pathophysiology
                          • Types
                          • Slide 12
                          • Slide 13
                          • Slide 14
                          • Conthellip
                          • Conthellip (2)
                          • Drug Therapy
                          • Classification
                          • Nursing Management
                          • Nursing Management (2)
                          • Acute Coronary Syndrome
                          • Slide 22
                          • Conthellip (3)
                          • Slide 24
                          • Conthellip(MI)
                          • Slide 26
                          • Pathophysiology (2)
                          • Tissue Changes After MI
                          • Management of MI
                          • Slide 30
                          • Slide 31
                          • ASSESSMENT
                          • ANALYSIS NURSING DIAGNOSES
                          • NURSING CARE PLAN
                          • NURSING CARE PLAN (2)
                          • NURSING CARE PLAN (3)
                          • NURSING CARE PLAN (4)
                          • NURSING CARE PLAN (5)
                          • NURSING CARE PLAN (6)
                          • NURSING CARE PLAN (7)
                          • NURSING CARE PLAN (8)
                          • EVALUATION
                          • CONGESTIVE HEART FAILURE
                          • PATHOPHYSIOLOGY
                          • ASSESSMENT (2)
                          • ASSESSMENT (3)
                          • Left Ventricular Compared with Right Ventricular Heart Failure
                          • ANALYSIS NURSING DIAGNOSES (2)
                          • Slide 49
                          • NURSING CARE PLAN (9)
                          • NURSING CARE PLAN (10)
                          • NURSING CARE PLAN (11)
                          • NURSING CARE PLAN (12)
                          • NURSING CARE PLAN (13)
                          • EVALUATION
                          • Slide 56
                          • Slide 57
                          • Slide 58
                          • Slide 59
                          • Slide 60
                          • Treatment of Hyperlipidemia
                          • Slide 62
                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                          • HYPERTROPHIC CARDIOMYOPATHY
                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                          • RESTRICTIVE CARDIOMYOPATHY
                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                          • CARDIOMYOPATHIES
                          • CARDIOMYOPATHIES (2)
                          • CARDIOMYOPATHIES (3)
                          • CARDIOMYOPATHIES (4)
                          • CARDIOMYOPATHIES (5)
                          • CARDIOMYOPATHIES (6)
                          • Infective endocarditis
                          • Infective endocarditis (2)
                          • Infective endocarditis (3)
                          • Infective endocarditis (4)
                          • Infective endocarditis (5)
                          • Infective endocarditis (6)
                          • Infective endocarditis (7)
                          • Infective endocarditis (8)
                          • Infective endocarditis (9)
                          • Infective endocarditis (10)
                          • Infective endocarditis (11)
                          • Infective endocarditis (12)
                          • CARDIOGENIC SHOCK
                          • CARDIOGENIC SHOCK (2)
                          • CARDIOGENIC SHOCK (3)
                          • CARDIOGENIC SHOCK (4)
                          • CARDIOGENIC SHOCK (5)
                          • CARDIAC TAMPONADE
                          • CARDIAC TAMPONADE (2)
                          • CARDIAC TAMPONADE (3)
                          • CARDIAC TAMPONADE (4)
                          • CARDIAC TAMPONADE (5)
                          • CARDIAC TAMPONADE (6)
                          • CARDIAC TAMPONADE (7)
                          • Slide 100
                          • HYPERTENSION
                          • HYPERTENSION (2)
                          • Slide 103
                          • Slide 104
                          • Slide 105
                          • Alterations in Blood Flow in the Systemic Circulation
                          • Buergerrsquos Disease
                          • Slide 108
                          • Manifestations
                          • Slide 110
                          • Diagnosis amp Treatment
                          • Rynaudrsquos Disease
                          • Manifestations (2)
                          • Slide 114
                          • Diagnosis amp Treatment (2)
                          • Slide 116
                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                          • Slide 118
                          • Slide 119
                          • Slide 120
                          • Slide 121

                            Conthellip

                            C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)

                            D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up

                            E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina

                            ConthellipDx detailed pain history ECG TST

                            angiogram may be used to confirm amp describe type of angina

                            Tx directed towards MI prevention- Lifestyle modification (individualized

                            regular exercise program smoking cessation)

                            - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                            coronary angioplasty) may be indicated if with severe artery occlusion

                            Drug Therapy Nitroglycerin (NTGs) ndash

                            vasodilators patch (Deponit

                            Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                            Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                            Calcium channel blockers Nifedipine (Calcibloc

                            Adalat) Diltiazem (Cardizem)

                            Lipid lowering agents ndashstatins Simvastatin

                            Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                            Classification

                            Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                            Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                            Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                            Class IV ndash angina occurs even at rest

                            Nursing Management

                            Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                            Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                            limitations NTGs ndash max of 3doses at 5-min intervals

                            Stinging sensation under the tongue for SL is normal

                            Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                            bottles amp change stocks every 6months Inform clients that headache dizziness

                            flushed face are common side effects

                            Do not discontinue the drug For patches rotate skin sites usually on

                            chest wall Instrct on evaluation of effectiveness based

                            on pain reliefPropanolols causes bronchospasm amp

                            hypoglycemia do not administer to asthmatic amp diabetic clients

                            Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                            Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                            Nursing Management

                            Acute Coronary Syndrome

                            Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                            Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                            Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                            gt20mins)2 New onset exertional angina (increased in

                            severity of at least 1 class ndash to at least class III) in lt2months

                            3 Recent acceleration of angina to at least class III in lt2months

                            Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                            When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                            Conthellip

                            ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                            myocardial tissue associated with atherosclerotic disease of coronary arteries

                            Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                            Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                            elevation Q wave prolongation T wave inversion

                            Conthellip(MI)

                            Manifestations chest pain ndash severe crushing

                            constricting ldquosomeone sitting on my chestrdquo

                            - substernal radiating to left arm neck or jaw

                            - prolonged (gt35mins) amp not relieved by rest

                            Shortness of breath profuse perspirationFeeling of impending doom

                            Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                            profound LV failure from massive MI resulting to low cardiac output

                            Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                            Rupture of myocardiumVentricular aneurysms ndash decreases

                            pumping efficiency of heart amp increases work of LV

                            Pathophysiology

                            Causes atherosclerotic heart disease thrombosisembolism

                            shock ampor hemorrhage direct traumaMyocardial ischemia

                            uarrcellular hypoxia

                            darrmyocardial O2 supplydarr myocardial contractility

                            darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                            uarrperipheral vasoconstriction

                            uarr myocardial contractility

                            uarr afterload uarrmyocardial O2 demand

                            uarr HR uarrdiastolicfilling

                            darrmyocardial tissue perfusion

                            Tissue Changes After MI

                            Time after Onset Type of Injury amp Gross Tissue Changes

                            0-05hrs Reversible injury

                            1-2hrs Onset of irreversible injury

                            4-12hrs Beginning of coagulation necrosis

                            18-24hrs Continued necrosis gross pallor of infected tissue

                            1-3days Total necrosis onset of acute inflammatory process

                            3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                            7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                            8th week Complete scar tissue replacement

                            Management of MI Initial Management OMEN

                            - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                            vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                            may be given to limit infarction size amp most effective if given within 4hrs of onset)

                            Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                            Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                            bull Surgery 1Revascularization

                            bullPTCAbullCoronary stent implantation

                            bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                            2Resection ndash aneurysm

                            ASSESSMENT

                            bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                            bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                            ANALYSIS NURSING DIAGNOSES

                            bull Decreased cardiac output related to myocardial damage

                            bull Impaired gas exchange related to poor perfusion shock

                            bull Pain related to myocardial ischemia

                            bull Activity intolerance related to pain or inadequate oxygenation

                            bull Fear related to possibility of death

                            NURSING CARE PLANbull Goal 1 reduce pain discomfort

                            bull Narcotics ndash morphine note response Avoid IM

                            bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                            bull Position semi-Fowlerrsquos to improve ventilation

                            NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                            rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                            thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                            cracklesbull Check labs troponin blood gases electrolytes

                            clotting timebull CVP (5-15 cm H2O) increases with heart failure

                            bull ROM of lower extremities antiembolic stockings

                            NURSING CARE PLAN

                            bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                            bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                            bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                            bull Anticipate needs of client call light water Reassurance

                            bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                            NURSING CARE PLAN

                            bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                            Mg)bull Monitor ECGbull Diet progressive low

                            calorie low sodium low cholesterol low fat without caffeine

                            NURSING CARE PLAN

                            bull Goal 5 facilitate fecal eliminationbull Medications stool

                            softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                            bull Bedside commode

                            NURSING CARE PLAN

                            bull Goal 6 provide emotional supportbull Recognize fear of dying

                            denial anger withdrawalbull Encourage expression of

                            feelings fears concernsbull Discuss rehabilitation lifestyle

                            changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                            NURSING CARE PLAN

                            bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                            activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                            bull Identify need for referral for sexual counselling

                            NURSING CARE PLAN

                            bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                            meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                            bull Information about sexual activity less fatiguing positions

                            bull Support groups Follow-up carebull Medications administration importance untoward

                            effects pulse takingbull Control risk factors rest diet exercise no smoking

                            weight control stress reduction

                            EVALUATION

                            bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                            CONGESTIVE HEART FAILURE

                            bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                            PATHOPHYSIOLOGY

                            Increased cardiac workload

                            decreased effective myocardial contractility

                            Decreased cardiac output

                            LV failure Pulmonary congestion

                            RA RV failure

                            Systemic congestion

                            Peripheral edema

                            ASSESSMENTbull Subjective data

                            bull Shortness of breathbull Orthopnea (sleeps on two

                            or more pillows)bull Paroxysmal nocturnal

                            dyspnea (sudden breathlessness during sleep)

                            bull Dyspnea on exertion (climbing stairs)

                            bull Apprehension anxiety irritability

                            bull Fatigue weaknessbull Reported weight gain

                            feeling of puffiness

                            ASSESSMENTbull Objective data

                            bull VSbull BP decreasing systolic

                            narrowing pulse pressurebull Pulse pulsus alternans

                            (alternating strong-weak-strong cardiac contraction) increased

                            bull Respirations crackles Cheyne-Stokes

                            bull Edema dependent pitting (1+ to 4+ mm)

                            bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                            dilated pulmonary vessels lung edema

                            Left Ventricular Compared with Right Ventricular Heart Failure

                            LEFT VENTRICULAR

                            FAILURE

                            RIGHT VENTRICULAR

                            FAILURE

                            Pulmonary crackles Jugular venous distention

                            Tachypnea Peripheral edema

                            S3 gallop Perioral and peripheral cyanosis

                            Cardiac murmurs Congestive hepatomegaly

                            Paradoxical splitting of S2

                            Ascites

                            Hepatojugular reflux

                            ANALYSIS NURSING DIAGNOSES

                            bull Decreased cardiac output related to decreased myocardial contractility

                            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                            bull Fatigue related to edema and poor oxygenation

                            bull Fluid volume excess related to compensatory mechanisms

                            bull Impaired gas exchange related to pulmonary congestion

                            bull Anxiety related to shortness of breath

                            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                            NURSING CARE PLAN

                            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                            tachycardia dyspnea edema resolved change position frequently pillows for support

                            bull Rest planned periods limit visitors activity noise Chair and commode privileges

                            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                            bull Warm fluids if appropriate

                            NURSING CARE PLAN

                            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                            NURSING CARE PLANbull Goal 3 provide for special safety

                            needsbull Skin care

                            bull Inspect massage lubricate bony prominences

                            bull Use foot cradle heel protectors sheepskin

                            bull Side rails up if hypoxic (disoriented)

                            bull Vital signs monitor for signs of fatigue pulmonary emboli

                            bull ROM active passive elastic stockings

                            NURSING CARE PLAN

                            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                            strict IObull Diet

                            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                            NURSING CARE PLAN

                            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                            bull Refer to available community resources for dietary assistance weight reduction exercise program

                            EVALUATION

                            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                            distressbull Reduction in dependent edema

                            DAY 3 OF

                            CARDIOVASCULARDISEASES

                            bull hyperlipidemia means high lipid levels

                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                            Treatment of Hyperlipidemia

                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                            bull SYSTOLIC DYSFUNCTION

                            HYPERTROPHIC CARDIOMYOPATHY

                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                            HYPERTROPHIC CARDIOMYOPATHY

                            bull Pathophysiologybull 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

                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                            CARDIOMYOPATHIES

                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                            CARDIOMYOPATHIES

                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                            CARDIOMYOPATHIES

                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                            relief

                            CARDIOMYOPATHIES

                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                            CARDIOMYOPATHIES

                            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

                            Infective endocarditis

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

                            bull Can be acute or chronic

                            Infective endocarditis

                            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

                            Infective endocarditis

                            bull Pathophysiologybull 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

                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                            Infective endocarditis

                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                            retina

                            Infective endocarditis

                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                            Infective endocarditis

                            bull Preventionbull Antibiotic prophylaxis if patient is

                            undergoing procedures like dental extractions bronchoscopy surgery etc

                            Infective endocarditis

                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                            organism

                            Infective endocarditis

                            bull Nursing managementbull 1 regular monitoring of temperature heart

                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                            Infective endocarditis

                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                            B

                            Infective endocarditis

                            bull Medical managementbull 2 Surgerybull Valvular replacement

                            CARDIOGENIC SHOCK

                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                            CARDIOGENIC SHOCK

                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                            CARDIOGENIC SHOCK

                            bull LABORATORY FINDINGSIncreased CVP

                            Normal is 4-10 cmH2O

                            CARDIOGENIC SHOCK

                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                            inotropics such as DOPAMINE and DOBUTAMINE

                            bull 3 Administer O2bull 4 Morphine is administered to

                            decreased pulmonary congestion and to relieve pain

                            CARDIOGENIC SHOCK

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

                            bull 6 Monitor urinary output BP and pulses

                            bull 7 cautiously administer diuretics and nitrates

                            CARDIAC TAMPONADE

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

                            CARDIAC TAMPONADE

                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                            CARDIAC TAMPONADE

                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                            CARDIAC TAMPONADE

                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                            distention hypotension and distantmuffled heart sound

                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                            CARDIAC TAMPONADE

                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                            anterior chest

                            CARDIAC TAMPONADE

                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                            CARDIAC TAMPONADE

                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                            tamponade

                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                            HYPERTENSION

                            bull 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

                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                            bull Most common typebull 2 Secondary

                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                            Alterations in Blood Flow in the Systemic Circulation

                            Buergerrsquos Disease

                            bull Also known as Thromboangiitis obliterans

                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                            reaction of the vessel wall

                            Manifestations

                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                            Increased sensitivity to cold (due to impaired circulation

                            Absentdiminished peripheral pulses

                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                            gangrenous changes may arise may necessitate amputation

                            Diagnosis amp Treatment

                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                            emotionsRaynaudrsquos phenomenon ndash associated with

                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                            bull Return to normal colorbull Note although all of the fingers are

                            affected symmetrically only 1-2digits may be involved

                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                            (rare occasions)

                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                            Immersion of hand in cold water to initiate attack aids in the Dx

                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                            protection from cold Avoidance of emotional stress (anxiety amp

                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                            A Assessment

                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                            2 vsB Nursing Dx

                            1 ineffective tissue perfusion (cardiopulmonary)

                            2 Impaired gas exchange

                            3 Anxiety due to fear of death (clients with MI or Angina)

                            C Goals

                            1 Relief of pain amp symptoms

                            2 Prevention of further cardiac damage

                            D Nursing Interventions

                            1 Pain control

                            2 Proper medications

                            3 Decrease clientrsquos anxiety

                            4 Health teachings (meds activities diet exercise etc)

                            • CARDIOVASCULAR DISEASES
                            • Slide 2
                            • GENERAL CARDIAC ASSESSMENT
                            • Pathophysiology
                            • Slide 5
                            • ASSESSING CHEST PAIN
                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                            • Angina Pectoris Myocardial Ischemia
                            • Pathophysiology
                            • Types
                            • Slide 12
                            • Slide 13
                            • Slide 14
                            • Conthellip
                            • Conthellip (2)
                            • Drug Therapy
                            • Classification
                            • Nursing Management
                            • Nursing Management (2)
                            • Acute Coronary Syndrome
                            • Slide 22
                            • Conthellip (3)
                            • Slide 24
                            • Conthellip(MI)
                            • Slide 26
                            • Pathophysiology (2)
                            • Tissue Changes After MI
                            • Management of MI
                            • Slide 30
                            • Slide 31
                            • ASSESSMENT
                            • ANALYSIS NURSING DIAGNOSES
                            • NURSING CARE PLAN
                            • NURSING CARE PLAN (2)
                            • NURSING CARE PLAN (3)
                            • NURSING CARE PLAN (4)
                            • NURSING CARE PLAN (5)
                            • NURSING CARE PLAN (6)
                            • NURSING CARE PLAN (7)
                            • NURSING CARE PLAN (8)
                            • EVALUATION
                            • CONGESTIVE HEART FAILURE
                            • PATHOPHYSIOLOGY
                            • ASSESSMENT (2)
                            • ASSESSMENT (3)
                            • Left Ventricular Compared with Right Ventricular Heart Failure
                            • ANALYSIS NURSING DIAGNOSES (2)
                            • Slide 49
                            • NURSING CARE PLAN (9)
                            • NURSING CARE PLAN (10)
                            • NURSING CARE PLAN (11)
                            • NURSING CARE PLAN (12)
                            • NURSING CARE PLAN (13)
                            • EVALUATION
                            • Slide 56
                            • Slide 57
                            • Slide 58
                            • Slide 59
                            • Slide 60
                            • Treatment of Hyperlipidemia
                            • Slide 62
                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                            • HYPERTROPHIC CARDIOMYOPATHY
                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                            • RESTRICTIVE CARDIOMYOPATHY
                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                            • CARDIOMYOPATHIES
                            • CARDIOMYOPATHIES (2)
                            • CARDIOMYOPATHIES (3)
                            • CARDIOMYOPATHIES (4)
                            • CARDIOMYOPATHIES (5)
                            • CARDIOMYOPATHIES (6)
                            • Infective endocarditis
                            • Infective endocarditis (2)
                            • Infective endocarditis (3)
                            • Infective endocarditis (4)
                            • Infective endocarditis (5)
                            • Infective endocarditis (6)
                            • Infective endocarditis (7)
                            • Infective endocarditis (8)
                            • Infective endocarditis (9)
                            • Infective endocarditis (10)
                            • Infective endocarditis (11)
                            • Infective endocarditis (12)
                            • CARDIOGENIC SHOCK
                            • CARDIOGENIC SHOCK (2)
                            • CARDIOGENIC SHOCK (3)
                            • CARDIOGENIC SHOCK (4)
                            • CARDIOGENIC SHOCK (5)
                            • CARDIAC TAMPONADE
                            • CARDIAC TAMPONADE (2)
                            • CARDIAC TAMPONADE (3)
                            • CARDIAC TAMPONADE (4)
                            • CARDIAC TAMPONADE (5)
                            • CARDIAC TAMPONADE (6)
                            • CARDIAC TAMPONADE (7)
                            • Slide 100
                            • HYPERTENSION
                            • HYPERTENSION (2)
                            • Slide 103
                            • Slide 104
                            • Slide 105
                            • Alterations in Blood Flow in the Systemic Circulation
                            • Buergerrsquos Disease
                            • Slide 108
                            • Manifestations
                            • Slide 110
                            • Diagnosis amp Treatment
                            • Rynaudrsquos Disease
                            • Manifestations (2)
                            • Slide 114
                            • Diagnosis amp Treatment (2)
                            • Slide 116
                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                            • Slide 118
                            • Slide 119
                            • Slide 120
                            • Slide 121

                              ConthellipDx detailed pain history ECG TST

                              angiogram may be used to confirm amp describe type of angina

                              Tx directed towards MI prevention- Lifestyle modification (individualized

                              regular exercise program smoking cessation)

                              - Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal

                              coronary angioplasty) may be indicated if with severe artery occlusion

                              Drug Therapy Nitroglycerin (NTGs) ndash

                              vasodilators patch (Deponit

                              Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                              Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                              Calcium channel blockers Nifedipine (Calcibloc

                              Adalat) Diltiazem (Cardizem)

                              Lipid lowering agents ndashstatins Simvastatin

                              Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                              Classification

                              Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                              Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                              Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                              Class IV ndash angina occurs even at rest

                              Nursing Management

                              Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                              Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                              limitations NTGs ndash max of 3doses at 5-min intervals

                              Stinging sensation under the tongue for SL is normal

                              Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                              bottles amp change stocks every 6months Inform clients that headache dizziness

                              flushed face are common side effects

                              Do not discontinue the drug For patches rotate skin sites usually on

                              chest wall Instrct on evaluation of effectiveness based

                              on pain reliefPropanolols causes bronchospasm amp

                              hypoglycemia do not administer to asthmatic amp diabetic clients

                              Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                              Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                              Nursing Management

                              Acute Coronary Syndrome

                              Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                              Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                              Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                              gt20mins)2 New onset exertional angina (increased in

                              severity of at least 1 class ndash to at least class III) in lt2months

                              3 Recent acceleration of angina to at least class III in lt2months

                              Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                              When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                              Conthellip

                              ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                              myocardial tissue associated with atherosclerotic disease of coronary arteries

                              Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                              Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                              elevation Q wave prolongation T wave inversion

                              Conthellip(MI)

                              Manifestations chest pain ndash severe crushing

                              constricting ldquosomeone sitting on my chestrdquo

                              - substernal radiating to left arm neck or jaw

                              - prolonged (gt35mins) amp not relieved by rest

                              Shortness of breath profuse perspirationFeeling of impending doom

                              Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                              profound LV failure from massive MI resulting to low cardiac output

                              Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                              Rupture of myocardiumVentricular aneurysms ndash decreases

                              pumping efficiency of heart amp increases work of LV

                              Pathophysiology

                              Causes atherosclerotic heart disease thrombosisembolism

                              shock ampor hemorrhage direct traumaMyocardial ischemia

                              uarrcellular hypoxia

                              darrmyocardial O2 supplydarr myocardial contractility

                              darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                              uarrperipheral vasoconstriction

                              uarr myocardial contractility

                              uarr afterload uarrmyocardial O2 demand

                              uarr HR uarrdiastolicfilling

                              darrmyocardial tissue perfusion

                              Tissue Changes After MI

                              Time after Onset Type of Injury amp Gross Tissue Changes

                              0-05hrs Reversible injury

                              1-2hrs Onset of irreversible injury

                              4-12hrs Beginning of coagulation necrosis

                              18-24hrs Continued necrosis gross pallor of infected tissue

                              1-3days Total necrosis onset of acute inflammatory process

                              3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                              7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                              8th week Complete scar tissue replacement

                              Management of MI Initial Management OMEN

                              - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                              vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                              may be given to limit infarction size amp most effective if given within 4hrs of onset)

                              Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                              Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                              bull Surgery 1Revascularization

                              bullPTCAbullCoronary stent implantation

                              bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                              2Resection ndash aneurysm

                              ASSESSMENT

                              bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                              bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                              ANALYSIS NURSING DIAGNOSES

                              bull Decreased cardiac output related to myocardial damage

                              bull Impaired gas exchange related to poor perfusion shock

                              bull Pain related to myocardial ischemia

                              bull Activity intolerance related to pain or inadequate oxygenation

                              bull Fear related to possibility of death

                              NURSING CARE PLANbull Goal 1 reduce pain discomfort

                              bull Narcotics ndash morphine note response Avoid IM

                              bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                              bull Position semi-Fowlerrsquos to improve ventilation

                              NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                              rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                              thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                              cracklesbull Check labs troponin blood gases electrolytes

                              clotting timebull CVP (5-15 cm H2O) increases with heart failure

                              bull ROM of lower extremities antiembolic stockings

                              NURSING CARE PLAN

                              bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                              bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                              bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                              bull Anticipate needs of client call light water Reassurance

                              bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                              NURSING CARE PLAN

                              bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                              Mg)bull Monitor ECGbull Diet progressive low

                              calorie low sodium low cholesterol low fat without caffeine

                              NURSING CARE PLAN

                              bull Goal 5 facilitate fecal eliminationbull Medications stool

                              softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                              bull Bedside commode

                              NURSING CARE PLAN

                              bull Goal 6 provide emotional supportbull Recognize fear of dying

                              denial anger withdrawalbull Encourage expression of

                              feelings fears concernsbull Discuss rehabilitation lifestyle

                              changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                              NURSING CARE PLAN

                              bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                              activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                              bull Identify need for referral for sexual counselling

                              NURSING CARE PLAN

                              bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                              meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                              bull Information about sexual activity less fatiguing positions

                              bull Support groups Follow-up carebull Medications administration importance untoward

                              effects pulse takingbull Control risk factors rest diet exercise no smoking

                              weight control stress reduction

                              EVALUATION

                              bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                              CONGESTIVE HEART FAILURE

                              bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                              PATHOPHYSIOLOGY

                              Increased cardiac workload

                              decreased effective myocardial contractility

                              Decreased cardiac output

                              LV failure Pulmonary congestion

                              RA RV failure

                              Systemic congestion

                              Peripheral edema

                              ASSESSMENTbull Subjective data

                              bull Shortness of breathbull Orthopnea (sleeps on two

                              or more pillows)bull Paroxysmal nocturnal

                              dyspnea (sudden breathlessness during sleep)

                              bull Dyspnea on exertion (climbing stairs)

                              bull Apprehension anxiety irritability

                              bull Fatigue weaknessbull Reported weight gain

                              feeling of puffiness

                              ASSESSMENTbull Objective data

                              bull VSbull BP decreasing systolic

                              narrowing pulse pressurebull Pulse pulsus alternans

                              (alternating strong-weak-strong cardiac contraction) increased

                              bull Respirations crackles Cheyne-Stokes

                              bull Edema dependent pitting (1+ to 4+ mm)

                              bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                              dilated pulmonary vessels lung edema

                              Left Ventricular Compared with Right Ventricular Heart Failure

                              LEFT VENTRICULAR

                              FAILURE

                              RIGHT VENTRICULAR

                              FAILURE

                              Pulmonary crackles Jugular venous distention

                              Tachypnea Peripheral edema

                              S3 gallop Perioral and peripheral cyanosis

                              Cardiac murmurs Congestive hepatomegaly

                              Paradoxical splitting of S2

                              Ascites

                              Hepatojugular reflux

                              ANALYSIS NURSING DIAGNOSES

                              bull Decreased cardiac output related to decreased myocardial contractility

                              bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                              bull Fatigue related to edema and poor oxygenation

                              bull Fluid volume excess related to compensatory mechanisms

                              bull Impaired gas exchange related to pulmonary congestion

                              bull Anxiety related to shortness of breath

                              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                              NURSING CARE PLAN

                              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                              tachycardia dyspnea edema resolved change position frequently pillows for support

                              bull Rest planned periods limit visitors activity noise Chair and commode privileges

                              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                              bull Warm fluids if appropriate

                              NURSING CARE PLAN

                              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                              NURSING CARE PLANbull Goal 3 provide for special safety

                              needsbull Skin care

                              bull Inspect massage lubricate bony prominences

                              bull Use foot cradle heel protectors sheepskin

                              bull Side rails up if hypoxic (disoriented)

                              bull Vital signs monitor for signs of fatigue pulmonary emboli

                              bull ROM active passive elastic stockings

                              NURSING CARE PLAN

                              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                              strict IObull Diet

                              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                              NURSING CARE PLAN

                              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                              bull Refer to available community resources for dietary assistance weight reduction exercise program

                              EVALUATION

                              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                              distressbull Reduction in dependent edema

                              DAY 3 OF

                              CARDIOVASCULARDISEASES

                              bull hyperlipidemia means high lipid levels

                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                              Treatment of Hyperlipidemia

                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                              bull SYSTOLIC DYSFUNCTION

                              HYPERTROPHIC CARDIOMYOPATHY

                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                              HYPERTROPHIC CARDIOMYOPATHY

                              bull Pathophysiologybull 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

                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                              CARDIOMYOPATHIES

                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                              CARDIOMYOPATHIES

                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                              CARDIOMYOPATHIES

                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                              relief

                              CARDIOMYOPATHIES

                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                              CARDIOMYOPATHIES

                              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

                              Infective endocarditis

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

                              bull Can be acute or chronic

                              Infective endocarditis

                              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

                              Infective endocarditis

                              bull Pathophysiologybull 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

                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                              Infective endocarditis

                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                              retina

                              Infective endocarditis

                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                              Infective endocarditis

                              bull Preventionbull Antibiotic prophylaxis if patient is

                              undergoing procedures like dental extractions bronchoscopy surgery etc

                              Infective endocarditis

                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                              organism

                              Infective endocarditis

                              bull Nursing managementbull 1 regular monitoring of temperature heart

                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                              Infective endocarditis

                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                              B

                              Infective endocarditis

                              bull Medical managementbull 2 Surgerybull Valvular replacement

                              CARDIOGENIC SHOCK

                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                              CARDIOGENIC SHOCK

                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                              CARDIOGENIC SHOCK

                              bull LABORATORY FINDINGSIncreased CVP

                              Normal is 4-10 cmH2O

                              CARDIOGENIC SHOCK

                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                              inotropics such as DOPAMINE and DOBUTAMINE

                              bull 3 Administer O2bull 4 Morphine is administered to

                              decreased pulmonary congestion and to relieve pain

                              CARDIOGENIC SHOCK

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

                              bull 6 Monitor urinary output BP and pulses

                              bull 7 cautiously administer diuretics and nitrates

                              CARDIAC TAMPONADE

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

                              CARDIAC TAMPONADE

                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                              CARDIAC TAMPONADE

                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                              CARDIAC TAMPONADE

                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                              distention hypotension and distantmuffled heart sound

                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                              CARDIAC TAMPONADE

                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                              anterior chest

                              CARDIAC TAMPONADE

                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                              CARDIAC TAMPONADE

                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                              tamponade

                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                              HYPERTENSION

                              bull 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

                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                              bull Most common typebull 2 Secondary

                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                              Alterations in Blood Flow in the Systemic Circulation

                              Buergerrsquos Disease

                              bull Also known as Thromboangiitis obliterans

                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                              reaction of the vessel wall

                              Manifestations

                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                              Increased sensitivity to cold (due to impaired circulation

                              Absentdiminished peripheral pulses

                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                              gangrenous changes may arise may necessitate amputation

                              Diagnosis amp Treatment

                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                              emotionsRaynaudrsquos phenomenon ndash associated with

                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                              bull Return to normal colorbull Note although all of the fingers are

                              affected symmetrically only 1-2digits may be involved

                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                              (rare occasions)

                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                              Immersion of hand in cold water to initiate attack aids in the Dx

                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                              protection from cold Avoidance of emotional stress (anxiety amp

                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                              A Assessment

                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                              2 vsB Nursing Dx

                              1 ineffective tissue perfusion (cardiopulmonary)

                              2 Impaired gas exchange

                              3 Anxiety due to fear of death (clients with MI or Angina)

                              C Goals

                              1 Relief of pain amp symptoms

                              2 Prevention of further cardiac damage

                              D Nursing Interventions

                              1 Pain control

                              2 Proper medications

                              3 Decrease clientrsquos anxiety

                              4 Health teachings (meds activities diet exercise etc)

                              • CARDIOVASCULAR DISEASES
                              • Slide 2
                              • GENERAL CARDIAC ASSESSMENT
                              • Pathophysiology
                              • Slide 5
                              • ASSESSING CHEST PAIN
                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                              • Angina Pectoris Myocardial Ischemia
                              • Pathophysiology
                              • Types
                              • Slide 12
                              • Slide 13
                              • Slide 14
                              • Conthellip
                              • Conthellip (2)
                              • Drug Therapy
                              • Classification
                              • Nursing Management
                              • Nursing Management (2)
                              • Acute Coronary Syndrome
                              • Slide 22
                              • Conthellip (3)
                              • Slide 24
                              • Conthellip(MI)
                              • Slide 26
                              • Pathophysiology (2)
                              • Tissue Changes After MI
                              • Management of MI
                              • Slide 30
                              • Slide 31
                              • ASSESSMENT
                              • ANALYSIS NURSING DIAGNOSES
                              • NURSING CARE PLAN
                              • NURSING CARE PLAN (2)
                              • NURSING CARE PLAN (3)
                              • NURSING CARE PLAN (4)
                              • NURSING CARE PLAN (5)
                              • NURSING CARE PLAN (6)
                              • NURSING CARE PLAN (7)
                              • NURSING CARE PLAN (8)
                              • EVALUATION
                              • CONGESTIVE HEART FAILURE
                              • PATHOPHYSIOLOGY
                              • ASSESSMENT (2)
                              • ASSESSMENT (3)
                              • Left Ventricular Compared with Right Ventricular Heart Failure
                              • ANALYSIS NURSING DIAGNOSES (2)
                              • Slide 49
                              • NURSING CARE PLAN (9)
                              • NURSING CARE PLAN (10)
                              • NURSING CARE PLAN (11)
                              • NURSING CARE PLAN (12)
                              • NURSING CARE PLAN (13)
                              • EVALUATION
                              • Slide 56
                              • Slide 57
                              • Slide 58
                              • Slide 59
                              • Slide 60
                              • Treatment of Hyperlipidemia
                              • Slide 62
                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                              • HYPERTROPHIC CARDIOMYOPATHY
                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                              • RESTRICTIVE CARDIOMYOPATHY
                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                              • CARDIOMYOPATHIES
                              • CARDIOMYOPATHIES (2)
                              • CARDIOMYOPATHIES (3)
                              • CARDIOMYOPATHIES (4)
                              • CARDIOMYOPATHIES (5)
                              • CARDIOMYOPATHIES (6)
                              • Infective endocarditis
                              • Infective endocarditis (2)
                              • Infective endocarditis (3)
                              • Infective endocarditis (4)
                              • Infective endocarditis (5)
                              • Infective endocarditis (6)
                              • Infective endocarditis (7)
                              • Infective endocarditis (8)
                              • Infective endocarditis (9)
                              • Infective endocarditis (10)
                              • Infective endocarditis (11)
                              • Infective endocarditis (12)
                              • CARDIOGENIC SHOCK
                              • CARDIOGENIC SHOCK (2)
                              • CARDIOGENIC SHOCK (3)
                              • CARDIOGENIC SHOCK (4)
                              • CARDIOGENIC SHOCK (5)
                              • CARDIAC TAMPONADE
                              • CARDIAC TAMPONADE (2)
                              • CARDIAC TAMPONADE (3)
                              • CARDIAC TAMPONADE (4)
                              • CARDIAC TAMPONADE (5)
                              • CARDIAC TAMPONADE (6)
                              • CARDIAC TAMPONADE (7)
                              • Slide 100
                              • HYPERTENSION
                              • HYPERTENSION (2)
                              • Slide 103
                              • Slide 104
                              • Slide 105
                              • Alterations in Blood Flow in the Systemic Circulation
                              • Buergerrsquos Disease
                              • Slide 108
                              • Manifestations
                              • Slide 110
                              • Diagnosis amp Treatment
                              • Rynaudrsquos Disease
                              • Manifestations (2)
                              • Slide 114
                              • Diagnosis amp Treatment (2)
                              • Slide 116
                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                              • Slide 118
                              • Slide 119
                              • Slide 120
                              • Slide 121

                                Drug Therapy Nitroglycerin (NTGs) ndash

                                vasodilators patch (Deponit

                                Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)

                                Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)

                                Calcium channel blockers Nifedipine (Calcibloc

                                Adalat) Diltiazem (Cardizem)

                                Lipid lowering agents ndashstatins Simvastatin

                                Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)

                                Classification

                                Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                                Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                                Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                                Class IV ndash angina occurs even at rest

                                Nursing Management

                                Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                                Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                                limitations NTGs ndash max of 3doses at 5-min intervals

                                Stinging sensation under the tongue for SL is normal

                                Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                                bottles amp change stocks every 6months Inform clients that headache dizziness

                                flushed face are common side effects

                                Do not discontinue the drug For patches rotate skin sites usually on

                                chest wall Instrct on evaluation of effectiveness based

                                on pain reliefPropanolols causes bronchospasm amp

                                hypoglycemia do not administer to asthmatic amp diabetic clients

                                Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                                Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                                Nursing Management

                                Acute Coronary Syndrome

                                Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                                Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                                Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                                gt20mins)2 New onset exertional angina (increased in

                                severity of at least 1 class ndash to at least class III) in lt2months

                                3 Recent acceleration of angina to at least class III in lt2months

                                Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                Conthellip

                                ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                myocardial tissue associated with atherosclerotic disease of coronary arteries

                                Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                elevation Q wave prolongation T wave inversion

                                Conthellip(MI)

                                Manifestations chest pain ndash severe crushing

                                constricting ldquosomeone sitting on my chestrdquo

                                - substernal radiating to left arm neck or jaw

                                - prolonged (gt35mins) amp not relieved by rest

                                Shortness of breath profuse perspirationFeeling of impending doom

                                Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                profound LV failure from massive MI resulting to low cardiac output

                                Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                Rupture of myocardiumVentricular aneurysms ndash decreases

                                pumping efficiency of heart amp increases work of LV

                                Pathophysiology

                                Causes atherosclerotic heart disease thrombosisembolism

                                shock ampor hemorrhage direct traumaMyocardial ischemia

                                uarrcellular hypoxia

                                darrmyocardial O2 supplydarr myocardial contractility

                                darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                uarrperipheral vasoconstriction

                                uarr myocardial contractility

                                uarr afterload uarrmyocardial O2 demand

                                uarr HR uarrdiastolicfilling

                                darrmyocardial tissue perfusion

                                Tissue Changes After MI

                                Time after Onset Type of Injury amp Gross Tissue Changes

                                0-05hrs Reversible injury

                                1-2hrs Onset of irreversible injury

                                4-12hrs Beginning of coagulation necrosis

                                18-24hrs Continued necrosis gross pallor of infected tissue

                                1-3days Total necrosis onset of acute inflammatory process

                                3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                8th week Complete scar tissue replacement

                                Management of MI Initial Management OMEN

                                - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                bull Surgery 1Revascularization

                                bullPTCAbullCoronary stent implantation

                                bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                2Resection ndash aneurysm

                                ASSESSMENT

                                bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                ANALYSIS NURSING DIAGNOSES

                                bull Decreased cardiac output related to myocardial damage

                                bull Impaired gas exchange related to poor perfusion shock

                                bull Pain related to myocardial ischemia

                                bull Activity intolerance related to pain or inadequate oxygenation

                                bull Fear related to possibility of death

                                NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                bull Narcotics ndash morphine note response Avoid IM

                                bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                bull Position semi-Fowlerrsquos to improve ventilation

                                NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                cracklesbull Check labs troponin blood gases electrolytes

                                clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                bull ROM of lower extremities antiembolic stockings

                                NURSING CARE PLAN

                                bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                bull Anticipate needs of client call light water Reassurance

                                bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                NURSING CARE PLAN

                                bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                Mg)bull Monitor ECGbull Diet progressive low

                                calorie low sodium low cholesterol low fat without caffeine

                                NURSING CARE PLAN

                                bull Goal 5 facilitate fecal eliminationbull Medications stool

                                softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                bull Bedside commode

                                NURSING CARE PLAN

                                bull Goal 6 provide emotional supportbull Recognize fear of dying

                                denial anger withdrawalbull Encourage expression of

                                feelings fears concernsbull Discuss rehabilitation lifestyle

                                changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                NURSING CARE PLAN

                                bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                bull Identify need for referral for sexual counselling

                                NURSING CARE PLAN

                                bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                bull Information about sexual activity less fatiguing positions

                                bull Support groups Follow-up carebull Medications administration importance untoward

                                effects pulse takingbull Control risk factors rest diet exercise no smoking

                                weight control stress reduction

                                EVALUATION

                                bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                CONGESTIVE HEART FAILURE

                                bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                PATHOPHYSIOLOGY

                                Increased cardiac workload

                                decreased effective myocardial contractility

                                Decreased cardiac output

                                LV failure Pulmonary congestion

                                RA RV failure

                                Systemic congestion

                                Peripheral edema

                                ASSESSMENTbull Subjective data

                                bull Shortness of breathbull Orthopnea (sleeps on two

                                or more pillows)bull Paroxysmal nocturnal

                                dyspnea (sudden breathlessness during sleep)

                                bull Dyspnea on exertion (climbing stairs)

                                bull Apprehension anxiety irritability

                                bull Fatigue weaknessbull Reported weight gain

                                feeling of puffiness

                                ASSESSMENTbull Objective data

                                bull VSbull BP decreasing systolic

                                narrowing pulse pressurebull Pulse pulsus alternans

                                (alternating strong-weak-strong cardiac contraction) increased

                                bull Respirations crackles Cheyne-Stokes

                                bull Edema dependent pitting (1+ to 4+ mm)

                                bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                dilated pulmonary vessels lung edema

                                Left Ventricular Compared with Right Ventricular Heart Failure

                                LEFT VENTRICULAR

                                FAILURE

                                RIGHT VENTRICULAR

                                FAILURE

                                Pulmonary crackles Jugular venous distention

                                Tachypnea Peripheral edema

                                S3 gallop Perioral and peripheral cyanosis

                                Cardiac murmurs Congestive hepatomegaly

                                Paradoxical splitting of S2

                                Ascites

                                Hepatojugular reflux

                                ANALYSIS NURSING DIAGNOSES

                                bull Decreased cardiac output related to decreased myocardial contractility

                                bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                bull Fatigue related to edema and poor oxygenation

                                bull Fluid volume excess related to compensatory mechanisms

                                bull Impaired gas exchange related to pulmonary congestion

                                bull Anxiety related to shortness of breath

                                bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                NURSING CARE PLAN

                                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                tachycardia dyspnea edema resolved change position frequently pillows for support

                                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                bull Warm fluids if appropriate

                                NURSING CARE PLAN

                                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                NURSING CARE PLANbull Goal 3 provide for special safety

                                needsbull Skin care

                                bull Inspect massage lubricate bony prominences

                                bull Use foot cradle heel protectors sheepskin

                                bull Side rails up if hypoxic (disoriented)

                                bull Vital signs monitor for signs of fatigue pulmonary emboli

                                bull ROM active passive elastic stockings

                                NURSING CARE PLAN

                                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                strict IObull Diet

                                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                NURSING CARE PLAN

                                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                bull Refer to available community resources for dietary assistance weight reduction exercise program

                                EVALUATION

                                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                distressbull Reduction in dependent edema

                                DAY 3 OF

                                CARDIOVASCULARDISEASES

                                bull hyperlipidemia means high lipid levels

                                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                Treatment of Hyperlipidemia

                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                bull SYSTOLIC DYSFUNCTION

                                HYPERTROPHIC CARDIOMYOPATHY

                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                HYPERTROPHIC CARDIOMYOPATHY

                                bull Pathophysiologybull 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

                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                CARDIOMYOPATHIES

                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                CARDIOMYOPATHIES

                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                CARDIOMYOPATHIES

                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                relief

                                CARDIOMYOPATHIES

                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                CARDIOMYOPATHIES

                                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

                                Infective endocarditis

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

                                bull Can be acute or chronic

                                Infective endocarditis

                                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

                                Infective endocarditis

                                bull Pathophysiologybull 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

                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                Infective endocarditis

                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                retina

                                Infective endocarditis

                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                Infective endocarditis

                                bull Preventionbull Antibiotic prophylaxis if patient is

                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                Infective endocarditis

                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                organism

                                Infective endocarditis

                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                Infective endocarditis

                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                B

                                Infective endocarditis

                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                CARDIOGENIC SHOCK

                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                CARDIOGENIC SHOCK

                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                CARDIOGENIC SHOCK

                                bull LABORATORY FINDINGSIncreased CVP

                                Normal is 4-10 cmH2O

                                CARDIOGENIC SHOCK

                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                inotropics such as DOPAMINE and DOBUTAMINE

                                bull 3 Administer O2bull 4 Morphine is administered to

                                decreased pulmonary congestion and to relieve pain

                                CARDIOGENIC SHOCK

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

                                bull 6 Monitor urinary output BP and pulses

                                bull 7 cautiously administer diuretics and nitrates

                                CARDIAC TAMPONADE

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

                                CARDIAC TAMPONADE

                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                CARDIAC TAMPONADE

                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                CARDIAC TAMPONADE

                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                distention hypotension and distantmuffled heart sound

                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                CARDIAC TAMPONADE

                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                anterior chest

                                CARDIAC TAMPONADE

                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                CARDIAC TAMPONADE

                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                tamponade

                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                HYPERTENSION

                                bull 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

                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                bull Most common typebull 2 Secondary

                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                Alterations in Blood Flow in the Systemic Circulation

                                Buergerrsquos Disease

                                bull Also known as Thromboangiitis obliterans

                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                reaction of the vessel wall

                                Manifestations

                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                Increased sensitivity to cold (due to impaired circulation

                                Absentdiminished peripheral pulses

                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                gangrenous changes may arise may necessitate amputation

                                Diagnosis amp Treatment

                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                emotionsRaynaudrsquos phenomenon ndash associated with

                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                bull Return to normal colorbull Note although all of the fingers are

                                affected symmetrically only 1-2digits may be involved

                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                (rare occasions)

                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                Immersion of hand in cold water to initiate attack aids in the Dx

                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                protection from cold Avoidance of emotional stress (anxiety amp

                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                A Assessment

                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                2 vsB Nursing Dx

                                1 ineffective tissue perfusion (cardiopulmonary)

                                2 Impaired gas exchange

                                3 Anxiety due to fear of death (clients with MI or Angina)

                                C Goals

                                1 Relief of pain amp symptoms

                                2 Prevention of further cardiac damage

                                D Nursing Interventions

                                1 Pain control

                                2 Proper medications

                                3 Decrease clientrsquos anxiety

                                4 Health teachings (meds activities diet exercise etc)

                                • CARDIOVASCULAR DISEASES
                                • Slide 2
                                • GENERAL CARDIAC ASSESSMENT
                                • Pathophysiology
                                • Slide 5
                                • ASSESSING CHEST PAIN
                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                • Angina Pectoris Myocardial Ischemia
                                • Pathophysiology
                                • Types
                                • Slide 12
                                • Slide 13
                                • Slide 14
                                • Conthellip
                                • Conthellip (2)
                                • Drug Therapy
                                • Classification
                                • Nursing Management
                                • Nursing Management (2)
                                • Acute Coronary Syndrome
                                • Slide 22
                                • Conthellip (3)
                                • Slide 24
                                • Conthellip(MI)
                                • Slide 26
                                • Pathophysiology (2)
                                • Tissue Changes After MI
                                • Management of MI
                                • Slide 30
                                • Slide 31
                                • ASSESSMENT
                                • ANALYSIS NURSING DIAGNOSES
                                • NURSING CARE PLAN
                                • NURSING CARE PLAN (2)
                                • NURSING CARE PLAN (3)
                                • NURSING CARE PLAN (4)
                                • NURSING CARE PLAN (5)
                                • NURSING CARE PLAN (6)
                                • NURSING CARE PLAN (7)
                                • NURSING CARE PLAN (8)
                                • EVALUATION
                                • CONGESTIVE HEART FAILURE
                                • PATHOPHYSIOLOGY
                                • ASSESSMENT (2)
                                • ASSESSMENT (3)
                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                • ANALYSIS NURSING DIAGNOSES (2)
                                • Slide 49
                                • NURSING CARE PLAN (9)
                                • NURSING CARE PLAN (10)
                                • NURSING CARE PLAN (11)
                                • NURSING CARE PLAN (12)
                                • NURSING CARE PLAN (13)
                                • EVALUATION
                                • Slide 56
                                • Slide 57
                                • Slide 58
                                • Slide 59
                                • Slide 60
                                • Treatment of Hyperlipidemia
                                • Slide 62
                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                • HYPERTROPHIC CARDIOMYOPATHY
                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                • RESTRICTIVE CARDIOMYOPATHY
                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                • CARDIOMYOPATHIES
                                • CARDIOMYOPATHIES (2)
                                • CARDIOMYOPATHIES (3)
                                • CARDIOMYOPATHIES (4)
                                • CARDIOMYOPATHIES (5)
                                • CARDIOMYOPATHIES (6)
                                • Infective endocarditis
                                • Infective endocarditis (2)
                                • Infective endocarditis (3)
                                • Infective endocarditis (4)
                                • Infective endocarditis (5)
                                • Infective endocarditis (6)
                                • Infective endocarditis (7)
                                • Infective endocarditis (8)
                                • Infective endocarditis (9)
                                • Infective endocarditis (10)
                                • Infective endocarditis (11)
                                • Infective endocarditis (12)
                                • CARDIOGENIC SHOCK
                                • CARDIOGENIC SHOCK (2)
                                • CARDIOGENIC SHOCK (3)
                                • CARDIOGENIC SHOCK (4)
                                • CARDIOGENIC SHOCK (5)
                                • CARDIAC TAMPONADE
                                • CARDIAC TAMPONADE (2)
                                • CARDIAC TAMPONADE (3)
                                • CARDIAC TAMPONADE (4)
                                • CARDIAC TAMPONADE (5)
                                • CARDIAC TAMPONADE (6)
                                • CARDIAC TAMPONADE (7)
                                • Slide 100
                                • HYPERTENSION
                                • HYPERTENSION (2)
                                • Slide 103
                                • Slide 104
                                • Slide 105
                                • Alterations in Blood Flow in the Systemic Circulation
                                • Buergerrsquos Disease
                                • Slide 108
                                • Manifestations
                                • Slide 110
                                • Diagnosis amp Treatment
                                • Rynaudrsquos Disease
                                • Manifestations (2)
                                • Slide 114
                                • Diagnosis amp Treatment (2)
                                • Slide 116
                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                • Slide 118
                                • Slide 119
                                • Slide 120
                                • Slide 121

                                  Classification

                                  Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation

                                  Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold

                                  Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace

                                  Class IV ndash angina occurs even at rest

                                  Nursing Management

                                  Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                                  Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                                  limitations NTGs ndash max of 3doses at 5-min intervals

                                  Stinging sensation under the tongue for SL is normal

                                  Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                                  bottles amp change stocks every 6months Inform clients that headache dizziness

                                  flushed face are common side effects

                                  Do not discontinue the drug For patches rotate skin sites usually on

                                  chest wall Instrct on evaluation of effectiveness based

                                  on pain reliefPropanolols causes bronchospasm amp

                                  hypoglycemia do not administer to asthmatic amp diabetic clients

                                  Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                                  Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                                  Nursing Management

                                  Acute Coronary Syndrome

                                  Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                                  Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                                  Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                                  gt20mins)2 New onset exertional angina (increased in

                                  severity of at least 1 class ndash to at least class III) in lt2months

                                  3 Recent acceleration of angina to at least class III in lt2months

                                  Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                  When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                  Conthellip

                                  ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                  myocardial tissue associated with atherosclerotic disease of coronary arteries

                                  Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                  Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                  elevation Q wave prolongation T wave inversion

                                  Conthellip(MI)

                                  Manifestations chest pain ndash severe crushing

                                  constricting ldquosomeone sitting on my chestrdquo

                                  - substernal radiating to left arm neck or jaw

                                  - prolonged (gt35mins) amp not relieved by rest

                                  Shortness of breath profuse perspirationFeeling of impending doom

                                  Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                  profound LV failure from massive MI resulting to low cardiac output

                                  Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                  Rupture of myocardiumVentricular aneurysms ndash decreases

                                  pumping efficiency of heart amp increases work of LV

                                  Pathophysiology

                                  Causes atherosclerotic heart disease thrombosisembolism

                                  shock ampor hemorrhage direct traumaMyocardial ischemia

                                  uarrcellular hypoxia

                                  darrmyocardial O2 supplydarr myocardial contractility

                                  darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                  uarrperipheral vasoconstriction

                                  uarr myocardial contractility

                                  uarr afterload uarrmyocardial O2 demand

                                  uarr HR uarrdiastolicfilling

                                  darrmyocardial tissue perfusion

                                  Tissue Changes After MI

                                  Time after Onset Type of Injury amp Gross Tissue Changes

                                  0-05hrs Reversible injury

                                  1-2hrs Onset of irreversible injury

                                  4-12hrs Beginning of coagulation necrosis

                                  18-24hrs Continued necrosis gross pallor of infected tissue

                                  1-3days Total necrosis onset of acute inflammatory process

                                  3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                  7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                  8th week Complete scar tissue replacement

                                  Management of MI Initial Management OMEN

                                  - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                  vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                  may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                  Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                  Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                  bull Surgery 1Revascularization

                                  bullPTCAbullCoronary stent implantation

                                  bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                  2Resection ndash aneurysm

                                  ASSESSMENT

                                  bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                  bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                  ANALYSIS NURSING DIAGNOSES

                                  bull Decreased cardiac output related to myocardial damage

                                  bull Impaired gas exchange related to poor perfusion shock

                                  bull Pain related to myocardial ischemia

                                  bull Activity intolerance related to pain or inadequate oxygenation

                                  bull Fear related to possibility of death

                                  NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                  bull Narcotics ndash morphine note response Avoid IM

                                  bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                  bull Position semi-Fowlerrsquos to improve ventilation

                                  NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                  rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                  thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                  cracklesbull Check labs troponin blood gases electrolytes

                                  clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                  bull ROM of lower extremities antiembolic stockings

                                  NURSING CARE PLAN

                                  bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                  bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                  bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                  bull Anticipate needs of client call light water Reassurance

                                  bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                  NURSING CARE PLAN

                                  bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                  Mg)bull Monitor ECGbull Diet progressive low

                                  calorie low sodium low cholesterol low fat without caffeine

                                  NURSING CARE PLAN

                                  bull Goal 5 facilitate fecal eliminationbull Medications stool

                                  softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                  bull Bedside commode

                                  NURSING CARE PLAN

                                  bull Goal 6 provide emotional supportbull Recognize fear of dying

                                  denial anger withdrawalbull Encourage expression of

                                  feelings fears concernsbull Discuss rehabilitation lifestyle

                                  changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                  NURSING CARE PLAN

                                  bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                  activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                  bull Identify need for referral for sexual counselling

                                  NURSING CARE PLAN

                                  bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                  meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                  bull Information about sexual activity less fatiguing positions

                                  bull Support groups Follow-up carebull Medications administration importance untoward

                                  effects pulse takingbull Control risk factors rest diet exercise no smoking

                                  weight control stress reduction

                                  EVALUATION

                                  bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                  CONGESTIVE HEART FAILURE

                                  bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                  PATHOPHYSIOLOGY

                                  Increased cardiac workload

                                  decreased effective myocardial contractility

                                  Decreased cardiac output

                                  LV failure Pulmonary congestion

                                  RA RV failure

                                  Systemic congestion

                                  Peripheral edema

                                  ASSESSMENTbull Subjective data

                                  bull Shortness of breathbull Orthopnea (sleeps on two

                                  or more pillows)bull Paroxysmal nocturnal

                                  dyspnea (sudden breathlessness during sleep)

                                  bull Dyspnea on exertion (climbing stairs)

                                  bull Apprehension anxiety irritability

                                  bull Fatigue weaknessbull Reported weight gain

                                  feeling of puffiness

                                  ASSESSMENTbull Objective data

                                  bull VSbull BP decreasing systolic

                                  narrowing pulse pressurebull Pulse pulsus alternans

                                  (alternating strong-weak-strong cardiac contraction) increased

                                  bull Respirations crackles Cheyne-Stokes

                                  bull Edema dependent pitting (1+ to 4+ mm)

                                  bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                  dilated pulmonary vessels lung edema

                                  Left Ventricular Compared with Right Ventricular Heart Failure

                                  LEFT VENTRICULAR

                                  FAILURE

                                  RIGHT VENTRICULAR

                                  FAILURE

                                  Pulmonary crackles Jugular venous distention

                                  Tachypnea Peripheral edema

                                  S3 gallop Perioral and peripheral cyanosis

                                  Cardiac murmurs Congestive hepatomegaly

                                  Paradoxical splitting of S2

                                  Ascites

                                  Hepatojugular reflux

                                  ANALYSIS NURSING DIAGNOSES

                                  bull Decreased cardiac output related to decreased myocardial contractility

                                  bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                  bull Fatigue related to edema and poor oxygenation

                                  bull Fluid volume excess related to compensatory mechanisms

                                  bull Impaired gas exchange related to pulmonary congestion

                                  bull Anxiety related to shortness of breath

                                  bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                  NURSING CARE PLAN

                                  bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                  tachycardia dyspnea edema resolved change position frequently pillows for support

                                  bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                  bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                  bull Warm fluids if appropriate

                                  NURSING CARE PLAN

                                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                  NURSING CARE PLANbull Goal 3 provide for special safety

                                  needsbull Skin care

                                  bull Inspect massage lubricate bony prominences

                                  bull Use foot cradle heel protectors sheepskin

                                  bull Side rails up if hypoxic (disoriented)

                                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                                  bull ROM active passive elastic stockings

                                  NURSING CARE PLAN

                                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                  strict IObull Diet

                                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                  NURSING CARE PLAN

                                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                                  EVALUATION

                                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                  distressbull Reduction in dependent edema

                                  DAY 3 OF

                                  CARDIOVASCULARDISEASES

                                  bull hyperlipidemia means high lipid levels

                                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                  Treatment of Hyperlipidemia

                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                  bull SYSTOLIC DYSFUNCTION

                                  HYPERTROPHIC CARDIOMYOPATHY

                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                  HYPERTROPHIC CARDIOMYOPATHY

                                  bull Pathophysiologybull 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

                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                  CARDIOMYOPATHIES

                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                  CARDIOMYOPATHIES

                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                  CARDIOMYOPATHIES

                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                  relief

                                  CARDIOMYOPATHIES

                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                  CARDIOMYOPATHIES

                                  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

                                  Infective endocarditis

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

                                  bull Can be acute or chronic

                                  Infective endocarditis

                                  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

                                  Infective endocarditis

                                  bull Pathophysiologybull 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

                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                  Infective endocarditis

                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                  retina

                                  Infective endocarditis

                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                  Infective endocarditis

                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                  Infective endocarditis

                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                  organism

                                  Infective endocarditis

                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                  Infective endocarditis

                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                  B

                                  Infective endocarditis

                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                  CARDIOGENIC SHOCK

                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                  CARDIOGENIC SHOCK

                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                  CARDIOGENIC SHOCK

                                  bull LABORATORY FINDINGSIncreased CVP

                                  Normal is 4-10 cmH2O

                                  CARDIOGENIC SHOCK

                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                  inotropics such as DOPAMINE and DOBUTAMINE

                                  bull 3 Administer O2bull 4 Morphine is administered to

                                  decreased pulmonary congestion and to relieve pain

                                  CARDIOGENIC SHOCK

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

                                  bull 6 Monitor urinary output BP and pulses

                                  bull 7 cautiously administer diuretics and nitrates

                                  CARDIAC TAMPONADE

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

                                  CARDIAC TAMPONADE

                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                  CARDIAC TAMPONADE

                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                  CARDIAC TAMPONADE

                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                  distention hypotension and distantmuffled heart sound

                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                  CARDIAC TAMPONADE

                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                  anterior chest

                                  CARDIAC TAMPONADE

                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                  CARDIAC TAMPONADE

                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                  tamponade

                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                  HYPERTENSION

                                  bull 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

                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                  bull Most common typebull 2 Secondary

                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                  Alterations in Blood Flow in the Systemic Circulation

                                  Buergerrsquos Disease

                                  bull Also known as Thromboangiitis obliterans

                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                  reaction of the vessel wall

                                  Manifestations

                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                  Increased sensitivity to cold (due to impaired circulation

                                  Absentdiminished peripheral pulses

                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                  gangrenous changes may arise may necessitate amputation

                                  Diagnosis amp Treatment

                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                  bull Return to normal colorbull Note although all of the fingers are

                                  affected symmetrically only 1-2digits may be involved

                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                  (rare occasions)

                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                  protection from cold Avoidance of emotional stress (anxiety amp

                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                  A Assessment

                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                  2 vsB Nursing Dx

                                  1 ineffective tissue perfusion (cardiopulmonary)

                                  2 Impaired gas exchange

                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                  C Goals

                                  1 Relief of pain amp symptoms

                                  2 Prevention of further cardiac damage

                                  D Nursing Interventions

                                  1 Pain control

                                  2 Proper medications

                                  3 Decrease clientrsquos anxiety

                                  4 Health teachings (meds activities diet exercise etc)

                                  • CARDIOVASCULAR DISEASES
                                  • Slide 2
                                  • GENERAL CARDIAC ASSESSMENT
                                  • Pathophysiology
                                  • Slide 5
                                  • ASSESSING CHEST PAIN
                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                  • Angina Pectoris Myocardial Ischemia
                                  • Pathophysiology
                                  • Types
                                  • Slide 12
                                  • Slide 13
                                  • Slide 14
                                  • Conthellip
                                  • Conthellip (2)
                                  • Drug Therapy
                                  • Classification
                                  • Nursing Management
                                  • Nursing Management (2)
                                  • Acute Coronary Syndrome
                                  • Slide 22
                                  • Conthellip (3)
                                  • Slide 24
                                  • Conthellip(MI)
                                  • Slide 26
                                  • Pathophysiology (2)
                                  • Tissue Changes After MI
                                  • Management of MI
                                  • Slide 30
                                  • Slide 31
                                  • ASSESSMENT
                                  • ANALYSIS NURSING DIAGNOSES
                                  • NURSING CARE PLAN
                                  • NURSING CARE PLAN (2)
                                  • NURSING CARE PLAN (3)
                                  • NURSING CARE PLAN (4)
                                  • NURSING CARE PLAN (5)
                                  • NURSING CARE PLAN (6)
                                  • NURSING CARE PLAN (7)
                                  • NURSING CARE PLAN (8)
                                  • EVALUATION
                                  • CONGESTIVE HEART FAILURE
                                  • PATHOPHYSIOLOGY
                                  • ASSESSMENT (2)
                                  • ASSESSMENT (3)
                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                  • ANALYSIS NURSING DIAGNOSES (2)
                                  • Slide 49
                                  • NURSING CARE PLAN (9)
                                  • NURSING CARE PLAN (10)
                                  • NURSING CARE PLAN (11)
                                  • NURSING CARE PLAN (12)
                                  • NURSING CARE PLAN (13)
                                  • EVALUATION
                                  • Slide 56
                                  • Slide 57
                                  • Slide 58
                                  • Slide 59
                                  • Slide 60
                                  • Treatment of Hyperlipidemia
                                  • Slide 62
                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                  • HYPERTROPHIC CARDIOMYOPATHY
                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                  • RESTRICTIVE CARDIOMYOPATHY
                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                  • CARDIOMYOPATHIES
                                  • CARDIOMYOPATHIES (2)
                                  • CARDIOMYOPATHIES (3)
                                  • CARDIOMYOPATHIES (4)
                                  • CARDIOMYOPATHIES (5)
                                  • CARDIOMYOPATHIES (6)
                                  • Infective endocarditis
                                  • Infective endocarditis (2)
                                  • Infective endocarditis (3)
                                  • Infective endocarditis (4)
                                  • Infective endocarditis (5)
                                  • Infective endocarditis (6)
                                  • Infective endocarditis (7)
                                  • Infective endocarditis (8)
                                  • Infective endocarditis (9)
                                  • Infective endocarditis (10)
                                  • Infective endocarditis (11)
                                  • Infective endocarditis (12)
                                  • CARDIOGENIC SHOCK
                                  • CARDIOGENIC SHOCK (2)
                                  • CARDIOGENIC SHOCK (3)
                                  • CARDIOGENIC SHOCK (4)
                                  • CARDIOGENIC SHOCK (5)
                                  • CARDIAC TAMPONADE
                                  • CARDIAC TAMPONADE (2)
                                  • CARDIAC TAMPONADE (3)
                                  • CARDIAC TAMPONADE (4)
                                  • CARDIAC TAMPONADE (5)
                                  • CARDIAC TAMPONADE (6)
                                  • CARDIAC TAMPONADE (7)
                                  • Slide 100
                                  • HYPERTENSION
                                  • HYPERTENSION (2)
                                  • Slide 103
                                  • Slide 104
                                  • Slide 105
                                  • Alterations in Blood Flow in the Systemic Circulation
                                  • Buergerrsquos Disease
                                  • Slide 108
                                  • Manifestations
                                  • Slide 110
                                  • Diagnosis amp Treatment
                                  • Rynaudrsquos Disease
                                  • Manifestations (2)
                                  • Slide 114
                                  • Diagnosis amp Treatment (2)
                                  • Slide 116
                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                  • Slide 118
                                  • Slide 119
                                  • Slide 120
                                  • Slide 121

                                    Nursing Management

                                    Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish

                                    Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos

                                    limitations NTGs ndash max of 3doses at 5-min intervals

                                    Stinging sensation under the tongue for SL is normal

                                    Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber

                                    bottles amp change stocks every 6months Inform clients that headache dizziness

                                    flushed face are common side effects

                                    Do not discontinue the drug For patches rotate skin sites usually on

                                    chest wall Instrct on evaluation of effectiveness based

                                    on pain reliefPropanolols causes bronchospasm amp

                                    hypoglycemia do not administer to asthmatic amp diabetic clients

                                    Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                                    Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                                    Nursing Management

                                    Acute Coronary Syndrome

                                    Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                                    Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                                    Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                                    gt20mins)2 New onset exertional angina (increased in

                                    severity of at least 1 class ndash to at least class III) in lt2months

                                    3 Recent acceleration of angina to at least class III in lt2months

                                    Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                    When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                    Conthellip

                                    ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                    myocardial tissue associated with atherosclerotic disease of coronary arteries

                                    Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                    Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                    elevation Q wave prolongation T wave inversion

                                    Conthellip(MI)

                                    Manifestations chest pain ndash severe crushing

                                    constricting ldquosomeone sitting on my chestrdquo

                                    - substernal radiating to left arm neck or jaw

                                    - prolonged (gt35mins) amp not relieved by rest

                                    Shortness of breath profuse perspirationFeeling of impending doom

                                    Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                    profound LV failure from massive MI resulting to low cardiac output

                                    Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                    Rupture of myocardiumVentricular aneurysms ndash decreases

                                    pumping efficiency of heart amp increases work of LV

                                    Pathophysiology

                                    Causes atherosclerotic heart disease thrombosisembolism

                                    shock ampor hemorrhage direct traumaMyocardial ischemia

                                    uarrcellular hypoxia

                                    darrmyocardial O2 supplydarr myocardial contractility

                                    darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                    uarrperipheral vasoconstriction

                                    uarr myocardial contractility

                                    uarr afterload uarrmyocardial O2 demand

                                    uarr HR uarrdiastolicfilling

                                    darrmyocardial tissue perfusion

                                    Tissue Changes After MI

                                    Time after Onset Type of Injury amp Gross Tissue Changes

                                    0-05hrs Reversible injury

                                    1-2hrs Onset of irreversible injury

                                    4-12hrs Beginning of coagulation necrosis

                                    18-24hrs Continued necrosis gross pallor of infected tissue

                                    1-3days Total necrosis onset of acute inflammatory process

                                    3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                    7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                    8th week Complete scar tissue replacement

                                    Management of MI Initial Management OMEN

                                    - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                    vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                    may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                    Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                    Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                    bull Surgery 1Revascularization

                                    bullPTCAbullCoronary stent implantation

                                    bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                    2Resection ndash aneurysm

                                    ASSESSMENT

                                    bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                    bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                    ANALYSIS NURSING DIAGNOSES

                                    bull Decreased cardiac output related to myocardial damage

                                    bull Impaired gas exchange related to poor perfusion shock

                                    bull Pain related to myocardial ischemia

                                    bull Activity intolerance related to pain or inadequate oxygenation

                                    bull Fear related to possibility of death

                                    NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                    bull Narcotics ndash morphine note response Avoid IM

                                    bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                    bull Position semi-Fowlerrsquos to improve ventilation

                                    NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                    rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                    thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                    cracklesbull Check labs troponin blood gases electrolytes

                                    clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                    bull ROM of lower extremities antiembolic stockings

                                    NURSING CARE PLAN

                                    bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                    bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                    bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                    bull Anticipate needs of client call light water Reassurance

                                    bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                    NURSING CARE PLAN

                                    bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                    Mg)bull Monitor ECGbull Diet progressive low

                                    calorie low sodium low cholesterol low fat without caffeine

                                    NURSING CARE PLAN

                                    bull Goal 5 facilitate fecal eliminationbull Medications stool

                                    softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                    bull Bedside commode

                                    NURSING CARE PLAN

                                    bull Goal 6 provide emotional supportbull Recognize fear of dying

                                    denial anger withdrawalbull Encourage expression of

                                    feelings fears concernsbull Discuss rehabilitation lifestyle

                                    changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                    NURSING CARE PLAN

                                    bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                    activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                    bull Identify need for referral for sexual counselling

                                    NURSING CARE PLAN

                                    bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                    meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                    bull Information about sexual activity less fatiguing positions

                                    bull Support groups Follow-up carebull Medications administration importance untoward

                                    effects pulse takingbull Control risk factors rest diet exercise no smoking

                                    weight control stress reduction

                                    EVALUATION

                                    bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                    CONGESTIVE HEART FAILURE

                                    bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                    PATHOPHYSIOLOGY

                                    Increased cardiac workload

                                    decreased effective myocardial contractility

                                    Decreased cardiac output

                                    LV failure Pulmonary congestion

                                    RA RV failure

                                    Systemic congestion

                                    Peripheral edema

                                    ASSESSMENTbull Subjective data

                                    bull Shortness of breathbull Orthopnea (sleeps on two

                                    or more pillows)bull Paroxysmal nocturnal

                                    dyspnea (sudden breathlessness during sleep)

                                    bull Dyspnea on exertion (climbing stairs)

                                    bull Apprehension anxiety irritability

                                    bull Fatigue weaknessbull Reported weight gain

                                    feeling of puffiness

                                    ASSESSMENTbull Objective data

                                    bull VSbull BP decreasing systolic

                                    narrowing pulse pressurebull Pulse pulsus alternans

                                    (alternating strong-weak-strong cardiac contraction) increased

                                    bull Respirations crackles Cheyne-Stokes

                                    bull Edema dependent pitting (1+ to 4+ mm)

                                    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                    dilated pulmonary vessels lung edema

                                    Left Ventricular Compared with Right Ventricular Heart Failure

                                    LEFT VENTRICULAR

                                    FAILURE

                                    RIGHT VENTRICULAR

                                    FAILURE

                                    Pulmonary crackles Jugular venous distention

                                    Tachypnea Peripheral edema

                                    S3 gallop Perioral and peripheral cyanosis

                                    Cardiac murmurs Congestive hepatomegaly

                                    Paradoxical splitting of S2

                                    Ascites

                                    Hepatojugular reflux

                                    ANALYSIS NURSING DIAGNOSES

                                    bull Decreased cardiac output related to decreased myocardial contractility

                                    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                    bull Fatigue related to edema and poor oxygenation

                                    bull Fluid volume excess related to compensatory mechanisms

                                    bull Impaired gas exchange related to pulmonary congestion

                                    bull Anxiety related to shortness of breath

                                    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                    NURSING CARE PLAN

                                    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                    tachycardia dyspnea edema resolved change position frequently pillows for support

                                    bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                    bull Warm fluids if appropriate

                                    NURSING CARE PLAN

                                    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                    NURSING CARE PLANbull Goal 3 provide for special safety

                                    needsbull Skin care

                                    bull Inspect massage lubricate bony prominences

                                    bull Use foot cradle heel protectors sheepskin

                                    bull Side rails up if hypoxic (disoriented)

                                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                                    bull ROM active passive elastic stockings

                                    NURSING CARE PLAN

                                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                    strict IObull Diet

                                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                    NURSING CARE PLAN

                                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                                    EVALUATION

                                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                    distressbull Reduction in dependent edema

                                    DAY 3 OF

                                    CARDIOVASCULARDISEASES

                                    bull hyperlipidemia means high lipid levels

                                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                    Treatment of Hyperlipidemia

                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                    bull SYSTOLIC DYSFUNCTION

                                    HYPERTROPHIC CARDIOMYOPATHY

                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                    HYPERTROPHIC CARDIOMYOPATHY

                                    bull Pathophysiologybull 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

                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                    CARDIOMYOPATHIES

                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                    CARDIOMYOPATHIES

                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                    CARDIOMYOPATHIES

                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                    relief

                                    CARDIOMYOPATHIES

                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                    CARDIOMYOPATHIES

                                    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

                                    Infective endocarditis

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

                                    bull Can be acute or chronic

                                    Infective endocarditis

                                    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

                                    Infective endocarditis

                                    bull Pathophysiologybull 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

                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                    Infective endocarditis

                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                    retina

                                    Infective endocarditis

                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                    Infective endocarditis

                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                    Infective endocarditis

                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                    organism

                                    Infective endocarditis

                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                    Infective endocarditis

                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                    B

                                    Infective endocarditis

                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                    CARDIOGENIC SHOCK

                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                    CARDIOGENIC SHOCK

                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                    CARDIOGENIC SHOCK

                                    bull LABORATORY FINDINGSIncreased CVP

                                    Normal is 4-10 cmH2O

                                    CARDIOGENIC SHOCK

                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                    inotropics such as DOPAMINE and DOBUTAMINE

                                    bull 3 Administer O2bull 4 Morphine is administered to

                                    decreased pulmonary congestion and to relieve pain

                                    CARDIOGENIC SHOCK

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

                                    bull 6 Monitor urinary output BP and pulses

                                    bull 7 cautiously administer diuretics and nitrates

                                    CARDIAC TAMPONADE

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

                                    CARDIAC TAMPONADE

                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                    CARDIAC TAMPONADE

                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                    CARDIAC TAMPONADE

                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                    distention hypotension and distantmuffled heart sound

                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                    CARDIAC TAMPONADE

                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                    anterior chest

                                    CARDIAC TAMPONADE

                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                    CARDIAC TAMPONADE

                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                    tamponade

                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                    HYPERTENSION

                                    bull 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

                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                    bull Most common typebull 2 Secondary

                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                    Alterations in Blood Flow in the Systemic Circulation

                                    Buergerrsquos Disease

                                    bull Also known as Thromboangiitis obliterans

                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                    reaction of the vessel wall

                                    Manifestations

                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                    Increased sensitivity to cold (due to impaired circulation

                                    Absentdiminished peripheral pulses

                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                    gangrenous changes may arise may necessitate amputation

                                    Diagnosis amp Treatment

                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                    bull Return to normal colorbull Note although all of the fingers are

                                    affected symmetrically only 1-2digits may be involved

                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                    (rare occasions)

                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                    protection from cold Avoidance of emotional stress (anxiety amp

                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                    A Assessment

                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                    2 vsB Nursing Dx

                                    1 ineffective tissue perfusion (cardiopulmonary)

                                    2 Impaired gas exchange

                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                    C Goals

                                    1 Relief of pain amp symptoms

                                    2 Prevention of further cardiac damage

                                    D Nursing Interventions

                                    1 Pain control

                                    2 Proper medications

                                    3 Decrease clientrsquos anxiety

                                    4 Health teachings (meds activities diet exercise etc)

                                    • CARDIOVASCULAR DISEASES
                                    • Slide 2
                                    • GENERAL CARDIAC ASSESSMENT
                                    • Pathophysiology
                                    • Slide 5
                                    • ASSESSING CHEST PAIN
                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                    • Angina Pectoris Myocardial Ischemia
                                    • Pathophysiology
                                    • Types
                                    • Slide 12
                                    • Slide 13
                                    • Slide 14
                                    • Conthellip
                                    • Conthellip (2)
                                    • Drug Therapy
                                    • Classification
                                    • Nursing Management
                                    • Nursing Management (2)
                                    • Acute Coronary Syndrome
                                    • Slide 22
                                    • Conthellip (3)
                                    • Slide 24
                                    • Conthellip(MI)
                                    • Slide 26
                                    • Pathophysiology (2)
                                    • Tissue Changes After MI
                                    • Management of MI
                                    • Slide 30
                                    • Slide 31
                                    • ASSESSMENT
                                    • ANALYSIS NURSING DIAGNOSES
                                    • NURSING CARE PLAN
                                    • NURSING CARE PLAN (2)
                                    • NURSING CARE PLAN (3)
                                    • NURSING CARE PLAN (4)
                                    • NURSING CARE PLAN (5)
                                    • NURSING CARE PLAN (6)
                                    • NURSING CARE PLAN (7)
                                    • NURSING CARE PLAN (8)
                                    • EVALUATION
                                    • CONGESTIVE HEART FAILURE
                                    • PATHOPHYSIOLOGY
                                    • ASSESSMENT (2)
                                    • ASSESSMENT (3)
                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                    • ANALYSIS NURSING DIAGNOSES (2)
                                    • Slide 49
                                    • NURSING CARE PLAN (9)
                                    • NURSING CARE PLAN (10)
                                    • NURSING CARE PLAN (11)
                                    • NURSING CARE PLAN (12)
                                    • NURSING CARE PLAN (13)
                                    • EVALUATION
                                    • Slide 56
                                    • Slide 57
                                    • Slide 58
                                    • Slide 59
                                    • Slide 60
                                    • Treatment of Hyperlipidemia
                                    • Slide 62
                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                    • HYPERTROPHIC CARDIOMYOPATHY
                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                    • RESTRICTIVE CARDIOMYOPATHY
                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                    • CARDIOMYOPATHIES
                                    • CARDIOMYOPATHIES (2)
                                    • CARDIOMYOPATHIES (3)
                                    • CARDIOMYOPATHIES (4)
                                    • CARDIOMYOPATHIES (5)
                                    • CARDIOMYOPATHIES (6)
                                    • Infective endocarditis
                                    • Infective endocarditis (2)
                                    • Infective endocarditis (3)
                                    • Infective endocarditis (4)
                                    • Infective endocarditis (5)
                                    • Infective endocarditis (6)
                                    • Infective endocarditis (7)
                                    • Infective endocarditis (8)
                                    • Infective endocarditis (9)
                                    • Infective endocarditis (10)
                                    • Infective endocarditis (11)
                                    • Infective endocarditis (12)
                                    • CARDIOGENIC SHOCK
                                    • CARDIOGENIC SHOCK (2)
                                    • CARDIOGENIC SHOCK (3)
                                    • CARDIOGENIC SHOCK (4)
                                    • CARDIOGENIC SHOCK (5)
                                    • CARDIAC TAMPONADE
                                    • CARDIAC TAMPONADE (2)
                                    • CARDIAC TAMPONADE (3)
                                    • CARDIAC TAMPONADE (4)
                                    • CARDIAC TAMPONADE (5)
                                    • CARDIAC TAMPONADE (6)
                                    • CARDIAC TAMPONADE (7)
                                    • Slide 100
                                    • HYPERTENSION
                                    • HYPERTENSION (2)
                                    • Slide 103
                                    • Slide 104
                                    • Slide 105
                                    • Alterations in Blood Flow in the Systemic Circulation
                                    • Buergerrsquos Disease
                                    • Slide 108
                                    • Manifestations
                                    • Slide 110
                                    • Diagnosis amp Treatment
                                    • Rynaudrsquos Disease
                                    • Manifestations (2)
                                    • Slide 114
                                    • Diagnosis amp Treatment (2)
                                    • Slide 116
                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                    • Slide 118
                                    • Slide 119
                                    • Slide 120
                                    • Slide 121

                                      Do not discontinue the drug For patches rotate skin sites usually on

                                      chest wall Instrct on evaluation of effectiveness based

                                      on pain reliefPropanolols causes bronchospasm amp

                                      hypoglycemia do not administer to asthmatic amp diabetic clients

                                      Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available

                                      Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)

                                      Nursing Management

                                      Acute Coronary Syndrome

                                      Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                                      Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                                      Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                                      gt20mins)2 New onset exertional angina (increased in

                                      severity of at least 1 class ndash to at least class III) in lt2months

                                      3 Recent acceleration of angina to at least class III in lt2months

                                      Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                      When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                      Conthellip

                                      ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                      myocardial tissue associated with atherosclerotic disease of coronary arteries

                                      Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                      Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                      elevation Q wave prolongation T wave inversion

                                      Conthellip(MI)

                                      Manifestations chest pain ndash severe crushing

                                      constricting ldquosomeone sitting on my chestrdquo

                                      - substernal radiating to left arm neck or jaw

                                      - prolonged (gt35mins) amp not relieved by rest

                                      Shortness of breath profuse perspirationFeeling of impending doom

                                      Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                      profound LV failure from massive MI resulting to low cardiac output

                                      Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                      Rupture of myocardiumVentricular aneurysms ndash decreases

                                      pumping efficiency of heart amp increases work of LV

                                      Pathophysiology

                                      Causes atherosclerotic heart disease thrombosisembolism

                                      shock ampor hemorrhage direct traumaMyocardial ischemia

                                      uarrcellular hypoxia

                                      darrmyocardial O2 supplydarr myocardial contractility

                                      darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                      uarrperipheral vasoconstriction

                                      uarr myocardial contractility

                                      uarr afterload uarrmyocardial O2 demand

                                      uarr HR uarrdiastolicfilling

                                      darrmyocardial tissue perfusion

                                      Tissue Changes After MI

                                      Time after Onset Type of Injury amp Gross Tissue Changes

                                      0-05hrs Reversible injury

                                      1-2hrs Onset of irreversible injury

                                      4-12hrs Beginning of coagulation necrosis

                                      18-24hrs Continued necrosis gross pallor of infected tissue

                                      1-3days Total necrosis onset of acute inflammatory process

                                      3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                      7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                      8th week Complete scar tissue replacement

                                      Management of MI Initial Management OMEN

                                      - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                      vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                      may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                      Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                      Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                      bull Surgery 1Revascularization

                                      bullPTCAbullCoronary stent implantation

                                      bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                      2Resection ndash aneurysm

                                      ASSESSMENT

                                      bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                      bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                      ANALYSIS NURSING DIAGNOSES

                                      bull Decreased cardiac output related to myocardial damage

                                      bull Impaired gas exchange related to poor perfusion shock

                                      bull Pain related to myocardial ischemia

                                      bull Activity intolerance related to pain or inadequate oxygenation

                                      bull Fear related to possibility of death

                                      NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                      bull Narcotics ndash morphine note response Avoid IM

                                      bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                      bull Position semi-Fowlerrsquos to improve ventilation

                                      NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                      rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                      thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                      cracklesbull Check labs troponin blood gases electrolytes

                                      clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                      bull ROM of lower extremities antiembolic stockings

                                      NURSING CARE PLAN

                                      bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                      bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                      bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                      bull Anticipate needs of client call light water Reassurance

                                      bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                      NURSING CARE PLAN

                                      bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                      Mg)bull Monitor ECGbull Diet progressive low

                                      calorie low sodium low cholesterol low fat without caffeine

                                      NURSING CARE PLAN

                                      bull Goal 5 facilitate fecal eliminationbull Medications stool

                                      softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                      bull Bedside commode

                                      NURSING CARE PLAN

                                      bull Goal 6 provide emotional supportbull Recognize fear of dying

                                      denial anger withdrawalbull Encourage expression of

                                      feelings fears concernsbull Discuss rehabilitation lifestyle

                                      changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                      NURSING CARE PLAN

                                      bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                      activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                      bull Identify need for referral for sexual counselling

                                      NURSING CARE PLAN

                                      bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                      meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                      bull Information about sexual activity less fatiguing positions

                                      bull Support groups Follow-up carebull Medications administration importance untoward

                                      effects pulse takingbull Control risk factors rest diet exercise no smoking

                                      weight control stress reduction

                                      EVALUATION

                                      bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                      CONGESTIVE HEART FAILURE

                                      bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                      PATHOPHYSIOLOGY

                                      Increased cardiac workload

                                      decreased effective myocardial contractility

                                      Decreased cardiac output

                                      LV failure Pulmonary congestion

                                      RA RV failure

                                      Systemic congestion

                                      Peripheral edema

                                      ASSESSMENTbull Subjective data

                                      bull Shortness of breathbull Orthopnea (sleeps on two

                                      or more pillows)bull Paroxysmal nocturnal

                                      dyspnea (sudden breathlessness during sleep)

                                      bull Dyspnea on exertion (climbing stairs)

                                      bull Apprehension anxiety irritability

                                      bull Fatigue weaknessbull Reported weight gain

                                      feeling of puffiness

                                      ASSESSMENTbull Objective data

                                      bull VSbull BP decreasing systolic

                                      narrowing pulse pressurebull Pulse pulsus alternans

                                      (alternating strong-weak-strong cardiac contraction) increased

                                      bull Respirations crackles Cheyne-Stokes

                                      bull Edema dependent pitting (1+ to 4+ mm)

                                      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                      dilated pulmonary vessels lung edema

                                      Left Ventricular Compared with Right Ventricular Heart Failure

                                      LEFT VENTRICULAR

                                      FAILURE

                                      RIGHT VENTRICULAR

                                      FAILURE

                                      Pulmonary crackles Jugular venous distention

                                      Tachypnea Peripheral edema

                                      S3 gallop Perioral and peripheral cyanosis

                                      Cardiac murmurs Congestive hepatomegaly

                                      Paradoxical splitting of S2

                                      Ascites

                                      Hepatojugular reflux

                                      ANALYSIS NURSING DIAGNOSES

                                      bull Decreased cardiac output related to decreased myocardial contractility

                                      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                      bull Fatigue related to edema and poor oxygenation

                                      bull Fluid volume excess related to compensatory mechanisms

                                      bull Impaired gas exchange related to pulmonary congestion

                                      bull Anxiety related to shortness of breath

                                      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                      NURSING CARE PLAN

                                      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                      tachycardia dyspnea edema resolved change position frequently pillows for support

                                      bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                      bull Warm fluids if appropriate

                                      NURSING CARE PLAN

                                      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                      NURSING CARE PLANbull Goal 3 provide for special safety

                                      needsbull Skin care

                                      bull Inspect massage lubricate bony prominences

                                      bull Use foot cradle heel protectors sheepskin

                                      bull Side rails up if hypoxic (disoriented)

                                      bull Vital signs monitor for signs of fatigue pulmonary emboli

                                      bull ROM active passive elastic stockings

                                      NURSING CARE PLAN

                                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                      strict IObull Diet

                                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                      NURSING CARE PLAN

                                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                                      EVALUATION

                                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                      distressbull Reduction in dependent edema

                                      DAY 3 OF

                                      CARDIOVASCULARDISEASES

                                      bull hyperlipidemia means high lipid levels

                                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                      Treatment of Hyperlipidemia

                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                      bull SYSTOLIC DYSFUNCTION

                                      HYPERTROPHIC CARDIOMYOPATHY

                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                      HYPERTROPHIC CARDIOMYOPATHY

                                      bull Pathophysiologybull 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

                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                      CARDIOMYOPATHIES

                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                      CARDIOMYOPATHIES

                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                      CARDIOMYOPATHIES

                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                      relief

                                      CARDIOMYOPATHIES

                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                      CARDIOMYOPATHIES

                                      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

                                      Infective endocarditis

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

                                      bull Can be acute or chronic

                                      Infective endocarditis

                                      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

                                      Infective endocarditis

                                      bull Pathophysiologybull 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

                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                      Infective endocarditis

                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                      retina

                                      Infective endocarditis

                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                      Infective endocarditis

                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                      Infective endocarditis

                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                      organism

                                      Infective endocarditis

                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                      Infective endocarditis

                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                      B

                                      Infective endocarditis

                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                      CARDIOGENIC SHOCK

                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                      CARDIOGENIC SHOCK

                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                      CARDIOGENIC SHOCK

                                      bull LABORATORY FINDINGSIncreased CVP

                                      Normal is 4-10 cmH2O

                                      CARDIOGENIC SHOCK

                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                      inotropics such as DOPAMINE and DOBUTAMINE

                                      bull 3 Administer O2bull 4 Morphine is administered to

                                      decreased pulmonary congestion and to relieve pain

                                      CARDIOGENIC SHOCK

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

                                      bull 6 Monitor urinary output BP and pulses

                                      bull 7 cautiously administer diuretics and nitrates

                                      CARDIAC TAMPONADE

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

                                      CARDIAC TAMPONADE

                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                      CARDIAC TAMPONADE

                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                      CARDIAC TAMPONADE

                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                      distention hypotension and distantmuffled heart sound

                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                      CARDIAC TAMPONADE

                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                      anterior chest

                                      CARDIAC TAMPONADE

                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                      CARDIAC TAMPONADE

                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                      tamponade

                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                      HYPERTENSION

                                      bull 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

                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                      bull Most common typebull 2 Secondary

                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                      Alterations in Blood Flow in the Systemic Circulation

                                      Buergerrsquos Disease

                                      bull Also known as Thromboangiitis obliterans

                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                      reaction of the vessel wall

                                      Manifestations

                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                      Increased sensitivity to cold (due to impaired circulation

                                      Absentdiminished peripheral pulses

                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                      gangrenous changes may arise may necessitate amputation

                                      Diagnosis amp Treatment

                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                      bull Return to normal colorbull Note although all of the fingers are

                                      affected symmetrically only 1-2digits may be involved

                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                      (rare occasions)

                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                      protection from cold Avoidance of emotional stress (anxiety amp

                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                      A Assessment

                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                      2 vsB Nursing Dx

                                      1 ineffective tissue perfusion (cardiopulmonary)

                                      2 Impaired gas exchange

                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                      C Goals

                                      1 Relief of pain amp symptoms

                                      2 Prevention of further cardiac damage

                                      D Nursing Interventions

                                      1 Pain control

                                      2 Proper medications

                                      3 Decrease clientrsquos anxiety

                                      4 Health teachings (meds activities diet exercise etc)

                                      • CARDIOVASCULAR DISEASES
                                      • Slide 2
                                      • GENERAL CARDIAC ASSESSMENT
                                      • Pathophysiology
                                      • Slide 5
                                      • ASSESSING CHEST PAIN
                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                      • Angina Pectoris Myocardial Ischemia
                                      • Pathophysiology
                                      • Types
                                      • Slide 12
                                      • Slide 13
                                      • Slide 14
                                      • Conthellip
                                      • Conthellip (2)
                                      • Drug Therapy
                                      • Classification
                                      • Nursing Management
                                      • Nursing Management (2)
                                      • Acute Coronary Syndrome
                                      • Slide 22
                                      • Conthellip (3)
                                      • Slide 24
                                      • Conthellip(MI)
                                      • Slide 26
                                      • Pathophysiology (2)
                                      • Tissue Changes After MI
                                      • Management of MI
                                      • Slide 30
                                      • Slide 31
                                      • ASSESSMENT
                                      • ANALYSIS NURSING DIAGNOSES
                                      • NURSING CARE PLAN
                                      • NURSING CARE PLAN (2)
                                      • NURSING CARE PLAN (3)
                                      • NURSING CARE PLAN (4)
                                      • NURSING CARE PLAN (5)
                                      • NURSING CARE PLAN (6)
                                      • NURSING CARE PLAN (7)
                                      • NURSING CARE PLAN (8)
                                      • EVALUATION
                                      • CONGESTIVE HEART FAILURE
                                      • PATHOPHYSIOLOGY
                                      • ASSESSMENT (2)
                                      • ASSESSMENT (3)
                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                      • ANALYSIS NURSING DIAGNOSES (2)
                                      • Slide 49
                                      • NURSING CARE PLAN (9)
                                      • NURSING CARE PLAN (10)
                                      • NURSING CARE PLAN (11)
                                      • NURSING CARE PLAN (12)
                                      • NURSING CARE PLAN (13)
                                      • EVALUATION
                                      • Slide 56
                                      • Slide 57
                                      • Slide 58
                                      • Slide 59
                                      • Slide 60
                                      • Treatment of Hyperlipidemia
                                      • Slide 62
                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                      • HYPERTROPHIC CARDIOMYOPATHY
                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                      • RESTRICTIVE CARDIOMYOPATHY
                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                      • CARDIOMYOPATHIES
                                      • CARDIOMYOPATHIES (2)
                                      • CARDIOMYOPATHIES (3)
                                      • CARDIOMYOPATHIES (4)
                                      • CARDIOMYOPATHIES (5)
                                      • CARDIOMYOPATHIES (6)
                                      • Infective endocarditis
                                      • Infective endocarditis (2)
                                      • Infective endocarditis (3)
                                      • Infective endocarditis (4)
                                      • Infective endocarditis (5)
                                      • Infective endocarditis (6)
                                      • Infective endocarditis (7)
                                      • Infective endocarditis (8)
                                      • Infective endocarditis (9)
                                      • Infective endocarditis (10)
                                      • Infective endocarditis (11)
                                      • Infective endocarditis (12)
                                      • CARDIOGENIC SHOCK
                                      • CARDIOGENIC SHOCK (2)
                                      • CARDIOGENIC SHOCK (3)
                                      • CARDIOGENIC SHOCK (4)
                                      • CARDIOGENIC SHOCK (5)
                                      • CARDIAC TAMPONADE
                                      • CARDIAC TAMPONADE (2)
                                      • CARDIAC TAMPONADE (3)
                                      • CARDIAC TAMPONADE (4)
                                      • CARDIAC TAMPONADE (5)
                                      • CARDIAC TAMPONADE (6)
                                      • CARDIAC TAMPONADE (7)
                                      • Slide 100
                                      • HYPERTENSION
                                      • HYPERTENSION (2)
                                      • Slide 103
                                      • Slide 104
                                      • Slide 105
                                      • Alterations in Blood Flow in the Systemic Circulation
                                      • Buergerrsquos Disease
                                      • Slide 108
                                      • Manifestations
                                      • Slide 110
                                      • Diagnosis amp Treatment
                                      • Rynaudrsquos Disease
                                      • Manifestations (2)
                                      • Slide 114
                                      • Diagnosis amp Treatment (2)
                                      • Slide 116
                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                      • Slide 118
                                      • Slide 119
                                      • Slide 120
                                      • Slide 121

                                        Acute Coronary Syndrome

                                        Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia

                                        Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)

                                        Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie

                                        gt20mins)2 New onset exertional angina (increased in

                                        severity of at least 1 class ndash to at least class III) in lt2months

                                        3 Recent acceleration of angina to at least class III in lt2months

                                        Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                        When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                        Conthellip

                                        ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                        myocardial tissue associated with atherosclerotic disease of coronary arteries

                                        Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                        Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                        elevation Q wave prolongation T wave inversion

                                        Conthellip(MI)

                                        Manifestations chest pain ndash severe crushing

                                        constricting ldquosomeone sitting on my chestrdquo

                                        - substernal radiating to left arm neck or jaw

                                        - prolonged (gt35mins) amp not relieved by rest

                                        Shortness of breath profuse perspirationFeeling of impending doom

                                        Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                        profound LV failure from massive MI resulting to low cardiac output

                                        Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                        Rupture of myocardiumVentricular aneurysms ndash decreases

                                        pumping efficiency of heart amp increases work of LV

                                        Pathophysiology

                                        Causes atherosclerotic heart disease thrombosisembolism

                                        shock ampor hemorrhage direct traumaMyocardial ischemia

                                        uarrcellular hypoxia

                                        darrmyocardial O2 supplydarr myocardial contractility

                                        darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                        uarrperipheral vasoconstriction

                                        uarr myocardial contractility

                                        uarr afterload uarrmyocardial O2 demand

                                        uarr HR uarrdiastolicfilling

                                        darrmyocardial tissue perfusion

                                        Tissue Changes After MI

                                        Time after Onset Type of Injury amp Gross Tissue Changes

                                        0-05hrs Reversible injury

                                        1-2hrs Onset of irreversible injury

                                        4-12hrs Beginning of coagulation necrosis

                                        18-24hrs Continued necrosis gross pallor of infected tissue

                                        1-3days Total necrosis onset of acute inflammatory process

                                        3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                        7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                        8th week Complete scar tissue replacement

                                        Management of MI Initial Management OMEN

                                        - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                        vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                        may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                        Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                        Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                        bull Surgery 1Revascularization

                                        bullPTCAbullCoronary stent implantation

                                        bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                        2Resection ndash aneurysm

                                        ASSESSMENT

                                        bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                        bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                        ANALYSIS NURSING DIAGNOSES

                                        bull Decreased cardiac output related to myocardial damage

                                        bull Impaired gas exchange related to poor perfusion shock

                                        bull Pain related to myocardial ischemia

                                        bull Activity intolerance related to pain or inadequate oxygenation

                                        bull Fear related to possibility of death

                                        NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                        bull Narcotics ndash morphine note response Avoid IM

                                        bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                        bull Position semi-Fowlerrsquos to improve ventilation

                                        NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                        rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                        thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                        cracklesbull Check labs troponin blood gases electrolytes

                                        clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                        bull ROM of lower extremities antiembolic stockings

                                        NURSING CARE PLAN

                                        bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                        bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                        bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                        bull Anticipate needs of client call light water Reassurance

                                        bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                        NURSING CARE PLAN

                                        bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                        Mg)bull Monitor ECGbull Diet progressive low

                                        calorie low sodium low cholesterol low fat without caffeine

                                        NURSING CARE PLAN

                                        bull Goal 5 facilitate fecal eliminationbull Medications stool

                                        softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                        bull Bedside commode

                                        NURSING CARE PLAN

                                        bull Goal 6 provide emotional supportbull Recognize fear of dying

                                        denial anger withdrawalbull Encourage expression of

                                        feelings fears concernsbull Discuss rehabilitation lifestyle

                                        changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                        NURSING CARE PLAN

                                        bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                        activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                        bull Identify need for referral for sexual counselling

                                        NURSING CARE PLAN

                                        bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                        meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                        bull Information about sexual activity less fatiguing positions

                                        bull Support groups Follow-up carebull Medications administration importance untoward

                                        effects pulse takingbull Control risk factors rest diet exercise no smoking

                                        weight control stress reduction

                                        EVALUATION

                                        bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                        CONGESTIVE HEART FAILURE

                                        bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                        PATHOPHYSIOLOGY

                                        Increased cardiac workload

                                        decreased effective myocardial contractility

                                        Decreased cardiac output

                                        LV failure Pulmonary congestion

                                        RA RV failure

                                        Systemic congestion

                                        Peripheral edema

                                        ASSESSMENTbull Subjective data

                                        bull Shortness of breathbull Orthopnea (sleeps on two

                                        or more pillows)bull Paroxysmal nocturnal

                                        dyspnea (sudden breathlessness during sleep)

                                        bull Dyspnea on exertion (climbing stairs)

                                        bull Apprehension anxiety irritability

                                        bull Fatigue weaknessbull Reported weight gain

                                        feeling of puffiness

                                        ASSESSMENTbull Objective data

                                        bull VSbull BP decreasing systolic

                                        narrowing pulse pressurebull Pulse pulsus alternans

                                        (alternating strong-weak-strong cardiac contraction) increased

                                        bull Respirations crackles Cheyne-Stokes

                                        bull Edema dependent pitting (1+ to 4+ mm)

                                        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                        dilated pulmonary vessels lung edema

                                        Left Ventricular Compared with Right Ventricular Heart Failure

                                        LEFT VENTRICULAR

                                        FAILURE

                                        RIGHT VENTRICULAR

                                        FAILURE

                                        Pulmonary crackles Jugular venous distention

                                        Tachypnea Peripheral edema

                                        S3 gallop Perioral and peripheral cyanosis

                                        Cardiac murmurs Congestive hepatomegaly

                                        Paradoxical splitting of S2

                                        Ascites

                                        Hepatojugular reflux

                                        ANALYSIS NURSING DIAGNOSES

                                        bull Decreased cardiac output related to decreased myocardial contractility

                                        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                        bull Fatigue related to edema and poor oxygenation

                                        bull Fluid volume excess related to compensatory mechanisms

                                        bull Impaired gas exchange related to pulmonary congestion

                                        bull Anxiety related to shortness of breath

                                        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                        NURSING CARE PLAN

                                        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                        tachycardia dyspnea edema resolved change position frequently pillows for support

                                        bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                        bull Warm fluids if appropriate

                                        NURSING CARE PLAN

                                        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                        NURSING CARE PLANbull Goal 3 provide for special safety

                                        needsbull Skin care

                                        bull Inspect massage lubricate bony prominences

                                        bull Use foot cradle heel protectors sheepskin

                                        bull Side rails up if hypoxic (disoriented)

                                        bull Vital signs monitor for signs of fatigue pulmonary emboli

                                        bull ROM active passive elastic stockings

                                        NURSING CARE PLAN

                                        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                        strict IObull Diet

                                        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                        NURSING CARE PLAN

                                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                                        EVALUATION

                                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                        distressbull Reduction in dependent edema

                                        DAY 3 OF

                                        CARDIOVASCULARDISEASES

                                        bull hyperlipidemia means high lipid levels

                                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                        Treatment of Hyperlipidemia

                                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                        bull SYSTOLIC DYSFUNCTION

                                        HYPERTROPHIC CARDIOMYOPATHY

                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                        HYPERTROPHIC CARDIOMYOPATHY

                                        bull Pathophysiologybull 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

                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                        CARDIOMYOPATHIES

                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                        CARDIOMYOPATHIES

                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                        CARDIOMYOPATHIES

                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                        relief

                                        CARDIOMYOPATHIES

                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                        CARDIOMYOPATHIES

                                        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

                                        Infective endocarditis

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

                                        bull Can be acute or chronic

                                        Infective endocarditis

                                        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

                                        Infective endocarditis

                                        bull Pathophysiologybull 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

                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                        Infective endocarditis

                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                        retina

                                        Infective endocarditis

                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                        Infective endocarditis

                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                        Infective endocarditis

                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                        organism

                                        Infective endocarditis

                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                        Infective endocarditis

                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                        B

                                        Infective endocarditis

                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                        CARDIOGENIC SHOCK

                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                        CARDIOGENIC SHOCK

                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                        CARDIOGENIC SHOCK

                                        bull LABORATORY FINDINGSIncreased CVP

                                        Normal is 4-10 cmH2O

                                        CARDIOGENIC SHOCK

                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                        inotropics such as DOPAMINE and DOBUTAMINE

                                        bull 3 Administer O2bull 4 Morphine is administered to

                                        decreased pulmonary congestion and to relieve pain

                                        CARDIOGENIC SHOCK

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

                                        bull 6 Monitor urinary output BP and pulses

                                        bull 7 cautiously administer diuretics and nitrates

                                        CARDIAC TAMPONADE

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

                                        CARDIAC TAMPONADE

                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                        CARDIAC TAMPONADE

                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                        CARDIAC TAMPONADE

                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                        distention hypotension and distantmuffled heart sound

                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                        CARDIAC TAMPONADE

                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                        anterior chest

                                        CARDIAC TAMPONADE

                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                        CARDIAC TAMPONADE

                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                        tamponade

                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                        HYPERTENSION

                                        bull 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

                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                        bull Most common typebull 2 Secondary

                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                        Alterations in Blood Flow in the Systemic Circulation

                                        Buergerrsquos Disease

                                        bull Also known as Thromboangiitis obliterans

                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                        reaction of the vessel wall

                                        Manifestations

                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                        Increased sensitivity to cold (due to impaired circulation

                                        Absentdiminished peripheral pulses

                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                        gangrenous changes may arise may necessitate amputation

                                        Diagnosis amp Treatment

                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                        bull Return to normal colorbull Note although all of the fingers are

                                        affected symmetrically only 1-2digits may be involved

                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                        (rare occasions)

                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                        protection from cold Avoidance of emotional stress (anxiety amp

                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                        A Assessment

                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                        2 vsB Nursing Dx

                                        1 ineffective tissue perfusion (cardiopulmonary)

                                        2 Impaired gas exchange

                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                        C Goals

                                        1 Relief of pain amp symptoms

                                        2 Prevention of further cardiac damage

                                        D Nursing Interventions

                                        1 Pain control

                                        2 Proper medications

                                        3 Decrease clientrsquos anxiety

                                        4 Health teachings (meds activities diet exercise etc)

                                        • CARDIOVASCULAR DISEASES
                                        • Slide 2
                                        • GENERAL CARDIAC ASSESSMENT
                                        • Pathophysiology
                                        • Slide 5
                                        • ASSESSING CHEST PAIN
                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                        • Angina Pectoris Myocardial Ischemia
                                        • Pathophysiology
                                        • Types
                                        • Slide 12
                                        • Slide 13
                                        • Slide 14
                                        • Conthellip
                                        • Conthellip (2)
                                        • Drug Therapy
                                        • Classification
                                        • Nursing Management
                                        • Nursing Management (2)
                                        • Acute Coronary Syndrome
                                        • Slide 22
                                        • Conthellip (3)
                                        • Slide 24
                                        • Conthellip(MI)
                                        • Slide 26
                                        • Pathophysiology (2)
                                        • Tissue Changes After MI
                                        • Management of MI
                                        • Slide 30
                                        • Slide 31
                                        • ASSESSMENT
                                        • ANALYSIS NURSING DIAGNOSES
                                        • NURSING CARE PLAN
                                        • NURSING CARE PLAN (2)
                                        • NURSING CARE PLAN (3)
                                        • NURSING CARE PLAN (4)
                                        • NURSING CARE PLAN (5)
                                        • NURSING CARE PLAN (6)
                                        • NURSING CARE PLAN (7)
                                        • NURSING CARE PLAN (8)
                                        • EVALUATION
                                        • CONGESTIVE HEART FAILURE
                                        • PATHOPHYSIOLOGY
                                        • ASSESSMENT (2)
                                        • ASSESSMENT (3)
                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                        • ANALYSIS NURSING DIAGNOSES (2)
                                        • Slide 49
                                        • NURSING CARE PLAN (9)
                                        • NURSING CARE PLAN (10)
                                        • NURSING CARE PLAN (11)
                                        • NURSING CARE PLAN (12)
                                        • NURSING CARE PLAN (13)
                                        • EVALUATION
                                        • Slide 56
                                        • Slide 57
                                        • Slide 58
                                        • Slide 59
                                        • Slide 60
                                        • Treatment of Hyperlipidemia
                                        • Slide 62
                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                        • HYPERTROPHIC CARDIOMYOPATHY
                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                        • RESTRICTIVE CARDIOMYOPATHY
                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                        • CARDIOMYOPATHIES
                                        • CARDIOMYOPATHIES (2)
                                        • CARDIOMYOPATHIES (3)
                                        • CARDIOMYOPATHIES (4)
                                        • CARDIOMYOPATHIES (5)
                                        • CARDIOMYOPATHIES (6)
                                        • Infective endocarditis
                                        • Infective endocarditis (2)
                                        • Infective endocarditis (3)
                                        • Infective endocarditis (4)
                                        • Infective endocarditis (5)
                                        • Infective endocarditis (6)
                                        • Infective endocarditis (7)
                                        • Infective endocarditis (8)
                                        • Infective endocarditis (9)
                                        • Infective endocarditis (10)
                                        • Infective endocarditis (11)
                                        • Infective endocarditis (12)
                                        • CARDIOGENIC SHOCK
                                        • CARDIOGENIC SHOCK (2)
                                        • CARDIOGENIC SHOCK (3)
                                        • CARDIOGENIC SHOCK (4)
                                        • CARDIOGENIC SHOCK (5)
                                        • CARDIAC TAMPONADE
                                        • CARDIAC TAMPONADE (2)
                                        • CARDIAC TAMPONADE (3)
                                        • CARDIAC TAMPONADE (4)
                                        • CARDIAC TAMPONADE (5)
                                        • CARDIAC TAMPONADE (6)
                                        • CARDIAC TAMPONADE (7)
                                        • Slide 100
                                        • HYPERTENSION
                                        • HYPERTENSION (2)
                                        • Slide 103
                                        • Slide 104
                                        • Slide 105
                                        • Alterations in Blood Flow in the Systemic Circulation
                                        • Buergerrsquos Disease
                                        • Slide 108
                                        • Manifestations
                                        • Slide 110
                                        • Diagnosis amp Treatment
                                        • Rynaudrsquos Disease
                                        • Manifestations (2)
                                        • Slide 114
                                        • Diagnosis amp Treatment (2)
                                        • Slide 116
                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                        • Slide 118
                                        • Slide 119
                                        • Slide 120
                                        • Slide 121

                                          Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers

                                          When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered

                                          Conthellip

                                          ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                          myocardial tissue associated with atherosclerotic disease of coronary arteries

                                          Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                          Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                          elevation Q wave prolongation T wave inversion

                                          Conthellip(MI)

                                          Manifestations chest pain ndash severe crushing

                                          constricting ldquosomeone sitting on my chestrdquo

                                          - substernal radiating to left arm neck or jaw

                                          - prolonged (gt35mins) amp not relieved by rest

                                          Shortness of breath profuse perspirationFeeling of impending doom

                                          Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                          profound LV failure from massive MI resulting to low cardiac output

                                          Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                          Rupture of myocardiumVentricular aneurysms ndash decreases

                                          pumping efficiency of heart amp increases work of LV

                                          Pathophysiology

                                          Causes atherosclerotic heart disease thrombosisembolism

                                          shock ampor hemorrhage direct traumaMyocardial ischemia

                                          uarrcellular hypoxia

                                          darrmyocardial O2 supplydarr myocardial contractility

                                          darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                          uarrperipheral vasoconstriction

                                          uarr myocardial contractility

                                          uarr afterload uarrmyocardial O2 demand

                                          uarr HR uarrdiastolicfilling

                                          darrmyocardial tissue perfusion

                                          Tissue Changes After MI

                                          Time after Onset Type of Injury amp Gross Tissue Changes

                                          0-05hrs Reversible injury

                                          1-2hrs Onset of irreversible injury

                                          4-12hrs Beginning of coagulation necrosis

                                          18-24hrs Continued necrosis gross pallor of infected tissue

                                          1-3days Total necrosis onset of acute inflammatory process

                                          3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                          7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                          8th week Complete scar tissue replacement

                                          Management of MI Initial Management OMEN

                                          - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                          vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                          may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                          Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                          Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                          bull Surgery 1Revascularization

                                          bullPTCAbullCoronary stent implantation

                                          bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                          2Resection ndash aneurysm

                                          ASSESSMENT

                                          bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                          bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                          ANALYSIS NURSING DIAGNOSES

                                          bull Decreased cardiac output related to myocardial damage

                                          bull Impaired gas exchange related to poor perfusion shock

                                          bull Pain related to myocardial ischemia

                                          bull Activity intolerance related to pain or inadequate oxygenation

                                          bull Fear related to possibility of death

                                          NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                          bull Narcotics ndash morphine note response Avoid IM

                                          bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                          bull Position semi-Fowlerrsquos to improve ventilation

                                          NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                          rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                          thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                          cracklesbull Check labs troponin blood gases electrolytes

                                          clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                          bull ROM of lower extremities antiembolic stockings

                                          NURSING CARE PLAN

                                          bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                          bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                          bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                          bull Anticipate needs of client call light water Reassurance

                                          bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                          NURSING CARE PLAN

                                          bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                          Mg)bull Monitor ECGbull Diet progressive low

                                          calorie low sodium low cholesterol low fat without caffeine

                                          NURSING CARE PLAN

                                          bull Goal 5 facilitate fecal eliminationbull Medications stool

                                          softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                          bull Bedside commode

                                          NURSING CARE PLAN

                                          bull Goal 6 provide emotional supportbull Recognize fear of dying

                                          denial anger withdrawalbull Encourage expression of

                                          feelings fears concernsbull Discuss rehabilitation lifestyle

                                          changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                          NURSING CARE PLAN

                                          bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                          activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                          bull Identify need for referral for sexual counselling

                                          NURSING CARE PLAN

                                          bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                          meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                          bull Information about sexual activity less fatiguing positions

                                          bull Support groups Follow-up carebull Medications administration importance untoward

                                          effects pulse takingbull Control risk factors rest diet exercise no smoking

                                          weight control stress reduction

                                          EVALUATION

                                          bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                          CONGESTIVE HEART FAILURE

                                          bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                          PATHOPHYSIOLOGY

                                          Increased cardiac workload

                                          decreased effective myocardial contractility

                                          Decreased cardiac output

                                          LV failure Pulmonary congestion

                                          RA RV failure

                                          Systemic congestion

                                          Peripheral edema

                                          ASSESSMENTbull Subjective data

                                          bull Shortness of breathbull Orthopnea (sleeps on two

                                          or more pillows)bull Paroxysmal nocturnal

                                          dyspnea (sudden breathlessness during sleep)

                                          bull Dyspnea on exertion (climbing stairs)

                                          bull Apprehension anxiety irritability

                                          bull Fatigue weaknessbull Reported weight gain

                                          feeling of puffiness

                                          ASSESSMENTbull Objective data

                                          bull VSbull BP decreasing systolic

                                          narrowing pulse pressurebull Pulse pulsus alternans

                                          (alternating strong-weak-strong cardiac contraction) increased

                                          bull Respirations crackles Cheyne-Stokes

                                          bull Edema dependent pitting (1+ to 4+ mm)

                                          bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                          dilated pulmonary vessels lung edema

                                          Left Ventricular Compared with Right Ventricular Heart Failure

                                          LEFT VENTRICULAR

                                          FAILURE

                                          RIGHT VENTRICULAR

                                          FAILURE

                                          Pulmonary crackles Jugular venous distention

                                          Tachypnea Peripheral edema

                                          S3 gallop Perioral and peripheral cyanosis

                                          Cardiac murmurs Congestive hepatomegaly

                                          Paradoxical splitting of S2

                                          Ascites

                                          Hepatojugular reflux

                                          ANALYSIS NURSING DIAGNOSES

                                          bull Decreased cardiac output related to decreased myocardial contractility

                                          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                          bull Fatigue related to edema and poor oxygenation

                                          bull Fluid volume excess related to compensatory mechanisms

                                          bull Impaired gas exchange related to pulmonary congestion

                                          bull Anxiety related to shortness of breath

                                          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                          NURSING CARE PLAN

                                          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                          tachycardia dyspnea edema resolved change position frequently pillows for support

                                          bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                          bull Warm fluids if appropriate

                                          NURSING CARE PLAN

                                          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                          NURSING CARE PLANbull Goal 3 provide for special safety

                                          needsbull Skin care

                                          bull Inspect massage lubricate bony prominences

                                          bull Use foot cradle heel protectors sheepskin

                                          bull Side rails up if hypoxic (disoriented)

                                          bull Vital signs monitor for signs of fatigue pulmonary emboli

                                          bull ROM active passive elastic stockings

                                          NURSING CARE PLAN

                                          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                          strict IObull Diet

                                          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                          NURSING CARE PLAN

                                          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                          bull Refer to available community resources for dietary assistance weight reduction exercise program

                                          EVALUATION

                                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                          distressbull Reduction in dependent edema

                                          DAY 3 OF

                                          CARDIOVASCULARDISEASES

                                          bull hyperlipidemia means high lipid levels

                                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                          Treatment of Hyperlipidemia

                                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                          bull SYSTOLIC DYSFUNCTION

                                          HYPERTROPHIC CARDIOMYOPATHY

                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                          HYPERTROPHIC CARDIOMYOPATHY

                                          bull Pathophysiologybull 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

                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                          CARDIOMYOPATHIES

                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                          CARDIOMYOPATHIES

                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                          CARDIOMYOPATHIES

                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                          relief

                                          CARDIOMYOPATHIES

                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                          CARDIOMYOPATHIES

                                          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

                                          Infective endocarditis

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

                                          bull Can be acute or chronic

                                          Infective endocarditis

                                          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

                                          Infective endocarditis

                                          bull Pathophysiologybull 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

                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                          Infective endocarditis

                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                          retina

                                          Infective endocarditis

                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                          Infective endocarditis

                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                          Infective endocarditis

                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                          organism

                                          Infective endocarditis

                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                          Infective endocarditis

                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                          B

                                          Infective endocarditis

                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                          CARDIOGENIC SHOCK

                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                          CARDIOGENIC SHOCK

                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                          CARDIOGENIC SHOCK

                                          bull LABORATORY FINDINGSIncreased CVP

                                          Normal is 4-10 cmH2O

                                          CARDIOGENIC SHOCK

                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                          inotropics such as DOPAMINE and DOBUTAMINE

                                          bull 3 Administer O2bull 4 Morphine is administered to

                                          decreased pulmonary congestion and to relieve pain

                                          CARDIOGENIC SHOCK

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

                                          bull 6 Monitor urinary output BP and pulses

                                          bull 7 cautiously administer diuretics and nitrates

                                          CARDIAC TAMPONADE

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

                                          CARDIAC TAMPONADE

                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                          CARDIAC TAMPONADE

                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                          CARDIAC TAMPONADE

                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                          distention hypotension and distantmuffled heart sound

                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                          CARDIAC TAMPONADE

                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                          anterior chest

                                          CARDIAC TAMPONADE

                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                          CARDIAC TAMPONADE

                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                          tamponade

                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                          HYPERTENSION

                                          bull 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

                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                          bull Most common typebull 2 Secondary

                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                          Alterations in Blood Flow in the Systemic Circulation

                                          Buergerrsquos Disease

                                          bull Also known as Thromboangiitis obliterans

                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                          reaction of the vessel wall

                                          Manifestations

                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                          Increased sensitivity to cold (due to impaired circulation

                                          Absentdiminished peripheral pulses

                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                          gangrenous changes may arise may necessitate amputation

                                          Diagnosis amp Treatment

                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                          bull Return to normal colorbull Note although all of the fingers are

                                          affected symmetrically only 1-2digits may be involved

                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                          (rare occasions)

                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                          protection from cold Avoidance of emotional stress (anxiety amp

                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                          A Assessment

                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                          2 vsB Nursing Dx

                                          1 ineffective tissue perfusion (cardiopulmonary)

                                          2 Impaired gas exchange

                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                          C Goals

                                          1 Relief of pain amp symptoms

                                          2 Prevention of further cardiac damage

                                          D Nursing Interventions

                                          1 Pain control

                                          2 Proper medications

                                          3 Decrease clientrsquos anxiety

                                          4 Health teachings (meds activities diet exercise etc)

                                          • CARDIOVASCULAR DISEASES
                                          • Slide 2
                                          • GENERAL CARDIAC ASSESSMENT
                                          • Pathophysiology
                                          • Slide 5
                                          • ASSESSING CHEST PAIN
                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                          • Angina Pectoris Myocardial Ischemia
                                          • Pathophysiology
                                          • Types
                                          • Slide 12
                                          • Slide 13
                                          • Slide 14
                                          • Conthellip
                                          • Conthellip (2)
                                          • Drug Therapy
                                          • Classification
                                          • Nursing Management
                                          • Nursing Management (2)
                                          • Acute Coronary Syndrome
                                          • Slide 22
                                          • Conthellip (3)
                                          • Slide 24
                                          • Conthellip(MI)
                                          • Slide 26
                                          • Pathophysiology (2)
                                          • Tissue Changes After MI
                                          • Management of MI
                                          • Slide 30
                                          • Slide 31
                                          • ASSESSMENT
                                          • ANALYSIS NURSING DIAGNOSES
                                          • NURSING CARE PLAN
                                          • NURSING CARE PLAN (2)
                                          • NURSING CARE PLAN (3)
                                          • NURSING CARE PLAN (4)
                                          • NURSING CARE PLAN (5)
                                          • NURSING CARE PLAN (6)
                                          • NURSING CARE PLAN (7)
                                          • NURSING CARE PLAN (8)
                                          • EVALUATION
                                          • CONGESTIVE HEART FAILURE
                                          • PATHOPHYSIOLOGY
                                          • ASSESSMENT (2)
                                          • ASSESSMENT (3)
                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                          • ANALYSIS NURSING DIAGNOSES (2)
                                          • Slide 49
                                          • NURSING CARE PLAN (9)
                                          • NURSING CARE PLAN (10)
                                          • NURSING CARE PLAN (11)
                                          • NURSING CARE PLAN (12)
                                          • NURSING CARE PLAN (13)
                                          • EVALUATION
                                          • Slide 56
                                          • Slide 57
                                          • Slide 58
                                          • Slide 59
                                          • Slide 60
                                          • Treatment of Hyperlipidemia
                                          • Slide 62
                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                          • HYPERTROPHIC CARDIOMYOPATHY
                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                          • RESTRICTIVE CARDIOMYOPATHY
                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                          • CARDIOMYOPATHIES
                                          • CARDIOMYOPATHIES (2)
                                          • CARDIOMYOPATHIES (3)
                                          • CARDIOMYOPATHIES (4)
                                          • CARDIOMYOPATHIES (5)
                                          • CARDIOMYOPATHIES (6)
                                          • Infective endocarditis
                                          • Infective endocarditis (2)
                                          • Infective endocarditis (3)
                                          • Infective endocarditis (4)
                                          • Infective endocarditis (5)
                                          • Infective endocarditis (6)
                                          • Infective endocarditis (7)
                                          • Infective endocarditis (8)
                                          • Infective endocarditis (9)
                                          • Infective endocarditis (10)
                                          • Infective endocarditis (11)
                                          • Infective endocarditis (12)
                                          • CARDIOGENIC SHOCK
                                          • CARDIOGENIC SHOCK (2)
                                          • CARDIOGENIC SHOCK (3)
                                          • CARDIOGENIC SHOCK (4)
                                          • CARDIOGENIC SHOCK (5)
                                          • CARDIAC TAMPONADE
                                          • CARDIAC TAMPONADE (2)
                                          • CARDIAC TAMPONADE (3)
                                          • CARDIAC TAMPONADE (4)
                                          • CARDIAC TAMPONADE (5)
                                          • CARDIAC TAMPONADE (6)
                                          • CARDIAC TAMPONADE (7)
                                          • Slide 100
                                          • HYPERTENSION
                                          • HYPERTENSION (2)
                                          • Slide 103
                                          • Slide 104
                                          • Slide 105
                                          • Alterations in Blood Flow in the Systemic Circulation
                                          • Buergerrsquos Disease
                                          • Slide 108
                                          • Manifestations
                                          • Slide 110
                                          • Diagnosis amp Treatment
                                          • Rynaudrsquos Disease
                                          • Manifestations (2)
                                          • Slide 114
                                          • Diagnosis amp Treatment (2)
                                          • Slide 116
                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                          • Slide 118
                                          • Slide 119
                                          • Slide 120
                                          • Slide 121

                                            Conthellip

                                            ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of

                                            myocardial tissue associated with atherosclerotic disease of coronary arteries

                                            Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)

                                            Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                            elevation Q wave prolongation T wave inversion

                                            Conthellip(MI)

                                            Manifestations chest pain ndash severe crushing

                                            constricting ldquosomeone sitting on my chestrdquo

                                            - substernal radiating to left arm neck or jaw

                                            - prolonged (gt35mins) amp not relieved by rest

                                            Shortness of breath profuse perspirationFeeling of impending doom

                                            Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                            profound LV failure from massive MI resulting to low cardiac output

                                            Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                            Rupture of myocardiumVentricular aneurysms ndash decreases

                                            pumping efficiency of heart amp increases work of LV

                                            Pathophysiology

                                            Causes atherosclerotic heart disease thrombosisembolism

                                            shock ampor hemorrhage direct traumaMyocardial ischemia

                                            uarrcellular hypoxia

                                            darrmyocardial O2 supplydarr myocardial contractility

                                            darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                            uarrperipheral vasoconstriction

                                            uarr myocardial contractility

                                            uarr afterload uarrmyocardial O2 demand

                                            uarr HR uarrdiastolicfilling

                                            darrmyocardial tissue perfusion

                                            Tissue Changes After MI

                                            Time after Onset Type of Injury amp Gross Tissue Changes

                                            0-05hrs Reversible injury

                                            1-2hrs Onset of irreversible injury

                                            4-12hrs Beginning of coagulation necrosis

                                            18-24hrs Continued necrosis gross pallor of infected tissue

                                            1-3days Total necrosis onset of acute inflammatory process

                                            3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                            7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                            8th week Complete scar tissue replacement

                                            Management of MI Initial Management OMEN

                                            - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                            vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                            may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                            Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                            Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                            bull Surgery 1Revascularization

                                            bullPTCAbullCoronary stent implantation

                                            bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                            2Resection ndash aneurysm

                                            ASSESSMENT

                                            bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                            bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                            ANALYSIS NURSING DIAGNOSES

                                            bull Decreased cardiac output related to myocardial damage

                                            bull Impaired gas exchange related to poor perfusion shock

                                            bull Pain related to myocardial ischemia

                                            bull Activity intolerance related to pain or inadequate oxygenation

                                            bull Fear related to possibility of death

                                            NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                            bull Narcotics ndash morphine note response Avoid IM

                                            bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                            bull Position semi-Fowlerrsquos to improve ventilation

                                            NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                            rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                            thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                            cracklesbull Check labs troponin blood gases electrolytes

                                            clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                            bull ROM of lower extremities antiembolic stockings

                                            NURSING CARE PLAN

                                            bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                            bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                            bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                            bull Anticipate needs of client call light water Reassurance

                                            bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                            NURSING CARE PLAN

                                            bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                            Mg)bull Monitor ECGbull Diet progressive low

                                            calorie low sodium low cholesterol low fat without caffeine

                                            NURSING CARE PLAN

                                            bull Goal 5 facilitate fecal eliminationbull Medications stool

                                            softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                            bull Bedside commode

                                            NURSING CARE PLAN

                                            bull Goal 6 provide emotional supportbull Recognize fear of dying

                                            denial anger withdrawalbull Encourage expression of

                                            feelings fears concernsbull Discuss rehabilitation lifestyle

                                            changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                            NURSING CARE PLAN

                                            bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                            activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                            bull Identify need for referral for sexual counselling

                                            NURSING CARE PLAN

                                            bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                            meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                            bull Information about sexual activity less fatiguing positions

                                            bull Support groups Follow-up carebull Medications administration importance untoward

                                            effects pulse takingbull Control risk factors rest diet exercise no smoking

                                            weight control stress reduction

                                            EVALUATION

                                            bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                            CONGESTIVE HEART FAILURE

                                            bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                            PATHOPHYSIOLOGY

                                            Increased cardiac workload

                                            decreased effective myocardial contractility

                                            Decreased cardiac output

                                            LV failure Pulmonary congestion

                                            RA RV failure

                                            Systemic congestion

                                            Peripheral edema

                                            ASSESSMENTbull Subjective data

                                            bull Shortness of breathbull Orthopnea (sleeps on two

                                            or more pillows)bull Paroxysmal nocturnal

                                            dyspnea (sudden breathlessness during sleep)

                                            bull Dyspnea on exertion (climbing stairs)

                                            bull Apprehension anxiety irritability

                                            bull Fatigue weaknessbull Reported weight gain

                                            feeling of puffiness

                                            ASSESSMENTbull Objective data

                                            bull VSbull BP decreasing systolic

                                            narrowing pulse pressurebull Pulse pulsus alternans

                                            (alternating strong-weak-strong cardiac contraction) increased

                                            bull Respirations crackles Cheyne-Stokes

                                            bull Edema dependent pitting (1+ to 4+ mm)

                                            bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                            dilated pulmonary vessels lung edema

                                            Left Ventricular Compared with Right Ventricular Heart Failure

                                            LEFT VENTRICULAR

                                            FAILURE

                                            RIGHT VENTRICULAR

                                            FAILURE

                                            Pulmonary crackles Jugular venous distention

                                            Tachypnea Peripheral edema

                                            S3 gallop Perioral and peripheral cyanosis

                                            Cardiac murmurs Congestive hepatomegaly

                                            Paradoxical splitting of S2

                                            Ascites

                                            Hepatojugular reflux

                                            ANALYSIS NURSING DIAGNOSES

                                            bull Decreased cardiac output related to decreased myocardial contractility

                                            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                            bull Fatigue related to edema and poor oxygenation

                                            bull Fluid volume excess related to compensatory mechanisms

                                            bull Impaired gas exchange related to pulmonary congestion

                                            bull Anxiety related to shortness of breath

                                            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                            NURSING CARE PLAN

                                            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                            tachycardia dyspnea edema resolved change position frequently pillows for support

                                            bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                            bull Warm fluids if appropriate

                                            NURSING CARE PLAN

                                            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                            NURSING CARE PLANbull Goal 3 provide for special safety

                                            needsbull Skin care

                                            bull Inspect massage lubricate bony prominences

                                            bull Use foot cradle heel protectors sheepskin

                                            bull Side rails up if hypoxic (disoriented)

                                            bull Vital signs monitor for signs of fatigue pulmonary emboli

                                            bull ROM active passive elastic stockings

                                            NURSING CARE PLAN

                                            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                            strict IObull Diet

                                            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                            NURSING CARE PLAN

                                            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                            bull Refer to available community resources for dietary assistance weight reduction exercise program

                                            EVALUATION

                                            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                            distressbull Reduction in dependent edema

                                            DAY 3 OF

                                            CARDIOVASCULARDISEASES

                                            bull hyperlipidemia means high lipid levels

                                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                            Treatment of Hyperlipidemia

                                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                            bull SYSTOLIC DYSFUNCTION

                                            HYPERTROPHIC CARDIOMYOPATHY

                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                            HYPERTROPHIC CARDIOMYOPATHY

                                            bull Pathophysiologybull 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

                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                            CARDIOMYOPATHIES

                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                            CARDIOMYOPATHIES

                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                            CARDIOMYOPATHIES

                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                            relief

                                            CARDIOMYOPATHIES

                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                            CARDIOMYOPATHIES

                                            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

                                            Infective endocarditis

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

                                            bull Can be acute or chronic

                                            Infective endocarditis

                                            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

                                            Infective endocarditis

                                            bull Pathophysiologybull 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

                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                            Infective endocarditis

                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                            retina

                                            Infective endocarditis

                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                            Infective endocarditis

                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                            Infective endocarditis

                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                            organism

                                            Infective endocarditis

                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                            Infective endocarditis

                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                            B

                                            Infective endocarditis

                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                            CARDIOGENIC SHOCK

                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                            CARDIOGENIC SHOCK

                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                            CARDIOGENIC SHOCK

                                            bull LABORATORY FINDINGSIncreased CVP

                                            Normal is 4-10 cmH2O

                                            CARDIOGENIC SHOCK

                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                            inotropics such as DOPAMINE and DOBUTAMINE

                                            bull 3 Administer O2bull 4 Morphine is administered to

                                            decreased pulmonary congestion and to relieve pain

                                            CARDIOGENIC SHOCK

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

                                            bull 6 Monitor urinary output BP and pulses

                                            bull 7 cautiously administer diuretics and nitrates

                                            CARDIAC TAMPONADE

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

                                            CARDIAC TAMPONADE

                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                            CARDIAC TAMPONADE

                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                            CARDIAC TAMPONADE

                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                            distention hypotension and distantmuffled heart sound

                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                            CARDIAC TAMPONADE

                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                            anterior chest

                                            CARDIAC TAMPONADE

                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                            CARDIAC TAMPONADE

                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                            tamponade

                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                            HYPERTENSION

                                            bull 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

                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                            bull Most common typebull 2 Secondary

                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                            Alterations in Blood Flow in the Systemic Circulation

                                            Buergerrsquos Disease

                                            bull Also known as Thromboangiitis obliterans

                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                            reaction of the vessel wall

                                            Manifestations

                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                            Increased sensitivity to cold (due to impaired circulation

                                            Absentdiminished peripheral pulses

                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                            gangrenous changes may arise may necessitate amputation

                                            Diagnosis amp Treatment

                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                            bull Return to normal colorbull Note although all of the fingers are

                                            affected symmetrically only 1-2digits may be involved

                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                            (rare occasions)

                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                            protection from cold Avoidance of emotional stress (anxiety amp

                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                            A Assessment

                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                            2 vsB Nursing Dx

                                            1 ineffective tissue perfusion (cardiopulmonary)

                                            2 Impaired gas exchange

                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                            C Goals

                                            1 Relief of pain amp symptoms

                                            2 Prevention of further cardiac damage

                                            D Nursing Interventions

                                            1 Pain control

                                            2 Proper medications

                                            3 Decrease clientrsquos anxiety

                                            4 Health teachings (meds activities diet exercise etc)

                                            • CARDIOVASCULAR DISEASES
                                            • Slide 2
                                            • GENERAL CARDIAC ASSESSMENT
                                            • Pathophysiology
                                            • Slide 5
                                            • ASSESSING CHEST PAIN
                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                            • Angina Pectoris Myocardial Ischemia
                                            • Pathophysiology
                                            • Types
                                            • Slide 12
                                            • Slide 13
                                            • Slide 14
                                            • Conthellip
                                            • Conthellip (2)
                                            • Drug Therapy
                                            • Classification
                                            • Nursing Management
                                            • Nursing Management (2)
                                            • Acute Coronary Syndrome
                                            • Slide 22
                                            • Conthellip (3)
                                            • Slide 24
                                            • Conthellip(MI)
                                            • Slide 26
                                            • Pathophysiology (2)
                                            • Tissue Changes After MI
                                            • Management of MI
                                            • Slide 30
                                            • Slide 31
                                            • ASSESSMENT
                                            • ANALYSIS NURSING DIAGNOSES
                                            • NURSING CARE PLAN
                                            • NURSING CARE PLAN (2)
                                            • NURSING CARE PLAN (3)
                                            • NURSING CARE PLAN (4)
                                            • NURSING CARE PLAN (5)
                                            • NURSING CARE PLAN (6)
                                            • NURSING CARE PLAN (7)
                                            • NURSING CARE PLAN (8)
                                            • EVALUATION
                                            • CONGESTIVE HEART FAILURE
                                            • PATHOPHYSIOLOGY
                                            • ASSESSMENT (2)
                                            • ASSESSMENT (3)
                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                            • ANALYSIS NURSING DIAGNOSES (2)
                                            • Slide 49
                                            • NURSING CARE PLAN (9)
                                            • NURSING CARE PLAN (10)
                                            • NURSING CARE PLAN (11)
                                            • NURSING CARE PLAN (12)
                                            • NURSING CARE PLAN (13)
                                            • EVALUATION
                                            • Slide 56
                                            • Slide 57
                                            • Slide 58
                                            • Slide 59
                                            • Slide 60
                                            • Treatment of Hyperlipidemia
                                            • Slide 62
                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                            • HYPERTROPHIC CARDIOMYOPATHY
                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                            • RESTRICTIVE CARDIOMYOPATHY
                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                            • CARDIOMYOPATHIES
                                            • CARDIOMYOPATHIES (2)
                                            • CARDIOMYOPATHIES (3)
                                            • CARDIOMYOPATHIES (4)
                                            • CARDIOMYOPATHIES (5)
                                            • CARDIOMYOPATHIES (6)
                                            • Infective endocarditis
                                            • Infective endocarditis (2)
                                            • Infective endocarditis (3)
                                            • Infective endocarditis (4)
                                            • Infective endocarditis (5)
                                            • Infective endocarditis (6)
                                            • Infective endocarditis (7)
                                            • Infective endocarditis (8)
                                            • Infective endocarditis (9)
                                            • Infective endocarditis (10)
                                            • Infective endocarditis (11)
                                            • Infective endocarditis (12)
                                            • CARDIOGENIC SHOCK
                                            • CARDIOGENIC SHOCK (2)
                                            • CARDIOGENIC SHOCK (3)
                                            • CARDIOGENIC SHOCK (4)
                                            • CARDIOGENIC SHOCK (5)
                                            • CARDIAC TAMPONADE
                                            • CARDIAC TAMPONADE (2)
                                            • CARDIAC TAMPONADE (3)
                                            • CARDIAC TAMPONADE (4)
                                            • CARDIAC TAMPONADE (5)
                                            • CARDIAC TAMPONADE (6)
                                            • CARDIAC TAMPONADE (7)
                                            • Slide 100
                                            • HYPERTENSION
                                            • HYPERTENSION (2)
                                            • Slide 103
                                            • Slide 104
                                            • Slide 105
                                            • Alterations in Blood Flow in the Systemic Circulation
                                            • Buergerrsquos Disease
                                            • Slide 108
                                            • Manifestations
                                            • Slide 110
                                            • Diagnosis amp Treatment
                                            • Rynaudrsquos Disease
                                            • Manifestations (2)
                                            • Slide 114
                                            • Diagnosis amp Treatment (2)
                                            • Slide 116
                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                            • Slide 118
                                            • Slide 119
                                            • Slide 120
                                            • Slide 121

                                              Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment

                                              elevation Q wave prolongation T wave inversion

                                              Conthellip(MI)

                                              Manifestations chest pain ndash severe crushing

                                              constricting ldquosomeone sitting on my chestrdquo

                                              - substernal radiating to left arm neck or jaw

                                              - prolonged (gt35mins) amp not relieved by rest

                                              Shortness of breath profuse perspirationFeeling of impending doom

                                              Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                              profound LV failure from massive MI resulting to low cardiac output

                                              Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                              Rupture of myocardiumVentricular aneurysms ndash decreases

                                              pumping efficiency of heart amp increases work of LV

                                              Pathophysiology

                                              Causes atherosclerotic heart disease thrombosisembolism

                                              shock ampor hemorrhage direct traumaMyocardial ischemia

                                              uarrcellular hypoxia

                                              darrmyocardial O2 supplydarr myocardial contractility

                                              darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                              uarrperipheral vasoconstriction

                                              uarr myocardial contractility

                                              uarr afterload uarrmyocardial O2 demand

                                              uarr HR uarrdiastolicfilling

                                              darrmyocardial tissue perfusion

                                              Tissue Changes After MI

                                              Time after Onset Type of Injury amp Gross Tissue Changes

                                              0-05hrs Reversible injury

                                              1-2hrs Onset of irreversible injury

                                              4-12hrs Beginning of coagulation necrosis

                                              18-24hrs Continued necrosis gross pallor of infected tissue

                                              1-3days Total necrosis onset of acute inflammatory process

                                              3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                              7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                              8th week Complete scar tissue replacement

                                              Management of MI Initial Management OMEN

                                              - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                              vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                              may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                              Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                              Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                              bull Surgery 1Revascularization

                                              bullPTCAbullCoronary stent implantation

                                              bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                              2Resection ndash aneurysm

                                              ASSESSMENT

                                              bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                              bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                              ANALYSIS NURSING DIAGNOSES

                                              bull Decreased cardiac output related to myocardial damage

                                              bull Impaired gas exchange related to poor perfusion shock

                                              bull Pain related to myocardial ischemia

                                              bull Activity intolerance related to pain or inadequate oxygenation

                                              bull Fear related to possibility of death

                                              NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                              bull Narcotics ndash morphine note response Avoid IM

                                              bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                              bull Position semi-Fowlerrsquos to improve ventilation

                                              NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                              rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                              thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                              cracklesbull Check labs troponin blood gases electrolytes

                                              clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                              bull ROM of lower extremities antiembolic stockings

                                              NURSING CARE PLAN

                                              bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                              bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                              bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                              bull Anticipate needs of client call light water Reassurance

                                              bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                              NURSING CARE PLAN

                                              bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                              Mg)bull Monitor ECGbull Diet progressive low

                                              calorie low sodium low cholesterol low fat without caffeine

                                              NURSING CARE PLAN

                                              bull Goal 5 facilitate fecal eliminationbull Medications stool

                                              softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                              bull Bedside commode

                                              NURSING CARE PLAN

                                              bull Goal 6 provide emotional supportbull Recognize fear of dying

                                              denial anger withdrawalbull Encourage expression of

                                              feelings fears concernsbull Discuss rehabilitation lifestyle

                                              changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                              NURSING CARE PLAN

                                              bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                              activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                              bull Identify need for referral for sexual counselling

                                              NURSING CARE PLAN

                                              bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                              meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                              bull Information about sexual activity less fatiguing positions

                                              bull Support groups Follow-up carebull Medications administration importance untoward

                                              effects pulse takingbull Control risk factors rest diet exercise no smoking

                                              weight control stress reduction

                                              EVALUATION

                                              bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                              CONGESTIVE HEART FAILURE

                                              bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                              PATHOPHYSIOLOGY

                                              Increased cardiac workload

                                              decreased effective myocardial contractility

                                              Decreased cardiac output

                                              LV failure Pulmonary congestion

                                              RA RV failure

                                              Systemic congestion

                                              Peripheral edema

                                              ASSESSMENTbull Subjective data

                                              bull Shortness of breathbull Orthopnea (sleeps on two

                                              or more pillows)bull Paroxysmal nocturnal

                                              dyspnea (sudden breathlessness during sleep)

                                              bull Dyspnea on exertion (climbing stairs)

                                              bull Apprehension anxiety irritability

                                              bull Fatigue weaknessbull Reported weight gain

                                              feeling of puffiness

                                              ASSESSMENTbull Objective data

                                              bull VSbull BP decreasing systolic

                                              narrowing pulse pressurebull Pulse pulsus alternans

                                              (alternating strong-weak-strong cardiac contraction) increased

                                              bull Respirations crackles Cheyne-Stokes

                                              bull Edema dependent pitting (1+ to 4+ mm)

                                              bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                              dilated pulmonary vessels lung edema

                                              Left Ventricular Compared with Right Ventricular Heart Failure

                                              LEFT VENTRICULAR

                                              FAILURE

                                              RIGHT VENTRICULAR

                                              FAILURE

                                              Pulmonary crackles Jugular venous distention

                                              Tachypnea Peripheral edema

                                              S3 gallop Perioral and peripheral cyanosis

                                              Cardiac murmurs Congestive hepatomegaly

                                              Paradoxical splitting of S2

                                              Ascites

                                              Hepatojugular reflux

                                              ANALYSIS NURSING DIAGNOSES

                                              bull Decreased cardiac output related to decreased myocardial contractility

                                              bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                              bull Fatigue related to edema and poor oxygenation

                                              bull Fluid volume excess related to compensatory mechanisms

                                              bull Impaired gas exchange related to pulmonary congestion

                                              bull Anxiety related to shortness of breath

                                              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                              NURSING CARE PLAN

                                              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                              tachycardia dyspnea edema resolved change position frequently pillows for support

                                              bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                              bull Warm fluids if appropriate

                                              NURSING CARE PLAN

                                              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                              NURSING CARE PLANbull Goal 3 provide for special safety

                                              needsbull Skin care

                                              bull Inspect massage lubricate bony prominences

                                              bull Use foot cradle heel protectors sheepskin

                                              bull Side rails up if hypoxic (disoriented)

                                              bull Vital signs monitor for signs of fatigue pulmonary emboli

                                              bull ROM active passive elastic stockings

                                              NURSING CARE PLAN

                                              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                              strict IObull Diet

                                              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                              NURSING CARE PLAN

                                              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                              bull Refer to available community resources for dietary assistance weight reduction exercise program

                                              EVALUATION

                                              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                              distressbull Reduction in dependent edema

                                              DAY 3 OF

                                              CARDIOVASCULARDISEASES

                                              bull hyperlipidemia means high lipid levels

                                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                              Treatment of Hyperlipidemia

                                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                              bull SYSTOLIC DYSFUNCTION

                                              HYPERTROPHIC CARDIOMYOPATHY

                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                              HYPERTROPHIC CARDIOMYOPATHY

                                              bull Pathophysiologybull 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

                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                              CARDIOMYOPATHIES

                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                              CARDIOMYOPATHIES

                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                              CARDIOMYOPATHIES

                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                              relief

                                              CARDIOMYOPATHIES

                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                              CARDIOMYOPATHIES

                                              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

                                              Infective endocarditis

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

                                              bull Can be acute or chronic

                                              Infective endocarditis

                                              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

                                              Infective endocarditis

                                              bull Pathophysiologybull 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

                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                              Infective endocarditis

                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                              retina

                                              Infective endocarditis

                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                              Infective endocarditis

                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                              Infective endocarditis

                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                              organism

                                              Infective endocarditis

                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                              Infective endocarditis

                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                              B

                                              Infective endocarditis

                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                              CARDIOGENIC SHOCK

                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                              CARDIOGENIC SHOCK

                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                              CARDIOGENIC SHOCK

                                              bull LABORATORY FINDINGSIncreased CVP

                                              Normal is 4-10 cmH2O

                                              CARDIOGENIC SHOCK

                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                              inotropics such as DOPAMINE and DOBUTAMINE

                                              bull 3 Administer O2bull 4 Morphine is administered to

                                              decreased pulmonary congestion and to relieve pain

                                              CARDIOGENIC SHOCK

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

                                              bull 6 Monitor urinary output BP and pulses

                                              bull 7 cautiously administer diuretics and nitrates

                                              CARDIAC TAMPONADE

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

                                              CARDIAC TAMPONADE

                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                              CARDIAC TAMPONADE

                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                              CARDIAC TAMPONADE

                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                              distention hypotension and distantmuffled heart sound

                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                              CARDIAC TAMPONADE

                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                              anterior chest

                                              CARDIAC TAMPONADE

                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                              CARDIAC TAMPONADE

                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                              tamponade

                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                              HYPERTENSION

                                              bull 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

                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                              bull Most common typebull 2 Secondary

                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                              Alterations in Blood Flow in the Systemic Circulation

                                              Buergerrsquos Disease

                                              bull Also known as Thromboangiitis obliterans

                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                              reaction of the vessel wall

                                              Manifestations

                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                              Increased sensitivity to cold (due to impaired circulation

                                              Absentdiminished peripheral pulses

                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                              gangrenous changes may arise may necessitate amputation

                                              Diagnosis amp Treatment

                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                              bull Return to normal colorbull Note although all of the fingers are

                                              affected symmetrically only 1-2digits may be involved

                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                              (rare occasions)

                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                              protection from cold Avoidance of emotional stress (anxiety amp

                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                              A Assessment

                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                              2 vsB Nursing Dx

                                              1 ineffective tissue perfusion (cardiopulmonary)

                                              2 Impaired gas exchange

                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                              C Goals

                                              1 Relief of pain amp symptoms

                                              2 Prevention of further cardiac damage

                                              D Nursing Interventions

                                              1 Pain control

                                              2 Proper medications

                                              3 Decrease clientrsquos anxiety

                                              4 Health teachings (meds activities diet exercise etc)

                                              • CARDIOVASCULAR DISEASES
                                              • Slide 2
                                              • GENERAL CARDIAC ASSESSMENT
                                              • Pathophysiology
                                              • Slide 5
                                              • ASSESSING CHEST PAIN
                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                              • Angina Pectoris Myocardial Ischemia
                                              • Pathophysiology
                                              • Types
                                              • Slide 12
                                              • Slide 13
                                              • Slide 14
                                              • Conthellip
                                              • Conthellip (2)
                                              • Drug Therapy
                                              • Classification
                                              • Nursing Management
                                              • Nursing Management (2)
                                              • Acute Coronary Syndrome
                                              • Slide 22
                                              • Conthellip (3)
                                              • Slide 24
                                              • Conthellip(MI)
                                              • Slide 26
                                              • Pathophysiology (2)
                                              • Tissue Changes After MI
                                              • Management of MI
                                              • Slide 30
                                              • Slide 31
                                              • ASSESSMENT
                                              • ANALYSIS NURSING DIAGNOSES
                                              • NURSING CARE PLAN
                                              • NURSING CARE PLAN (2)
                                              • NURSING CARE PLAN (3)
                                              • NURSING CARE PLAN (4)
                                              • NURSING CARE PLAN (5)
                                              • NURSING CARE PLAN (6)
                                              • NURSING CARE PLAN (7)
                                              • NURSING CARE PLAN (8)
                                              • EVALUATION
                                              • CONGESTIVE HEART FAILURE
                                              • PATHOPHYSIOLOGY
                                              • ASSESSMENT (2)
                                              • ASSESSMENT (3)
                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                              • ANALYSIS NURSING DIAGNOSES (2)
                                              • Slide 49
                                              • NURSING CARE PLAN (9)
                                              • NURSING CARE PLAN (10)
                                              • NURSING CARE PLAN (11)
                                              • NURSING CARE PLAN (12)
                                              • NURSING CARE PLAN (13)
                                              • EVALUATION
                                              • Slide 56
                                              • Slide 57
                                              • Slide 58
                                              • Slide 59
                                              • Slide 60
                                              • Treatment of Hyperlipidemia
                                              • Slide 62
                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                              • HYPERTROPHIC CARDIOMYOPATHY
                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                              • RESTRICTIVE CARDIOMYOPATHY
                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                              • CARDIOMYOPATHIES
                                              • CARDIOMYOPATHIES (2)
                                              • CARDIOMYOPATHIES (3)
                                              • CARDIOMYOPATHIES (4)
                                              • CARDIOMYOPATHIES (5)
                                              • CARDIOMYOPATHIES (6)
                                              • Infective endocarditis
                                              • Infective endocarditis (2)
                                              • Infective endocarditis (3)
                                              • Infective endocarditis (4)
                                              • Infective endocarditis (5)
                                              • Infective endocarditis (6)
                                              • Infective endocarditis (7)
                                              • Infective endocarditis (8)
                                              • Infective endocarditis (9)
                                              • Infective endocarditis (10)
                                              • Infective endocarditis (11)
                                              • Infective endocarditis (12)
                                              • CARDIOGENIC SHOCK
                                              • CARDIOGENIC SHOCK (2)
                                              • CARDIOGENIC SHOCK (3)
                                              • CARDIOGENIC SHOCK (4)
                                              • CARDIOGENIC SHOCK (5)
                                              • CARDIAC TAMPONADE
                                              • CARDIAC TAMPONADE (2)
                                              • CARDIAC TAMPONADE (3)
                                              • CARDIAC TAMPONADE (4)
                                              • CARDIAC TAMPONADE (5)
                                              • CARDIAC TAMPONADE (6)
                                              • CARDIAC TAMPONADE (7)
                                              • Slide 100
                                              • HYPERTENSION
                                              • HYPERTENSION (2)
                                              • Slide 103
                                              • Slide 104
                                              • Slide 105
                                              • Alterations in Blood Flow in the Systemic Circulation
                                              • Buergerrsquos Disease
                                              • Slide 108
                                              • Manifestations
                                              • Slide 110
                                              • Diagnosis amp Treatment
                                              • Rynaudrsquos Disease
                                              • Manifestations (2)
                                              • Slide 114
                                              • Diagnosis amp Treatment (2)
                                              • Slide 116
                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                              • Slide 118
                                              • Slide 119
                                              • Slide 120
                                              • Slide 121

                                                Conthellip(MI)

                                                Manifestations chest pain ndash severe crushing

                                                constricting ldquosomeone sitting on my chestrdquo

                                                - substernal radiating to left arm neck or jaw

                                                - prolonged (gt35mins) amp not relieved by rest

                                                Shortness of breath profuse perspirationFeeling of impending doom

                                                Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                                profound LV failure from massive MI resulting to low cardiac output

                                                Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                                Rupture of myocardiumVentricular aneurysms ndash decreases

                                                pumping efficiency of heart amp increases work of LV

                                                Pathophysiology

                                                Causes atherosclerotic heart disease thrombosisembolism

                                                shock ampor hemorrhage direct traumaMyocardial ischemia

                                                uarrcellular hypoxia

                                                darrmyocardial O2 supplydarr myocardial contractility

                                                darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                                uarrperipheral vasoconstriction

                                                uarr myocardial contractility

                                                uarr afterload uarrmyocardial O2 demand

                                                uarr HR uarrdiastolicfilling

                                                darrmyocardial tissue perfusion

                                                Tissue Changes After MI

                                                Time after Onset Type of Injury amp Gross Tissue Changes

                                                0-05hrs Reversible injury

                                                1-2hrs Onset of irreversible injury

                                                4-12hrs Beginning of coagulation necrosis

                                                18-24hrs Continued necrosis gross pallor of infected tissue

                                                1-3days Total necrosis onset of acute inflammatory process

                                                3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                                7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                                8th week Complete scar tissue replacement

                                                Management of MI Initial Management OMEN

                                                - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                                vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                                may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                                Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                                Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                                bull Surgery 1Revascularization

                                                bullPTCAbullCoronary stent implantation

                                                bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                2Resection ndash aneurysm

                                                ASSESSMENT

                                                bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                ANALYSIS NURSING DIAGNOSES

                                                bull Decreased cardiac output related to myocardial damage

                                                bull Impaired gas exchange related to poor perfusion shock

                                                bull Pain related to myocardial ischemia

                                                bull Activity intolerance related to pain or inadequate oxygenation

                                                bull Fear related to possibility of death

                                                NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                bull Narcotics ndash morphine note response Avoid IM

                                                bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                bull Position semi-Fowlerrsquos to improve ventilation

                                                NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                cracklesbull Check labs troponin blood gases electrolytes

                                                clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                bull ROM of lower extremities antiembolic stockings

                                                NURSING CARE PLAN

                                                bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                bull Anticipate needs of client call light water Reassurance

                                                bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                NURSING CARE PLAN

                                                bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                Mg)bull Monitor ECGbull Diet progressive low

                                                calorie low sodium low cholesterol low fat without caffeine

                                                NURSING CARE PLAN

                                                bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                bull Bedside commode

                                                NURSING CARE PLAN

                                                bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                denial anger withdrawalbull Encourage expression of

                                                feelings fears concernsbull Discuss rehabilitation lifestyle

                                                changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                NURSING CARE PLAN

                                                bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                bull Identify need for referral for sexual counselling

                                                NURSING CARE PLAN

                                                bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                bull Information about sexual activity less fatiguing positions

                                                bull Support groups Follow-up carebull Medications administration importance untoward

                                                effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                weight control stress reduction

                                                EVALUATION

                                                bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                CONGESTIVE HEART FAILURE

                                                bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                PATHOPHYSIOLOGY

                                                Increased cardiac workload

                                                decreased effective myocardial contractility

                                                Decreased cardiac output

                                                LV failure Pulmonary congestion

                                                RA RV failure

                                                Systemic congestion

                                                Peripheral edema

                                                ASSESSMENTbull Subjective data

                                                bull Shortness of breathbull Orthopnea (sleeps on two

                                                or more pillows)bull Paroxysmal nocturnal

                                                dyspnea (sudden breathlessness during sleep)

                                                bull Dyspnea on exertion (climbing stairs)

                                                bull Apprehension anxiety irritability

                                                bull Fatigue weaknessbull Reported weight gain

                                                feeling of puffiness

                                                ASSESSMENTbull Objective data

                                                bull VSbull BP decreasing systolic

                                                narrowing pulse pressurebull Pulse pulsus alternans

                                                (alternating strong-weak-strong cardiac contraction) increased

                                                bull Respirations crackles Cheyne-Stokes

                                                bull Edema dependent pitting (1+ to 4+ mm)

                                                bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                dilated pulmonary vessels lung edema

                                                Left Ventricular Compared with Right Ventricular Heart Failure

                                                LEFT VENTRICULAR

                                                FAILURE

                                                RIGHT VENTRICULAR

                                                FAILURE

                                                Pulmonary crackles Jugular venous distention

                                                Tachypnea Peripheral edema

                                                S3 gallop Perioral and peripheral cyanosis

                                                Cardiac murmurs Congestive hepatomegaly

                                                Paradoxical splitting of S2

                                                Ascites

                                                Hepatojugular reflux

                                                ANALYSIS NURSING DIAGNOSES

                                                bull Decreased cardiac output related to decreased myocardial contractility

                                                bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                bull Fatigue related to edema and poor oxygenation

                                                bull Fluid volume excess related to compensatory mechanisms

                                                bull Impaired gas exchange related to pulmonary congestion

                                                bull Anxiety related to shortness of breath

                                                bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                NURSING CARE PLAN

                                                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                tachycardia dyspnea edema resolved change position frequently pillows for support

                                                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                bull Warm fluids if appropriate

                                                NURSING CARE PLAN

                                                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                NURSING CARE PLANbull Goal 3 provide for special safety

                                                needsbull Skin care

                                                bull Inspect massage lubricate bony prominences

                                                bull Use foot cradle heel protectors sheepskin

                                                bull Side rails up if hypoxic (disoriented)

                                                bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                bull ROM active passive elastic stockings

                                                NURSING CARE PLAN

                                                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                strict IObull Diet

                                                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                NURSING CARE PLAN

                                                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                EVALUATION

                                                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                distressbull Reduction in dependent edema

                                                DAY 3 OF

                                                CARDIOVASCULARDISEASES

                                                bull hyperlipidemia means high lipid levels

                                                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                Treatment of Hyperlipidemia

                                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                bull SYSTOLIC DYSFUNCTION

                                                HYPERTROPHIC CARDIOMYOPATHY

                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                HYPERTROPHIC CARDIOMYOPATHY

                                                bull Pathophysiologybull 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

                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                CARDIOMYOPATHIES

                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                CARDIOMYOPATHIES

                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                CARDIOMYOPATHIES

                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                relief

                                                CARDIOMYOPATHIES

                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                CARDIOMYOPATHIES

                                                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

                                                Infective endocarditis

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

                                                bull Can be acute or chronic

                                                Infective endocarditis

                                                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

                                                Infective endocarditis

                                                bull Pathophysiologybull 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

                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                Infective endocarditis

                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                retina

                                                Infective endocarditis

                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                Infective endocarditis

                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                Infective endocarditis

                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                organism

                                                Infective endocarditis

                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                Infective endocarditis

                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                B

                                                Infective endocarditis

                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                CARDIOGENIC SHOCK

                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                CARDIOGENIC SHOCK

                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                CARDIOGENIC SHOCK

                                                bull LABORATORY FINDINGSIncreased CVP

                                                Normal is 4-10 cmH2O

                                                CARDIOGENIC SHOCK

                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                decreased pulmonary congestion and to relieve pain

                                                CARDIOGENIC SHOCK

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

                                                bull 6 Monitor urinary output BP and pulses

                                                bull 7 cautiously administer diuretics and nitrates

                                                CARDIAC TAMPONADE

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

                                                CARDIAC TAMPONADE

                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                CARDIAC TAMPONADE

                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                CARDIAC TAMPONADE

                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                distention hypotension and distantmuffled heart sound

                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                CARDIAC TAMPONADE

                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                anterior chest

                                                CARDIAC TAMPONADE

                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                CARDIAC TAMPONADE

                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                tamponade

                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                HYPERTENSION

                                                bull 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

                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                bull Most common typebull 2 Secondary

                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                Alterations in Blood Flow in the Systemic Circulation

                                                Buergerrsquos Disease

                                                bull Also known as Thromboangiitis obliterans

                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                reaction of the vessel wall

                                                Manifestations

                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                Increased sensitivity to cold (due to impaired circulation

                                                Absentdiminished peripheral pulses

                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                gangrenous changes may arise may necessitate amputation

                                                Diagnosis amp Treatment

                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                bull Return to normal colorbull Note although all of the fingers are

                                                affected symmetrically only 1-2digits may be involved

                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                (rare occasions)

                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                A Assessment

                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                2 vsB Nursing Dx

                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                2 Impaired gas exchange

                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                C Goals

                                                1 Relief of pain amp symptoms

                                                2 Prevention of further cardiac damage

                                                D Nursing Interventions

                                                1 Pain control

                                                2 Proper medications

                                                3 Decrease clientrsquos anxiety

                                                4 Health teachings (meds activities diet exercise etc)

                                                • CARDIOVASCULAR DISEASES
                                                • Slide 2
                                                • GENERAL CARDIAC ASSESSMENT
                                                • Pathophysiology
                                                • Slide 5
                                                • ASSESSING CHEST PAIN
                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                • Angina Pectoris Myocardial Ischemia
                                                • Pathophysiology
                                                • Types
                                                • Slide 12
                                                • Slide 13
                                                • Slide 14
                                                • Conthellip
                                                • Conthellip (2)
                                                • Drug Therapy
                                                • Classification
                                                • Nursing Management
                                                • Nursing Management (2)
                                                • Acute Coronary Syndrome
                                                • Slide 22
                                                • Conthellip (3)
                                                • Slide 24
                                                • Conthellip(MI)
                                                • Slide 26
                                                • Pathophysiology (2)
                                                • Tissue Changes After MI
                                                • Management of MI
                                                • Slide 30
                                                • Slide 31
                                                • ASSESSMENT
                                                • ANALYSIS NURSING DIAGNOSES
                                                • NURSING CARE PLAN
                                                • NURSING CARE PLAN (2)
                                                • NURSING CARE PLAN (3)
                                                • NURSING CARE PLAN (4)
                                                • NURSING CARE PLAN (5)
                                                • NURSING CARE PLAN (6)
                                                • NURSING CARE PLAN (7)
                                                • NURSING CARE PLAN (8)
                                                • EVALUATION
                                                • CONGESTIVE HEART FAILURE
                                                • PATHOPHYSIOLOGY
                                                • ASSESSMENT (2)
                                                • ASSESSMENT (3)
                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                • Slide 49
                                                • NURSING CARE PLAN (9)
                                                • NURSING CARE PLAN (10)
                                                • NURSING CARE PLAN (11)
                                                • NURSING CARE PLAN (12)
                                                • NURSING CARE PLAN (13)
                                                • EVALUATION
                                                • Slide 56
                                                • Slide 57
                                                • Slide 58
                                                • Slide 59
                                                • Slide 60
                                                • Treatment of Hyperlipidemia
                                                • Slide 62
                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                • RESTRICTIVE CARDIOMYOPATHY
                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                • CARDIOMYOPATHIES
                                                • CARDIOMYOPATHIES (2)
                                                • CARDIOMYOPATHIES (3)
                                                • CARDIOMYOPATHIES (4)
                                                • CARDIOMYOPATHIES (5)
                                                • CARDIOMYOPATHIES (6)
                                                • Infective endocarditis
                                                • Infective endocarditis (2)
                                                • Infective endocarditis (3)
                                                • Infective endocarditis (4)
                                                • Infective endocarditis (5)
                                                • Infective endocarditis (6)
                                                • Infective endocarditis (7)
                                                • Infective endocarditis (8)
                                                • Infective endocarditis (9)
                                                • Infective endocarditis (10)
                                                • Infective endocarditis (11)
                                                • Infective endocarditis (12)
                                                • CARDIOGENIC SHOCK
                                                • CARDIOGENIC SHOCK (2)
                                                • CARDIOGENIC SHOCK (3)
                                                • CARDIOGENIC SHOCK (4)
                                                • CARDIOGENIC SHOCK (5)
                                                • CARDIAC TAMPONADE
                                                • CARDIAC TAMPONADE (2)
                                                • CARDIAC TAMPONADE (3)
                                                • CARDIAC TAMPONADE (4)
                                                • CARDIAC TAMPONADE (5)
                                                • CARDIAC TAMPONADE (6)
                                                • CARDIAC TAMPONADE (7)
                                                • Slide 100
                                                • HYPERTENSION
                                                • HYPERTENSION (2)
                                                • Slide 103
                                                • Slide 104
                                                • Slide 105
                                                • Alterations in Blood Flow in the Systemic Circulation
                                                • Buergerrsquos Disease
                                                • Slide 108
                                                • Manifestations
                                                • Slide 110
                                                • Diagnosis amp Treatment
                                                • Rynaudrsquos Disease
                                                • Manifestations (2)
                                                • Slide 114
                                                • Diagnosis amp Treatment (2)
                                                • Slide 116
                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                • Slide 118
                                                • Slide 119
                                                • Slide 120
                                                • Slide 121

                                                  Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash

                                                  profound LV failure from massive MI resulting to low cardiac output

                                                  Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins

                                                  Rupture of myocardiumVentricular aneurysms ndash decreases

                                                  pumping efficiency of heart amp increases work of LV

                                                  Pathophysiology

                                                  Causes atherosclerotic heart disease thrombosisembolism

                                                  shock ampor hemorrhage direct traumaMyocardial ischemia

                                                  uarrcellular hypoxia

                                                  darrmyocardial O2 supplydarr myocardial contractility

                                                  darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                                  uarrperipheral vasoconstriction

                                                  uarr myocardial contractility

                                                  uarr afterload uarrmyocardial O2 demand

                                                  uarr HR uarrdiastolicfilling

                                                  darrmyocardial tissue perfusion

                                                  Tissue Changes After MI

                                                  Time after Onset Type of Injury amp Gross Tissue Changes

                                                  0-05hrs Reversible injury

                                                  1-2hrs Onset of irreversible injury

                                                  4-12hrs Beginning of coagulation necrosis

                                                  18-24hrs Continued necrosis gross pallor of infected tissue

                                                  1-3days Total necrosis onset of acute inflammatory process

                                                  3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                                  7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                                  8th week Complete scar tissue replacement

                                                  Management of MI Initial Management OMEN

                                                  - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                                  vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                                  may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                                  Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                                  Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                                  bull Surgery 1Revascularization

                                                  bullPTCAbullCoronary stent implantation

                                                  bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                  2Resection ndash aneurysm

                                                  ASSESSMENT

                                                  bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                  bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                  ANALYSIS NURSING DIAGNOSES

                                                  bull Decreased cardiac output related to myocardial damage

                                                  bull Impaired gas exchange related to poor perfusion shock

                                                  bull Pain related to myocardial ischemia

                                                  bull Activity intolerance related to pain or inadequate oxygenation

                                                  bull Fear related to possibility of death

                                                  NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                  bull Narcotics ndash morphine note response Avoid IM

                                                  bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                  bull Position semi-Fowlerrsquos to improve ventilation

                                                  NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                  rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                  thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                  cracklesbull Check labs troponin blood gases electrolytes

                                                  clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                  bull ROM of lower extremities antiembolic stockings

                                                  NURSING CARE PLAN

                                                  bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                  bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                  bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                  bull Anticipate needs of client call light water Reassurance

                                                  bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                  NURSING CARE PLAN

                                                  bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                  Mg)bull Monitor ECGbull Diet progressive low

                                                  calorie low sodium low cholesterol low fat without caffeine

                                                  NURSING CARE PLAN

                                                  bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                  softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                  bull Bedside commode

                                                  NURSING CARE PLAN

                                                  bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                  denial anger withdrawalbull Encourage expression of

                                                  feelings fears concernsbull Discuss rehabilitation lifestyle

                                                  changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                  NURSING CARE PLAN

                                                  bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                  activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                  bull Identify need for referral for sexual counselling

                                                  NURSING CARE PLAN

                                                  bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                  meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                  bull Information about sexual activity less fatiguing positions

                                                  bull Support groups Follow-up carebull Medications administration importance untoward

                                                  effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                  weight control stress reduction

                                                  EVALUATION

                                                  bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                  CONGESTIVE HEART FAILURE

                                                  bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                  PATHOPHYSIOLOGY

                                                  Increased cardiac workload

                                                  decreased effective myocardial contractility

                                                  Decreased cardiac output

                                                  LV failure Pulmonary congestion

                                                  RA RV failure

                                                  Systemic congestion

                                                  Peripheral edema

                                                  ASSESSMENTbull Subjective data

                                                  bull Shortness of breathbull Orthopnea (sleeps on two

                                                  or more pillows)bull Paroxysmal nocturnal

                                                  dyspnea (sudden breathlessness during sleep)

                                                  bull Dyspnea on exertion (climbing stairs)

                                                  bull Apprehension anxiety irritability

                                                  bull Fatigue weaknessbull Reported weight gain

                                                  feeling of puffiness

                                                  ASSESSMENTbull Objective data

                                                  bull VSbull BP decreasing systolic

                                                  narrowing pulse pressurebull Pulse pulsus alternans

                                                  (alternating strong-weak-strong cardiac contraction) increased

                                                  bull Respirations crackles Cheyne-Stokes

                                                  bull Edema dependent pitting (1+ to 4+ mm)

                                                  bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                  dilated pulmonary vessels lung edema

                                                  Left Ventricular Compared with Right Ventricular Heart Failure

                                                  LEFT VENTRICULAR

                                                  FAILURE

                                                  RIGHT VENTRICULAR

                                                  FAILURE

                                                  Pulmonary crackles Jugular venous distention

                                                  Tachypnea Peripheral edema

                                                  S3 gallop Perioral and peripheral cyanosis

                                                  Cardiac murmurs Congestive hepatomegaly

                                                  Paradoxical splitting of S2

                                                  Ascites

                                                  Hepatojugular reflux

                                                  ANALYSIS NURSING DIAGNOSES

                                                  bull Decreased cardiac output related to decreased myocardial contractility

                                                  bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                  bull Fatigue related to edema and poor oxygenation

                                                  bull Fluid volume excess related to compensatory mechanisms

                                                  bull Impaired gas exchange related to pulmonary congestion

                                                  bull Anxiety related to shortness of breath

                                                  bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                  NURSING CARE PLAN

                                                  bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                  tachycardia dyspnea edema resolved change position frequently pillows for support

                                                  bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                  bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                  bull Warm fluids if appropriate

                                                  NURSING CARE PLAN

                                                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                  NURSING CARE PLANbull Goal 3 provide for special safety

                                                  needsbull Skin care

                                                  bull Inspect massage lubricate bony prominences

                                                  bull Use foot cradle heel protectors sheepskin

                                                  bull Side rails up if hypoxic (disoriented)

                                                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                  bull ROM active passive elastic stockings

                                                  NURSING CARE PLAN

                                                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                  strict IObull Diet

                                                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                  NURSING CARE PLAN

                                                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                  EVALUATION

                                                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                  distressbull Reduction in dependent edema

                                                  DAY 3 OF

                                                  CARDIOVASCULARDISEASES

                                                  bull hyperlipidemia means high lipid levels

                                                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                  Treatment of Hyperlipidemia

                                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                  bull SYSTOLIC DYSFUNCTION

                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                  bull Pathophysiologybull 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

                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                  CARDIOMYOPATHIES

                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                  CARDIOMYOPATHIES

                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                  CARDIOMYOPATHIES

                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                  relief

                                                  CARDIOMYOPATHIES

                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                  CARDIOMYOPATHIES

                                                  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

                                                  Infective endocarditis

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

                                                  bull Can be acute or chronic

                                                  Infective endocarditis

                                                  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

                                                  Infective endocarditis

                                                  bull Pathophysiologybull 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

                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                  Infective endocarditis

                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                  retina

                                                  Infective endocarditis

                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                  Infective endocarditis

                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                  Infective endocarditis

                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                  organism

                                                  Infective endocarditis

                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                  Infective endocarditis

                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                  B

                                                  Infective endocarditis

                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                  CARDIOGENIC SHOCK

                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                  CARDIOGENIC SHOCK

                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                  CARDIOGENIC SHOCK

                                                  bull LABORATORY FINDINGSIncreased CVP

                                                  Normal is 4-10 cmH2O

                                                  CARDIOGENIC SHOCK

                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                  decreased pulmonary congestion and to relieve pain

                                                  CARDIOGENIC SHOCK

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

                                                  bull 6 Monitor urinary output BP and pulses

                                                  bull 7 cautiously administer diuretics and nitrates

                                                  CARDIAC TAMPONADE

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

                                                  CARDIAC TAMPONADE

                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                  CARDIAC TAMPONADE

                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                  CARDIAC TAMPONADE

                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                  distention hypotension and distantmuffled heart sound

                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                  CARDIAC TAMPONADE

                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                  anterior chest

                                                  CARDIAC TAMPONADE

                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                  CARDIAC TAMPONADE

                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                  tamponade

                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                  HYPERTENSION

                                                  bull 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

                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                  bull Most common typebull 2 Secondary

                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                  Alterations in Blood Flow in the Systemic Circulation

                                                  Buergerrsquos Disease

                                                  bull Also known as Thromboangiitis obliterans

                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                  reaction of the vessel wall

                                                  Manifestations

                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                  Increased sensitivity to cold (due to impaired circulation

                                                  Absentdiminished peripheral pulses

                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                  gangrenous changes may arise may necessitate amputation

                                                  Diagnosis amp Treatment

                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                  bull Return to normal colorbull Note although all of the fingers are

                                                  affected symmetrically only 1-2digits may be involved

                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                  (rare occasions)

                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                  A Assessment

                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                  2 vsB Nursing Dx

                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                  2 Impaired gas exchange

                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                  C Goals

                                                  1 Relief of pain amp symptoms

                                                  2 Prevention of further cardiac damage

                                                  D Nursing Interventions

                                                  1 Pain control

                                                  2 Proper medications

                                                  3 Decrease clientrsquos anxiety

                                                  4 Health teachings (meds activities diet exercise etc)

                                                  • CARDIOVASCULAR DISEASES
                                                  • Slide 2
                                                  • GENERAL CARDIAC ASSESSMENT
                                                  • Pathophysiology
                                                  • Slide 5
                                                  • ASSESSING CHEST PAIN
                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                  • Angina Pectoris Myocardial Ischemia
                                                  • Pathophysiology
                                                  • Types
                                                  • Slide 12
                                                  • Slide 13
                                                  • Slide 14
                                                  • Conthellip
                                                  • Conthellip (2)
                                                  • Drug Therapy
                                                  • Classification
                                                  • Nursing Management
                                                  • Nursing Management (2)
                                                  • Acute Coronary Syndrome
                                                  • Slide 22
                                                  • Conthellip (3)
                                                  • Slide 24
                                                  • Conthellip(MI)
                                                  • Slide 26
                                                  • Pathophysiology (2)
                                                  • Tissue Changes After MI
                                                  • Management of MI
                                                  • Slide 30
                                                  • Slide 31
                                                  • ASSESSMENT
                                                  • ANALYSIS NURSING DIAGNOSES
                                                  • NURSING CARE PLAN
                                                  • NURSING CARE PLAN (2)
                                                  • NURSING CARE PLAN (3)
                                                  • NURSING CARE PLAN (4)
                                                  • NURSING CARE PLAN (5)
                                                  • NURSING CARE PLAN (6)
                                                  • NURSING CARE PLAN (7)
                                                  • NURSING CARE PLAN (8)
                                                  • EVALUATION
                                                  • CONGESTIVE HEART FAILURE
                                                  • PATHOPHYSIOLOGY
                                                  • ASSESSMENT (2)
                                                  • ASSESSMENT (3)
                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                  • Slide 49
                                                  • NURSING CARE PLAN (9)
                                                  • NURSING CARE PLAN (10)
                                                  • NURSING CARE PLAN (11)
                                                  • NURSING CARE PLAN (12)
                                                  • NURSING CARE PLAN (13)
                                                  • EVALUATION
                                                  • Slide 56
                                                  • Slide 57
                                                  • Slide 58
                                                  • Slide 59
                                                  • Slide 60
                                                  • Treatment of Hyperlipidemia
                                                  • Slide 62
                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                  • CARDIOMYOPATHIES
                                                  • CARDIOMYOPATHIES (2)
                                                  • CARDIOMYOPATHIES (3)
                                                  • CARDIOMYOPATHIES (4)
                                                  • CARDIOMYOPATHIES (5)
                                                  • CARDIOMYOPATHIES (6)
                                                  • Infective endocarditis
                                                  • Infective endocarditis (2)
                                                  • Infective endocarditis (3)
                                                  • Infective endocarditis (4)
                                                  • Infective endocarditis (5)
                                                  • Infective endocarditis (6)
                                                  • Infective endocarditis (7)
                                                  • Infective endocarditis (8)
                                                  • Infective endocarditis (9)
                                                  • Infective endocarditis (10)
                                                  • Infective endocarditis (11)
                                                  • Infective endocarditis (12)
                                                  • CARDIOGENIC SHOCK
                                                  • CARDIOGENIC SHOCK (2)
                                                  • CARDIOGENIC SHOCK (3)
                                                  • CARDIOGENIC SHOCK (4)
                                                  • CARDIOGENIC SHOCK (5)
                                                  • CARDIAC TAMPONADE
                                                  • CARDIAC TAMPONADE (2)
                                                  • CARDIAC TAMPONADE (3)
                                                  • CARDIAC TAMPONADE (4)
                                                  • CARDIAC TAMPONADE (5)
                                                  • CARDIAC TAMPONADE (6)
                                                  • CARDIAC TAMPONADE (7)
                                                  • Slide 100
                                                  • HYPERTENSION
                                                  • HYPERTENSION (2)
                                                  • Slide 103
                                                  • Slide 104
                                                  • Slide 105
                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                  • Buergerrsquos Disease
                                                  • Slide 108
                                                  • Manifestations
                                                  • Slide 110
                                                  • Diagnosis amp Treatment
                                                  • Rynaudrsquos Disease
                                                  • Manifestations (2)
                                                  • Slide 114
                                                  • Diagnosis amp Treatment (2)
                                                  • Slide 116
                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                  • Slide 118
                                                  • Slide 119
                                                  • Slide 120
                                                  • Slide 121

                                                    Pathophysiology

                                                    Causes atherosclerotic heart disease thrombosisembolism

                                                    shock ampor hemorrhage direct traumaMyocardial ischemia

                                                    uarrcellular hypoxia

                                                    darrmyocardial O2 supplydarr myocardial contractility

                                                    darrcardiac output darrarterial pressure Stimulation of sympathetic receptors

                                                    uarrperipheral vasoconstriction

                                                    uarr myocardial contractility

                                                    uarr afterload uarrmyocardial O2 demand

                                                    uarr HR uarrdiastolicfilling

                                                    darrmyocardial tissue perfusion

                                                    Tissue Changes After MI

                                                    Time after Onset Type of Injury amp Gross Tissue Changes

                                                    0-05hrs Reversible injury

                                                    1-2hrs Onset of irreversible injury

                                                    4-12hrs Beginning of coagulation necrosis

                                                    18-24hrs Continued necrosis gross pallor of infected tissue

                                                    1-3days Total necrosis onset of acute inflammatory process

                                                    3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                                    7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                                    8th week Complete scar tissue replacement

                                                    Management of MI Initial Management OMEN

                                                    - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                                    vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                                    may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                                    Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                                    Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                                    bull Surgery 1Revascularization

                                                    bullPTCAbullCoronary stent implantation

                                                    bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                    2Resection ndash aneurysm

                                                    ASSESSMENT

                                                    bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                    bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                    ANALYSIS NURSING DIAGNOSES

                                                    bull Decreased cardiac output related to myocardial damage

                                                    bull Impaired gas exchange related to poor perfusion shock

                                                    bull Pain related to myocardial ischemia

                                                    bull Activity intolerance related to pain or inadequate oxygenation

                                                    bull Fear related to possibility of death

                                                    NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                    bull Narcotics ndash morphine note response Avoid IM

                                                    bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                    bull Position semi-Fowlerrsquos to improve ventilation

                                                    NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                    rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                    thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                    cracklesbull Check labs troponin blood gases electrolytes

                                                    clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                    bull ROM of lower extremities antiembolic stockings

                                                    NURSING CARE PLAN

                                                    bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                    bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                    bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                    bull Anticipate needs of client call light water Reassurance

                                                    bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                    NURSING CARE PLAN

                                                    bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                    Mg)bull Monitor ECGbull Diet progressive low

                                                    calorie low sodium low cholesterol low fat without caffeine

                                                    NURSING CARE PLAN

                                                    bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                    softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                    bull Bedside commode

                                                    NURSING CARE PLAN

                                                    bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                    denial anger withdrawalbull Encourage expression of

                                                    feelings fears concernsbull Discuss rehabilitation lifestyle

                                                    changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                    NURSING CARE PLAN

                                                    bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                    activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                    bull Identify need for referral for sexual counselling

                                                    NURSING CARE PLAN

                                                    bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                    meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                    bull Information about sexual activity less fatiguing positions

                                                    bull Support groups Follow-up carebull Medications administration importance untoward

                                                    effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                    weight control stress reduction

                                                    EVALUATION

                                                    bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                    CONGESTIVE HEART FAILURE

                                                    bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                    PATHOPHYSIOLOGY

                                                    Increased cardiac workload

                                                    decreased effective myocardial contractility

                                                    Decreased cardiac output

                                                    LV failure Pulmonary congestion

                                                    RA RV failure

                                                    Systemic congestion

                                                    Peripheral edema

                                                    ASSESSMENTbull Subjective data

                                                    bull Shortness of breathbull Orthopnea (sleeps on two

                                                    or more pillows)bull Paroxysmal nocturnal

                                                    dyspnea (sudden breathlessness during sleep)

                                                    bull Dyspnea on exertion (climbing stairs)

                                                    bull Apprehension anxiety irritability

                                                    bull Fatigue weaknessbull Reported weight gain

                                                    feeling of puffiness

                                                    ASSESSMENTbull Objective data

                                                    bull VSbull BP decreasing systolic

                                                    narrowing pulse pressurebull Pulse pulsus alternans

                                                    (alternating strong-weak-strong cardiac contraction) increased

                                                    bull Respirations crackles Cheyne-Stokes

                                                    bull Edema dependent pitting (1+ to 4+ mm)

                                                    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                    dilated pulmonary vessels lung edema

                                                    Left Ventricular Compared with Right Ventricular Heart Failure

                                                    LEFT VENTRICULAR

                                                    FAILURE

                                                    RIGHT VENTRICULAR

                                                    FAILURE

                                                    Pulmonary crackles Jugular venous distention

                                                    Tachypnea Peripheral edema

                                                    S3 gallop Perioral and peripheral cyanosis

                                                    Cardiac murmurs Congestive hepatomegaly

                                                    Paradoxical splitting of S2

                                                    Ascites

                                                    Hepatojugular reflux

                                                    ANALYSIS NURSING DIAGNOSES

                                                    bull Decreased cardiac output related to decreased myocardial contractility

                                                    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                    bull Fatigue related to edema and poor oxygenation

                                                    bull Fluid volume excess related to compensatory mechanisms

                                                    bull Impaired gas exchange related to pulmonary congestion

                                                    bull Anxiety related to shortness of breath

                                                    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                    NURSING CARE PLAN

                                                    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                    tachycardia dyspnea edema resolved change position frequently pillows for support

                                                    bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                    bull Warm fluids if appropriate

                                                    NURSING CARE PLAN

                                                    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                    NURSING CARE PLANbull Goal 3 provide for special safety

                                                    needsbull Skin care

                                                    bull Inspect massage lubricate bony prominences

                                                    bull Use foot cradle heel protectors sheepskin

                                                    bull Side rails up if hypoxic (disoriented)

                                                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                    bull ROM active passive elastic stockings

                                                    NURSING CARE PLAN

                                                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                    strict IObull Diet

                                                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                    NURSING CARE PLAN

                                                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                    EVALUATION

                                                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                    distressbull Reduction in dependent edema

                                                    DAY 3 OF

                                                    CARDIOVASCULARDISEASES

                                                    bull hyperlipidemia means high lipid levels

                                                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                    Treatment of Hyperlipidemia

                                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                    bull SYSTOLIC DYSFUNCTION

                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                    bull Pathophysiologybull 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

                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                    CARDIOMYOPATHIES

                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                    CARDIOMYOPATHIES

                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                    CARDIOMYOPATHIES

                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                    relief

                                                    CARDIOMYOPATHIES

                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                    CARDIOMYOPATHIES

                                                    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

                                                    Infective endocarditis

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

                                                    bull Can be acute or chronic

                                                    Infective endocarditis

                                                    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

                                                    Infective endocarditis

                                                    bull Pathophysiologybull 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

                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                    Infective endocarditis

                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                    retina

                                                    Infective endocarditis

                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                    Infective endocarditis

                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                    Infective endocarditis

                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                    organism

                                                    Infective endocarditis

                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                    Infective endocarditis

                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                    B

                                                    Infective endocarditis

                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                    CARDIOGENIC SHOCK

                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                    CARDIOGENIC SHOCK

                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                    CARDIOGENIC SHOCK

                                                    bull LABORATORY FINDINGSIncreased CVP

                                                    Normal is 4-10 cmH2O

                                                    CARDIOGENIC SHOCK

                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                    decreased pulmonary congestion and to relieve pain

                                                    CARDIOGENIC SHOCK

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

                                                    bull 6 Monitor urinary output BP and pulses

                                                    bull 7 cautiously administer diuretics and nitrates

                                                    CARDIAC TAMPONADE

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

                                                    CARDIAC TAMPONADE

                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                    CARDIAC TAMPONADE

                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                    CARDIAC TAMPONADE

                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                    distention hypotension and distantmuffled heart sound

                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                    CARDIAC TAMPONADE

                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                    anterior chest

                                                    CARDIAC TAMPONADE

                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                    CARDIAC TAMPONADE

                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                    tamponade

                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                    HYPERTENSION

                                                    bull 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

                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                    bull Most common typebull 2 Secondary

                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                    Alterations in Blood Flow in the Systemic Circulation

                                                    Buergerrsquos Disease

                                                    bull Also known as Thromboangiitis obliterans

                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                    reaction of the vessel wall

                                                    Manifestations

                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                    Increased sensitivity to cold (due to impaired circulation

                                                    Absentdiminished peripheral pulses

                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                    gangrenous changes may arise may necessitate amputation

                                                    Diagnosis amp Treatment

                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                    bull Return to normal colorbull Note although all of the fingers are

                                                    affected symmetrically only 1-2digits may be involved

                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                    (rare occasions)

                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                    A Assessment

                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                    2 vsB Nursing Dx

                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                    2 Impaired gas exchange

                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                    C Goals

                                                    1 Relief of pain amp symptoms

                                                    2 Prevention of further cardiac damage

                                                    D Nursing Interventions

                                                    1 Pain control

                                                    2 Proper medications

                                                    3 Decrease clientrsquos anxiety

                                                    4 Health teachings (meds activities diet exercise etc)

                                                    • CARDIOVASCULAR DISEASES
                                                    • Slide 2
                                                    • GENERAL CARDIAC ASSESSMENT
                                                    • Pathophysiology
                                                    • Slide 5
                                                    • ASSESSING CHEST PAIN
                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                    • Angina Pectoris Myocardial Ischemia
                                                    • Pathophysiology
                                                    • Types
                                                    • Slide 12
                                                    • Slide 13
                                                    • Slide 14
                                                    • Conthellip
                                                    • Conthellip (2)
                                                    • Drug Therapy
                                                    • Classification
                                                    • Nursing Management
                                                    • Nursing Management (2)
                                                    • Acute Coronary Syndrome
                                                    • Slide 22
                                                    • Conthellip (3)
                                                    • Slide 24
                                                    • Conthellip(MI)
                                                    • Slide 26
                                                    • Pathophysiology (2)
                                                    • Tissue Changes After MI
                                                    • Management of MI
                                                    • Slide 30
                                                    • Slide 31
                                                    • ASSESSMENT
                                                    • ANALYSIS NURSING DIAGNOSES
                                                    • NURSING CARE PLAN
                                                    • NURSING CARE PLAN (2)
                                                    • NURSING CARE PLAN (3)
                                                    • NURSING CARE PLAN (4)
                                                    • NURSING CARE PLAN (5)
                                                    • NURSING CARE PLAN (6)
                                                    • NURSING CARE PLAN (7)
                                                    • NURSING CARE PLAN (8)
                                                    • EVALUATION
                                                    • CONGESTIVE HEART FAILURE
                                                    • PATHOPHYSIOLOGY
                                                    • ASSESSMENT (2)
                                                    • ASSESSMENT (3)
                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                    • Slide 49
                                                    • NURSING CARE PLAN (9)
                                                    • NURSING CARE PLAN (10)
                                                    • NURSING CARE PLAN (11)
                                                    • NURSING CARE PLAN (12)
                                                    • NURSING CARE PLAN (13)
                                                    • EVALUATION
                                                    • Slide 56
                                                    • Slide 57
                                                    • Slide 58
                                                    • Slide 59
                                                    • Slide 60
                                                    • Treatment of Hyperlipidemia
                                                    • Slide 62
                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                    • CARDIOMYOPATHIES
                                                    • CARDIOMYOPATHIES (2)
                                                    • CARDIOMYOPATHIES (3)
                                                    • CARDIOMYOPATHIES (4)
                                                    • CARDIOMYOPATHIES (5)
                                                    • CARDIOMYOPATHIES (6)
                                                    • Infective endocarditis
                                                    • Infective endocarditis (2)
                                                    • Infective endocarditis (3)
                                                    • Infective endocarditis (4)
                                                    • Infective endocarditis (5)
                                                    • Infective endocarditis (6)
                                                    • Infective endocarditis (7)
                                                    • Infective endocarditis (8)
                                                    • Infective endocarditis (9)
                                                    • Infective endocarditis (10)
                                                    • Infective endocarditis (11)
                                                    • Infective endocarditis (12)
                                                    • CARDIOGENIC SHOCK
                                                    • CARDIOGENIC SHOCK (2)
                                                    • CARDIOGENIC SHOCK (3)
                                                    • CARDIOGENIC SHOCK (4)
                                                    • CARDIOGENIC SHOCK (5)
                                                    • CARDIAC TAMPONADE
                                                    • CARDIAC TAMPONADE (2)
                                                    • CARDIAC TAMPONADE (3)
                                                    • CARDIAC TAMPONADE (4)
                                                    • CARDIAC TAMPONADE (5)
                                                    • CARDIAC TAMPONADE (6)
                                                    • CARDIAC TAMPONADE (7)
                                                    • Slide 100
                                                    • HYPERTENSION
                                                    • HYPERTENSION (2)
                                                    • Slide 103
                                                    • Slide 104
                                                    • Slide 105
                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                    • Buergerrsquos Disease
                                                    • Slide 108
                                                    • Manifestations
                                                    • Slide 110
                                                    • Diagnosis amp Treatment
                                                    • Rynaudrsquos Disease
                                                    • Manifestations (2)
                                                    • Slide 114
                                                    • Diagnosis amp Treatment (2)
                                                    • Slide 116
                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                    • Slide 118
                                                    • Slide 119
                                                    • Slide 120
                                                    • Slide 121

                                                      Tissue Changes After MI

                                                      Time after Onset Type of Injury amp Gross Tissue Changes

                                                      0-05hrs Reversible injury

                                                      1-2hrs Onset of irreversible injury

                                                      4-12hrs Beginning of coagulation necrosis

                                                      18-24hrs Continued necrosis gross pallor of infected tissue

                                                      1-3days Total necrosis onset of acute inflammatory process

                                                      3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges

                                                      7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)

                                                      8th week Complete scar tissue replacement

                                                      Management of MI Initial Management OMEN

                                                      - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                                      vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                                      may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                                      Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                                      Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                                      bull Surgery 1Revascularization

                                                      bullPTCAbullCoronary stent implantation

                                                      bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                      2Resection ndash aneurysm

                                                      ASSESSMENT

                                                      bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                      bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                      ANALYSIS NURSING DIAGNOSES

                                                      bull Decreased cardiac output related to myocardial damage

                                                      bull Impaired gas exchange related to poor perfusion shock

                                                      bull Pain related to myocardial ischemia

                                                      bull Activity intolerance related to pain or inadequate oxygenation

                                                      bull Fear related to possibility of death

                                                      NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                      bull Narcotics ndash morphine note response Avoid IM

                                                      bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                      bull Position semi-Fowlerrsquos to improve ventilation

                                                      NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                      rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                      thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                      cracklesbull Check labs troponin blood gases electrolytes

                                                      clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                      bull ROM of lower extremities antiembolic stockings

                                                      NURSING CARE PLAN

                                                      bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                      bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                      bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                      bull Anticipate needs of client call light water Reassurance

                                                      bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                      NURSING CARE PLAN

                                                      bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                      Mg)bull Monitor ECGbull Diet progressive low

                                                      calorie low sodium low cholesterol low fat without caffeine

                                                      NURSING CARE PLAN

                                                      bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                      softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                      bull Bedside commode

                                                      NURSING CARE PLAN

                                                      bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                      denial anger withdrawalbull Encourage expression of

                                                      feelings fears concernsbull Discuss rehabilitation lifestyle

                                                      changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                      NURSING CARE PLAN

                                                      bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                      activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                      bull Identify need for referral for sexual counselling

                                                      NURSING CARE PLAN

                                                      bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                      meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                      bull Information about sexual activity less fatiguing positions

                                                      bull Support groups Follow-up carebull Medications administration importance untoward

                                                      effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                      weight control stress reduction

                                                      EVALUATION

                                                      bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                      CONGESTIVE HEART FAILURE

                                                      bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                      PATHOPHYSIOLOGY

                                                      Increased cardiac workload

                                                      decreased effective myocardial contractility

                                                      Decreased cardiac output

                                                      LV failure Pulmonary congestion

                                                      RA RV failure

                                                      Systemic congestion

                                                      Peripheral edema

                                                      ASSESSMENTbull Subjective data

                                                      bull Shortness of breathbull Orthopnea (sleeps on two

                                                      or more pillows)bull Paroxysmal nocturnal

                                                      dyspnea (sudden breathlessness during sleep)

                                                      bull Dyspnea on exertion (climbing stairs)

                                                      bull Apprehension anxiety irritability

                                                      bull Fatigue weaknessbull Reported weight gain

                                                      feeling of puffiness

                                                      ASSESSMENTbull Objective data

                                                      bull VSbull BP decreasing systolic

                                                      narrowing pulse pressurebull Pulse pulsus alternans

                                                      (alternating strong-weak-strong cardiac contraction) increased

                                                      bull Respirations crackles Cheyne-Stokes

                                                      bull Edema dependent pitting (1+ to 4+ mm)

                                                      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                      dilated pulmonary vessels lung edema

                                                      Left Ventricular Compared with Right Ventricular Heart Failure

                                                      LEFT VENTRICULAR

                                                      FAILURE

                                                      RIGHT VENTRICULAR

                                                      FAILURE

                                                      Pulmonary crackles Jugular venous distention

                                                      Tachypnea Peripheral edema

                                                      S3 gallop Perioral and peripheral cyanosis

                                                      Cardiac murmurs Congestive hepatomegaly

                                                      Paradoxical splitting of S2

                                                      Ascites

                                                      Hepatojugular reflux

                                                      ANALYSIS NURSING DIAGNOSES

                                                      bull Decreased cardiac output related to decreased myocardial contractility

                                                      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                      bull Fatigue related to edema and poor oxygenation

                                                      bull Fluid volume excess related to compensatory mechanisms

                                                      bull Impaired gas exchange related to pulmonary congestion

                                                      bull Anxiety related to shortness of breath

                                                      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                      NURSING CARE PLAN

                                                      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                      tachycardia dyspnea edema resolved change position frequently pillows for support

                                                      bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                      bull Warm fluids if appropriate

                                                      NURSING CARE PLAN

                                                      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                      NURSING CARE PLANbull Goal 3 provide for special safety

                                                      needsbull Skin care

                                                      bull Inspect massage lubricate bony prominences

                                                      bull Use foot cradle heel protectors sheepskin

                                                      bull Side rails up if hypoxic (disoriented)

                                                      bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                      bull ROM active passive elastic stockings

                                                      NURSING CARE PLAN

                                                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                      strict IObull Diet

                                                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                      NURSING CARE PLAN

                                                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                      EVALUATION

                                                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                      distressbull Reduction in dependent edema

                                                      DAY 3 OF

                                                      CARDIOVASCULARDISEASES

                                                      bull hyperlipidemia means high lipid levels

                                                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                      Treatment of Hyperlipidemia

                                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                      bull SYSTOLIC DYSFUNCTION

                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                      bull Pathophysiologybull 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

                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                      CARDIOMYOPATHIES

                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                      CARDIOMYOPATHIES

                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                      CARDIOMYOPATHIES

                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                      relief

                                                      CARDIOMYOPATHIES

                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                      CARDIOMYOPATHIES

                                                      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

                                                      Infective endocarditis

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

                                                      bull Can be acute or chronic

                                                      Infective endocarditis

                                                      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

                                                      Infective endocarditis

                                                      bull Pathophysiologybull 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

                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                      Infective endocarditis

                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                      retina

                                                      Infective endocarditis

                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                      Infective endocarditis

                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                      Infective endocarditis

                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                      organism

                                                      Infective endocarditis

                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                      Infective endocarditis

                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                      B

                                                      Infective endocarditis

                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                      CARDIOGENIC SHOCK

                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                      CARDIOGENIC SHOCK

                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                      CARDIOGENIC SHOCK

                                                      bull LABORATORY FINDINGSIncreased CVP

                                                      Normal is 4-10 cmH2O

                                                      CARDIOGENIC SHOCK

                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                      decreased pulmonary congestion and to relieve pain

                                                      CARDIOGENIC SHOCK

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

                                                      bull 6 Monitor urinary output BP and pulses

                                                      bull 7 cautiously administer diuretics and nitrates

                                                      CARDIAC TAMPONADE

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

                                                      CARDIAC TAMPONADE

                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                      CARDIAC TAMPONADE

                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                      CARDIAC TAMPONADE

                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                      distention hypotension and distantmuffled heart sound

                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                      CARDIAC TAMPONADE

                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                      anterior chest

                                                      CARDIAC TAMPONADE

                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                      CARDIAC TAMPONADE

                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                      tamponade

                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                      HYPERTENSION

                                                      bull 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

                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                      bull Most common typebull 2 Secondary

                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                      Alterations in Blood Flow in the Systemic Circulation

                                                      Buergerrsquos Disease

                                                      bull Also known as Thromboangiitis obliterans

                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                      reaction of the vessel wall

                                                      Manifestations

                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                      Increased sensitivity to cold (due to impaired circulation

                                                      Absentdiminished peripheral pulses

                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                      gangrenous changes may arise may necessitate amputation

                                                      Diagnosis amp Treatment

                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                      bull Return to normal colorbull Note although all of the fingers are

                                                      affected symmetrically only 1-2digits may be involved

                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                      (rare occasions)

                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                      A Assessment

                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                      2 vsB Nursing Dx

                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                      2 Impaired gas exchange

                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                      C Goals

                                                      1 Relief of pain amp symptoms

                                                      2 Prevention of further cardiac damage

                                                      D Nursing Interventions

                                                      1 Pain control

                                                      2 Proper medications

                                                      3 Decrease clientrsquos anxiety

                                                      4 Health teachings (meds activities diet exercise etc)

                                                      • CARDIOVASCULAR DISEASES
                                                      • Slide 2
                                                      • GENERAL CARDIAC ASSESSMENT
                                                      • Pathophysiology
                                                      • Slide 5
                                                      • ASSESSING CHEST PAIN
                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                      • Angina Pectoris Myocardial Ischemia
                                                      • Pathophysiology
                                                      • Types
                                                      • Slide 12
                                                      • Slide 13
                                                      • Slide 14
                                                      • Conthellip
                                                      • Conthellip (2)
                                                      • Drug Therapy
                                                      • Classification
                                                      • Nursing Management
                                                      • Nursing Management (2)
                                                      • Acute Coronary Syndrome
                                                      • Slide 22
                                                      • Conthellip (3)
                                                      • Slide 24
                                                      • Conthellip(MI)
                                                      • Slide 26
                                                      • Pathophysiology (2)
                                                      • Tissue Changes After MI
                                                      • Management of MI
                                                      • Slide 30
                                                      • Slide 31
                                                      • ASSESSMENT
                                                      • ANALYSIS NURSING DIAGNOSES
                                                      • NURSING CARE PLAN
                                                      • NURSING CARE PLAN (2)
                                                      • NURSING CARE PLAN (3)
                                                      • NURSING CARE PLAN (4)
                                                      • NURSING CARE PLAN (5)
                                                      • NURSING CARE PLAN (6)
                                                      • NURSING CARE PLAN (7)
                                                      • NURSING CARE PLAN (8)
                                                      • EVALUATION
                                                      • CONGESTIVE HEART FAILURE
                                                      • PATHOPHYSIOLOGY
                                                      • ASSESSMENT (2)
                                                      • ASSESSMENT (3)
                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                      • Slide 49
                                                      • NURSING CARE PLAN (9)
                                                      • NURSING CARE PLAN (10)
                                                      • NURSING CARE PLAN (11)
                                                      • NURSING CARE PLAN (12)
                                                      • NURSING CARE PLAN (13)
                                                      • EVALUATION
                                                      • Slide 56
                                                      • Slide 57
                                                      • Slide 58
                                                      • Slide 59
                                                      • Slide 60
                                                      • Treatment of Hyperlipidemia
                                                      • Slide 62
                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                      • CARDIOMYOPATHIES
                                                      • CARDIOMYOPATHIES (2)
                                                      • CARDIOMYOPATHIES (3)
                                                      • CARDIOMYOPATHIES (4)
                                                      • CARDIOMYOPATHIES (5)
                                                      • CARDIOMYOPATHIES (6)
                                                      • Infective endocarditis
                                                      • Infective endocarditis (2)
                                                      • Infective endocarditis (3)
                                                      • Infective endocarditis (4)
                                                      • Infective endocarditis (5)
                                                      • Infective endocarditis (6)
                                                      • Infective endocarditis (7)
                                                      • Infective endocarditis (8)
                                                      • Infective endocarditis (9)
                                                      • Infective endocarditis (10)
                                                      • Infective endocarditis (11)
                                                      • Infective endocarditis (12)
                                                      • CARDIOGENIC SHOCK
                                                      • CARDIOGENIC SHOCK (2)
                                                      • CARDIOGENIC SHOCK (3)
                                                      • CARDIOGENIC SHOCK (4)
                                                      • CARDIOGENIC SHOCK (5)
                                                      • CARDIAC TAMPONADE
                                                      • CARDIAC TAMPONADE (2)
                                                      • CARDIAC TAMPONADE (3)
                                                      • CARDIAC TAMPONADE (4)
                                                      • CARDIAC TAMPONADE (5)
                                                      • CARDIAC TAMPONADE (6)
                                                      • CARDIAC TAMPONADE (7)
                                                      • Slide 100
                                                      • HYPERTENSION
                                                      • HYPERTENSION (2)
                                                      • Slide 103
                                                      • Slide 104
                                                      • Slide 105
                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                      • Buergerrsquos Disease
                                                      • Slide 108
                                                      • Manifestations
                                                      • Slide 110
                                                      • Diagnosis amp Treatment
                                                      • Rynaudrsquos Disease
                                                      • Manifestations (2)
                                                      • Slide 114
                                                      • Diagnosis amp Treatment (2)
                                                      • Slide 116
                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                      • Slide 118
                                                      • Slide 119
                                                      • Slide 120
                                                      • Slide 121

                                                        Management of MI Initial Management OMEN

                                                        - O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has

                                                        vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV

                                                        may be given to limit infarction size amp most effective if given within 4hrs of onset)

                                                        Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)

                                                        Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners

                                                        bull Surgery 1Revascularization

                                                        bullPTCAbullCoronary stent implantation

                                                        bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                        2Resection ndash aneurysm

                                                        ASSESSMENT

                                                        bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                        bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                        ANALYSIS NURSING DIAGNOSES

                                                        bull Decreased cardiac output related to myocardial damage

                                                        bull Impaired gas exchange related to poor perfusion shock

                                                        bull Pain related to myocardial ischemia

                                                        bull Activity intolerance related to pain or inadequate oxygenation

                                                        bull Fear related to possibility of death

                                                        NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                        bull Narcotics ndash morphine note response Avoid IM

                                                        bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                        bull Position semi-Fowlerrsquos to improve ventilation

                                                        NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                        rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                        thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                        cracklesbull Check labs troponin blood gases electrolytes

                                                        clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                        bull ROM of lower extremities antiembolic stockings

                                                        NURSING CARE PLAN

                                                        bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                        bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                        bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                        bull Anticipate needs of client call light water Reassurance

                                                        bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                        NURSING CARE PLAN

                                                        bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                        Mg)bull Monitor ECGbull Diet progressive low

                                                        calorie low sodium low cholesterol low fat without caffeine

                                                        NURSING CARE PLAN

                                                        bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                        softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                        bull Bedside commode

                                                        NURSING CARE PLAN

                                                        bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                        denial anger withdrawalbull Encourage expression of

                                                        feelings fears concernsbull Discuss rehabilitation lifestyle

                                                        changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                        NURSING CARE PLAN

                                                        bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                        activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                        bull Identify need for referral for sexual counselling

                                                        NURSING CARE PLAN

                                                        bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                        meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                        bull Information about sexual activity less fatiguing positions

                                                        bull Support groups Follow-up carebull Medications administration importance untoward

                                                        effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                        weight control stress reduction

                                                        EVALUATION

                                                        bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                        CONGESTIVE HEART FAILURE

                                                        bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                        PATHOPHYSIOLOGY

                                                        Increased cardiac workload

                                                        decreased effective myocardial contractility

                                                        Decreased cardiac output

                                                        LV failure Pulmonary congestion

                                                        RA RV failure

                                                        Systemic congestion

                                                        Peripheral edema

                                                        ASSESSMENTbull Subjective data

                                                        bull Shortness of breathbull Orthopnea (sleeps on two

                                                        or more pillows)bull Paroxysmal nocturnal

                                                        dyspnea (sudden breathlessness during sleep)

                                                        bull Dyspnea on exertion (climbing stairs)

                                                        bull Apprehension anxiety irritability

                                                        bull Fatigue weaknessbull Reported weight gain

                                                        feeling of puffiness

                                                        ASSESSMENTbull Objective data

                                                        bull VSbull BP decreasing systolic

                                                        narrowing pulse pressurebull Pulse pulsus alternans

                                                        (alternating strong-weak-strong cardiac contraction) increased

                                                        bull Respirations crackles Cheyne-Stokes

                                                        bull Edema dependent pitting (1+ to 4+ mm)

                                                        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                        dilated pulmonary vessels lung edema

                                                        Left Ventricular Compared with Right Ventricular Heart Failure

                                                        LEFT VENTRICULAR

                                                        FAILURE

                                                        RIGHT VENTRICULAR

                                                        FAILURE

                                                        Pulmonary crackles Jugular venous distention

                                                        Tachypnea Peripheral edema

                                                        S3 gallop Perioral and peripheral cyanosis

                                                        Cardiac murmurs Congestive hepatomegaly

                                                        Paradoxical splitting of S2

                                                        Ascites

                                                        Hepatojugular reflux

                                                        ANALYSIS NURSING DIAGNOSES

                                                        bull Decreased cardiac output related to decreased myocardial contractility

                                                        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                        bull Fatigue related to edema and poor oxygenation

                                                        bull Fluid volume excess related to compensatory mechanisms

                                                        bull Impaired gas exchange related to pulmonary congestion

                                                        bull Anxiety related to shortness of breath

                                                        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                        NURSING CARE PLAN

                                                        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                        tachycardia dyspnea edema resolved change position frequently pillows for support

                                                        bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                        bull Warm fluids if appropriate

                                                        NURSING CARE PLAN

                                                        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                        NURSING CARE PLANbull Goal 3 provide for special safety

                                                        needsbull Skin care

                                                        bull Inspect massage lubricate bony prominences

                                                        bull Use foot cradle heel protectors sheepskin

                                                        bull Side rails up if hypoxic (disoriented)

                                                        bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                        bull ROM active passive elastic stockings

                                                        NURSING CARE PLAN

                                                        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                        strict IObull Diet

                                                        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                        NURSING CARE PLAN

                                                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                        EVALUATION

                                                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                        distressbull Reduction in dependent edema

                                                        DAY 3 OF

                                                        CARDIOVASCULARDISEASES

                                                        bull hyperlipidemia means high lipid levels

                                                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                        Treatment of Hyperlipidemia

                                                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                        bull SYSTOLIC DYSFUNCTION

                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                        bull Pathophysiologybull 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

                                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                        CARDIOMYOPATHIES

                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                        CARDIOMYOPATHIES

                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                        CARDIOMYOPATHIES

                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                        relief

                                                        CARDIOMYOPATHIES

                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                        CARDIOMYOPATHIES

                                                        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

                                                        Infective endocarditis

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

                                                        bull Can be acute or chronic

                                                        Infective endocarditis

                                                        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

                                                        Infective endocarditis

                                                        bull Pathophysiologybull 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

                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                        Infective endocarditis

                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                        retina

                                                        Infective endocarditis

                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                        Infective endocarditis

                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                        Infective endocarditis

                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                        organism

                                                        Infective endocarditis

                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                        Infective endocarditis

                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                        B

                                                        Infective endocarditis

                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                        CARDIOGENIC SHOCK

                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                        CARDIOGENIC SHOCK

                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                        CARDIOGENIC SHOCK

                                                        bull LABORATORY FINDINGSIncreased CVP

                                                        Normal is 4-10 cmH2O

                                                        CARDIOGENIC SHOCK

                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                        decreased pulmonary congestion and to relieve pain

                                                        CARDIOGENIC SHOCK

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

                                                        bull 6 Monitor urinary output BP and pulses

                                                        bull 7 cautiously administer diuretics and nitrates

                                                        CARDIAC TAMPONADE

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

                                                        CARDIAC TAMPONADE

                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                        CARDIAC TAMPONADE

                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                        CARDIAC TAMPONADE

                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                        distention hypotension and distantmuffled heart sound

                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                        CARDIAC TAMPONADE

                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                        anterior chest

                                                        CARDIAC TAMPONADE

                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                        CARDIAC TAMPONADE

                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                        tamponade

                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                        HYPERTENSION

                                                        bull 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

                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                        bull Most common typebull 2 Secondary

                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                        Alterations in Blood Flow in the Systemic Circulation

                                                        Buergerrsquos Disease

                                                        bull Also known as Thromboangiitis obliterans

                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                        reaction of the vessel wall

                                                        Manifestations

                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                        Increased sensitivity to cold (due to impaired circulation

                                                        Absentdiminished peripheral pulses

                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                        gangrenous changes may arise may necessitate amputation

                                                        Diagnosis amp Treatment

                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                        bull Return to normal colorbull Note although all of the fingers are

                                                        affected symmetrically only 1-2digits may be involved

                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                        (rare occasions)

                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                        A Assessment

                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                        2 vsB Nursing Dx

                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                        2 Impaired gas exchange

                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                        C Goals

                                                        1 Relief of pain amp symptoms

                                                        2 Prevention of further cardiac damage

                                                        D Nursing Interventions

                                                        1 Pain control

                                                        2 Proper medications

                                                        3 Decrease clientrsquos anxiety

                                                        4 Health teachings (meds activities diet exercise etc)

                                                        • CARDIOVASCULAR DISEASES
                                                        • Slide 2
                                                        • GENERAL CARDIAC ASSESSMENT
                                                        • Pathophysiology
                                                        • Slide 5
                                                        • ASSESSING CHEST PAIN
                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                        • Angina Pectoris Myocardial Ischemia
                                                        • Pathophysiology
                                                        • Types
                                                        • Slide 12
                                                        • Slide 13
                                                        • Slide 14
                                                        • Conthellip
                                                        • Conthellip (2)
                                                        • Drug Therapy
                                                        • Classification
                                                        • Nursing Management
                                                        • Nursing Management (2)
                                                        • Acute Coronary Syndrome
                                                        • Slide 22
                                                        • Conthellip (3)
                                                        • Slide 24
                                                        • Conthellip(MI)
                                                        • Slide 26
                                                        • Pathophysiology (2)
                                                        • Tissue Changes After MI
                                                        • Management of MI
                                                        • Slide 30
                                                        • Slide 31
                                                        • ASSESSMENT
                                                        • ANALYSIS NURSING DIAGNOSES
                                                        • NURSING CARE PLAN
                                                        • NURSING CARE PLAN (2)
                                                        • NURSING CARE PLAN (3)
                                                        • NURSING CARE PLAN (4)
                                                        • NURSING CARE PLAN (5)
                                                        • NURSING CARE PLAN (6)
                                                        • NURSING CARE PLAN (7)
                                                        • NURSING CARE PLAN (8)
                                                        • EVALUATION
                                                        • CONGESTIVE HEART FAILURE
                                                        • PATHOPHYSIOLOGY
                                                        • ASSESSMENT (2)
                                                        • ASSESSMENT (3)
                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                        • Slide 49
                                                        • NURSING CARE PLAN (9)
                                                        • NURSING CARE PLAN (10)
                                                        • NURSING CARE PLAN (11)
                                                        • NURSING CARE PLAN (12)
                                                        • NURSING CARE PLAN (13)
                                                        • EVALUATION
                                                        • Slide 56
                                                        • Slide 57
                                                        • Slide 58
                                                        • Slide 59
                                                        • Slide 60
                                                        • Treatment of Hyperlipidemia
                                                        • Slide 62
                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                        • CARDIOMYOPATHIES
                                                        • CARDIOMYOPATHIES (2)
                                                        • CARDIOMYOPATHIES (3)
                                                        • CARDIOMYOPATHIES (4)
                                                        • CARDIOMYOPATHIES (5)
                                                        • CARDIOMYOPATHIES (6)
                                                        • Infective endocarditis
                                                        • Infective endocarditis (2)
                                                        • Infective endocarditis (3)
                                                        • Infective endocarditis (4)
                                                        • Infective endocarditis (5)
                                                        • Infective endocarditis (6)
                                                        • Infective endocarditis (7)
                                                        • Infective endocarditis (8)
                                                        • Infective endocarditis (9)
                                                        • Infective endocarditis (10)
                                                        • Infective endocarditis (11)
                                                        • Infective endocarditis (12)
                                                        • CARDIOGENIC SHOCK
                                                        • CARDIOGENIC SHOCK (2)
                                                        • CARDIOGENIC SHOCK (3)
                                                        • CARDIOGENIC SHOCK (4)
                                                        • CARDIOGENIC SHOCK (5)
                                                        • CARDIAC TAMPONADE
                                                        • CARDIAC TAMPONADE (2)
                                                        • CARDIAC TAMPONADE (3)
                                                        • CARDIAC TAMPONADE (4)
                                                        • CARDIAC TAMPONADE (5)
                                                        • CARDIAC TAMPONADE (6)
                                                        • CARDIAC TAMPONADE (7)
                                                        • Slide 100
                                                        • HYPERTENSION
                                                        • HYPERTENSION (2)
                                                        • Slide 103
                                                        • Slide 104
                                                        • Slide 105
                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                        • Buergerrsquos Disease
                                                        • Slide 108
                                                        • Manifestations
                                                        • Slide 110
                                                        • Diagnosis amp Treatment
                                                        • Rynaudrsquos Disease
                                                        • Manifestations (2)
                                                        • Slide 114
                                                        • Diagnosis amp Treatment (2)
                                                        • Slide 116
                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                        • Slide 118
                                                        • Slide 119
                                                        • Slide 120
                                                        • Slide 121

                                                          bull Surgery 1Revascularization

                                                          bullPTCAbullCoronary stent implantation

                                                          bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA

                                                          2Resection ndash aneurysm

                                                          ASSESSMENT

                                                          bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                          bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                          ANALYSIS NURSING DIAGNOSES

                                                          bull Decreased cardiac output related to myocardial damage

                                                          bull Impaired gas exchange related to poor perfusion shock

                                                          bull Pain related to myocardial ischemia

                                                          bull Activity intolerance related to pain or inadequate oxygenation

                                                          bull Fear related to possibility of death

                                                          NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                          bull Narcotics ndash morphine note response Avoid IM

                                                          bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                          bull Position semi-Fowlerrsquos to improve ventilation

                                                          NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                          rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                          thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                          cracklesbull Check labs troponin blood gases electrolytes

                                                          clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                          bull ROM of lower extremities antiembolic stockings

                                                          NURSING CARE PLAN

                                                          bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                          bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                          bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                          bull Anticipate needs of client call light water Reassurance

                                                          bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                          NURSING CARE PLAN

                                                          bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                          Mg)bull Monitor ECGbull Diet progressive low

                                                          calorie low sodium low cholesterol low fat without caffeine

                                                          NURSING CARE PLAN

                                                          bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                          softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                          bull Bedside commode

                                                          NURSING CARE PLAN

                                                          bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                          denial anger withdrawalbull Encourage expression of

                                                          feelings fears concernsbull Discuss rehabilitation lifestyle

                                                          changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                          NURSING CARE PLAN

                                                          bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                          activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                          bull Identify need for referral for sexual counselling

                                                          NURSING CARE PLAN

                                                          bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                          meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                          bull Information about sexual activity less fatiguing positions

                                                          bull Support groups Follow-up carebull Medications administration importance untoward

                                                          effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                          weight control stress reduction

                                                          EVALUATION

                                                          bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                          CONGESTIVE HEART FAILURE

                                                          bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                          PATHOPHYSIOLOGY

                                                          Increased cardiac workload

                                                          decreased effective myocardial contractility

                                                          Decreased cardiac output

                                                          LV failure Pulmonary congestion

                                                          RA RV failure

                                                          Systemic congestion

                                                          Peripheral edema

                                                          ASSESSMENTbull Subjective data

                                                          bull Shortness of breathbull Orthopnea (sleeps on two

                                                          or more pillows)bull Paroxysmal nocturnal

                                                          dyspnea (sudden breathlessness during sleep)

                                                          bull Dyspnea on exertion (climbing stairs)

                                                          bull Apprehension anxiety irritability

                                                          bull Fatigue weaknessbull Reported weight gain

                                                          feeling of puffiness

                                                          ASSESSMENTbull Objective data

                                                          bull VSbull BP decreasing systolic

                                                          narrowing pulse pressurebull Pulse pulsus alternans

                                                          (alternating strong-weak-strong cardiac contraction) increased

                                                          bull Respirations crackles Cheyne-Stokes

                                                          bull Edema dependent pitting (1+ to 4+ mm)

                                                          bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                          dilated pulmonary vessels lung edema

                                                          Left Ventricular Compared with Right Ventricular Heart Failure

                                                          LEFT VENTRICULAR

                                                          FAILURE

                                                          RIGHT VENTRICULAR

                                                          FAILURE

                                                          Pulmonary crackles Jugular venous distention

                                                          Tachypnea Peripheral edema

                                                          S3 gallop Perioral and peripheral cyanosis

                                                          Cardiac murmurs Congestive hepatomegaly

                                                          Paradoxical splitting of S2

                                                          Ascites

                                                          Hepatojugular reflux

                                                          ANALYSIS NURSING DIAGNOSES

                                                          bull Decreased cardiac output related to decreased myocardial contractility

                                                          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                          bull Fatigue related to edema and poor oxygenation

                                                          bull Fluid volume excess related to compensatory mechanisms

                                                          bull Impaired gas exchange related to pulmonary congestion

                                                          bull Anxiety related to shortness of breath

                                                          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                          NURSING CARE PLAN

                                                          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                          tachycardia dyspnea edema resolved change position frequently pillows for support

                                                          bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                          bull Warm fluids if appropriate

                                                          NURSING CARE PLAN

                                                          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                          NURSING CARE PLANbull Goal 3 provide for special safety

                                                          needsbull Skin care

                                                          bull Inspect massage lubricate bony prominences

                                                          bull Use foot cradle heel protectors sheepskin

                                                          bull Side rails up if hypoxic (disoriented)

                                                          bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                          bull ROM active passive elastic stockings

                                                          NURSING CARE PLAN

                                                          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                          strict IObull Diet

                                                          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                          NURSING CARE PLAN

                                                          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                          bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                          EVALUATION

                                                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                          distressbull Reduction in dependent edema

                                                          DAY 3 OF

                                                          CARDIOVASCULARDISEASES

                                                          bull hyperlipidemia means high lipid levels

                                                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                          Treatment of Hyperlipidemia

                                                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                          bull SYSTOLIC DYSFUNCTION

                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                          bull Pathophysiologybull 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

                                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                          CARDIOMYOPATHIES

                                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                          CARDIOMYOPATHIES

                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                          CARDIOMYOPATHIES

                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                          relief

                                                          CARDIOMYOPATHIES

                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                          CARDIOMYOPATHIES

                                                          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

                                                          Infective endocarditis

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

                                                          bull Can be acute or chronic

                                                          Infective endocarditis

                                                          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

                                                          Infective endocarditis

                                                          bull Pathophysiologybull 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

                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                          Infective endocarditis

                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                          retina

                                                          Infective endocarditis

                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                          Infective endocarditis

                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                          Infective endocarditis

                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                          organism

                                                          Infective endocarditis

                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                          Infective endocarditis

                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                          B

                                                          Infective endocarditis

                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                          CARDIOGENIC SHOCK

                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                          CARDIOGENIC SHOCK

                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                          CARDIOGENIC SHOCK

                                                          bull LABORATORY FINDINGSIncreased CVP

                                                          Normal is 4-10 cmH2O

                                                          CARDIOGENIC SHOCK

                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                          decreased pulmonary congestion and to relieve pain

                                                          CARDIOGENIC SHOCK

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

                                                          bull 6 Monitor urinary output BP and pulses

                                                          bull 7 cautiously administer diuretics and nitrates

                                                          CARDIAC TAMPONADE

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

                                                          CARDIAC TAMPONADE

                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                          CARDIAC TAMPONADE

                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                          CARDIAC TAMPONADE

                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                          distention hypotension and distantmuffled heart sound

                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                          CARDIAC TAMPONADE

                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                          anterior chest

                                                          CARDIAC TAMPONADE

                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                          CARDIAC TAMPONADE

                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                          tamponade

                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                          HYPERTENSION

                                                          bull 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

                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                          bull Most common typebull 2 Secondary

                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                          Alterations in Blood Flow in the Systemic Circulation

                                                          Buergerrsquos Disease

                                                          bull Also known as Thromboangiitis obliterans

                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                          reaction of the vessel wall

                                                          Manifestations

                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                          Increased sensitivity to cold (due to impaired circulation

                                                          Absentdiminished peripheral pulses

                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                          gangrenous changes may arise may necessitate amputation

                                                          Diagnosis amp Treatment

                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                          bull Return to normal colorbull Note although all of the fingers are

                                                          affected symmetrically only 1-2digits may be involved

                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                          (rare occasions)

                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                          A Assessment

                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                          2 vsB Nursing Dx

                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                          2 Impaired gas exchange

                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                          C Goals

                                                          1 Relief of pain amp symptoms

                                                          2 Prevention of further cardiac damage

                                                          D Nursing Interventions

                                                          1 Pain control

                                                          2 Proper medications

                                                          3 Decrease clientrsquos anxiety

                                                          4 Health teachings (meds activities diet exercise etc)

                                                          • CARDIOVASCULAR DISEASES
                                                          • Slide 2
                                                          • GENERAL CARDIAC ASSESSMENT
                                                          • Pathophysiology
                                                          • Slide 5
                                                          • ASSESSING CHEST PAIN
                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                          • Angina Pectoris Myocardial Ischemia
                                                          • Pathophysiology
                                                          • Types
                                                          • Slide 12
                                                          • Slide 13
                                                          • Slide 14
                                                          • Conthellip
                                                          • Conthellip (2)
                                                          • Drug Therapy
                                                          • Classification
                                                          • Nursing Management
                                                          • Nursing Management (2)
                                                          • Acute Coronary Syndrome
                                                          • Slide 22
                                                          • Conthellip (3)
                                                          • Slide 24
                                                          • Conthellip(MI)
                                                          • Slide 26
                                                          • Pathophysiology (2)
                                                          • Tissue Changes After MI
                                                          • Management of MI
                                                          • Slide 30
                                                          • Slide 31
                                                          • ASSESSMENT
                                                          • ANALYSIS NURSING DIAGNOSES
                                                          • NURSING CARE PLAN
                                                          • NURSING CARE PLAN (2)
                                                          • NURSING CARE PLAN (3)
                                                          • NURSING CARE PLAN (4)
                                                          • NURSING CARE PLAN (5)
                                                          • NURSING CARE PLAN (6)
                                                          • NURSING CARE PLAN (7)
                                                          • NURSING CARE PLAN (8)
                                                          • EVALUATION
                                                          • CONGESTIVE HEART FAILURE
                                                          • PATHOPHYSIOLOGY
                                                          • ASSESSMENT (2)
                                                          • ASSESSMENT (3)
                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                          • Slide 49
                                                          • NURSING CARE PLAN (9)
                                                          • NURSING CARE PLAN (10)
                                                          • NURSING CARE PLAN (11)
                                                          • NURSING CARE PLAN (12)
                                                          • NURSING CARE PLAN (13)
                                                          • EVALUATION
                                                          • Slide 56
                                                          • Slide 57
                                                          • Slide 58
                                                          • Slide 59
                                                          • Slide 60
                                                          • Treatment of Hyperlipidemia
                                                          • Slide 62
                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                          • CARDIOMYOPATHIES
                                                          • CARDIOMYOPATHIES (2)
                                                          • CARDIOMYOPATHIES (3)
                                                          • CARDIOMYOPATHIES (4)
                                                          • CARDIOMYOPATHIES (5)
                                                          • CARDIOMYOPATHIES (6)
                                                          • Infective endocarditis
                                                          • Infective endocarditis (2)
                                                          • Infective endocarditis (3)
                                                          • Infective endocarditis (4)
                                                          • Infective endocarditis (5)
                                                          • Infective endocarditis (6)
                                                          • Infective endocarditis (7)
                                                          • Infective endocarditis (8)
                                                          • Infective endocarditis (9)
                                                          • Infective endocarditis (10)
                                                          • Infective endocarditis (11)
                                                          • Infective endocarditis (12)
                                                          • CARDIOGENIC SHOCK
                                                          • CARDIOGENIC SHOCK (2)
                                                          • CARDIOGENIC SHOCK (3)
                                                          • CARDIOGENIC SHOCK (4)
                                                          • CARDIOGENIC SHOCK (5)
                                                          • CARDIAC TAMPONADE
                                                          • CARDIAC TAMPONADE (2)
                                                          • CARDIAC TAMPONADE (3)
                                                          • CARDIAC TAMPONADE (4)
                                                          • CARDIAC TAMPONADE (5)
                                                          • CARDIAC TAMPONADE (6)
                                                          • CARDIAC TAMPONADE (7)
                                                          • Slide 100
                                                          • HYPERTENSION
                                                          • HYPERTENSION (2)
                                                          • Slide 103
                                                          • Slide 104
                                                          • Slide 105
                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                          • Buergerrsquos Disease
                                                          • Slide 108
                                                          • Manifestations
                                                          • Slide 110
                                                          • Diagnosis amp Treatment
                                                          • Rynaudrsquos Disease
                                                          • Manifestations (2)
                                                          • Slide 114
                                                          • Diagnosis amp Treatment (2)
                                                          • Slide 116
                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                          • Slide 118
                                                          • Slide 119
                                                          • Slide 120
                                                          • Slide 121

                                                            ASSESSMENT

                                                            bull Subjective databull PAINbull Nauseabull SOBbull Apprehension

                                                            bull Objective databull VSbull Diaphoresisbull Emotional restlessness

                                                            ANALYSIS NURSING DIAGNOSES

                                                            bull Decreased cardiac output related to myocardial damage

                                                            bull Impaired gas exchange related to poor perfusion shock

                                                            bull Pain related to myocardial ischemia

                                                            bull Activity intolerance related to pain or inadequate oxygenation

                                                            bull Fear related to possibility of death

                                                            NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                            bull Narcotics ndash morphine note response Avoid IM

                                                            bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                            bull Position semi-Fowlerrsquos to improve ventilation

                                                            NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                            rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                            thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                            cracklesbull Check labs troponin blood gases electrolytes

                                                            clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                            bull ROM of lower extremities antiembolic stockings

                                                            NURSING CARE PLAN

                                                            bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                            bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                            bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                            bull Anticipate needs of client call light water Reassurance

                                                            bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                            NURSING CARE PLAN

                                                            bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                            Mg)bull Monitor ECGbull Diet progressive low

                                                            calorie low sodium low cholesterol low fat without caffeine

                                                            NURSING CARE PLAN

                                                            bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                            softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                            bull Bedside commode

                                                            NURSING CARE PLAN

                                                            bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                            denial anger withdrawalbull Encourage expression of

                                                            feelings fears concernsbull Discuss rehabilitation lifestyle

                                                            changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                            NURSING CARE PLAN

                                                            bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                            activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                            bull Identify need for referral for sexual counselling

                                                            NURSING CARE PLAN

                                                            bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                            meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                            bull Information about sexual activity less fatiguing positions

                                                            bull Support groups Follow-up carebull Medications administration importance untoward

                                                            effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                            weight control stress reduction

                                                            EVALUATION

                                                            bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                            CONGESTIVE HEART FAILURE

                                                            bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                            PATHOPHYSIOLOGY

                                                            Increased cardiac workload

                                                            decreased effective myocardial contractility

                                                            Decreased cardiac output

                                                            LV failure Pulmonary congestion

                                                            RA RV failure

                                                            Systemic congestion

                                                            Peripheral edema

                                                            ASSESSMENTbull Subjective data

                                                            bull Shortness of breathbull Orthopnea (sleeps on two

                                                            or more pillows)bull Paroxysmal nocturnal

                                                            dyspnea (sudden breathlessness during sleep)

                                                            bull Dyspnea on exertion (climbing stairs)

                                                            bull Apprehension anxiety irritability

                                                            bull Fatigue weaknessbull Reported weight gain

                                                            feeling of puffiness

                                                            ASSESSMENTbull Objective data

                                                            bull VSbull BP decreasing systolic

                                                            narrowing pulse pressurebull Pulse pulsus alternans

                                                            (alternating strong-weak-strong cardiac contraction) increased

                                                            bull Respirations crackles Cheyne-Stokes

                                                            bull Edema dependent pitting (1+ to 4+ mm)

                                                            bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                            dilated pulmonary vessels lung edema

                                                            Left Ventricular Compared with Right Ventricular Heart Failure

                                                            LEFT VENTRICULAR

                                                            FAILURE

                                                            RIGHT VENTRICULAR

                                                            FAILURE

                                                            Pulmonary crackles Jugular venous distention

                                                            Tachypnea Peripheral edema

                                                            S3 gallop Perioral and peripheral cyanosis

                                                            Cardiac murmurs Congestive hepatomegaly

                                                            Paradoxical splitting of S2

                                                            Ascites

                                                            Hepatojugular reflux

                                                            ANALYSIS NURSING DIAGNOSES

                                                            bull Decreased cardiac output related to decreased myocardial contractility

                                                            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                            bull Fatigue related to edema and poor oxygenation

                                                            bull Fluid volume excess related to compensatory mechanisms

                                                            bull Impaired gas exchange related to pulmonary congestion

                                                            bull Anxiety related to shortness of breath

                                                            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                            NURSING CARE PLAN

                                                            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                            tachycardia dyspnea edema resolved change position frequently pillows for support

                                                            bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                            bull Warm fluids if appropriate

                                                            NURSING CARE PLAN

                                                            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                            NURSING CARE PLANbull Goal 3 provide for special safety

                                                            needsbull Skin care

                                                            bull Inspect massage lubricate bony prominences

                                                            bull Use foot cradle heel protectors sheepskin

                                                            bull Side rails up if hypoxic (disoriented)

                                                            bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                            bull ROM active passive elastic stockings

                                                            NURSING CARE PLAN

                                                            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                            strict IObull Diet

                                                            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                            NURSING CARE PLAN

                                                            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                            bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                            EVALUATION

                                                            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                            distressbull Reduction in dependent edema

                                                            DAY 3 OF

                                                            CARDIOVASCULARDISEASES

                                                            bull hyperlipidemia means high lipid levels

                                                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                            Treatment of Hyperlipidemia

                                                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                            bull SYSTOLIC DYSFUNCTION

                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                            bull Pathophysiologybull 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

                                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                            CARDIOMYOPATHIES

                                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                            CARDIOMYOPATHIES

                                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                            CARDIOMYOPATHIES

                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                            relief

                                                            CARDIOMYOPATHIES

                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                            CARDIOMYOPATHIES

                                                            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

                                                            Infective endocarditis

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

                                                            bull Can be acute or chronic

                                                            Infective endocarditis

                                                            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

                                                            Infective endocarditis

                                                            bull Pathophysiologybull 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

                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                            Infective endocarditis

                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                            retina

                                                            Infective endocarditis

                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                            Infective endocarditis

                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                            Infective endocarditis

                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                            organism

                                                            Infective endocarditis

                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                            Infective endocarditis

                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                            B

                                                            Infective endocarditis

                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                            CARDIOGENIC SHOCK

                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                            CARDIOGENIC SHOCK

                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                            CARDIOGENIC SHOCK

                                                            bull LABORATORY FINDINGSIncreased CVP

                                                            Normal is 4-10 cmH2O

                                                            CARDIOGENIC SHOCK

                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                            decreased pulmonary congestion and to relieve pain

                                                            CARDIOGENIC SHOCK

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

                                                            bull 6 Monitor urinary output BP and pulses

                                                            bull 7 cautiously administer diuretics and nitrates

                                                            CARDIAC TAMPONADE

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

                                                            CARDIAC TAMPONADE

                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                            CARDIAC TAMPONADE

                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                            CARDIAC TAMPONADE

                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                            distention hypotension and distantmuffled heart sound

                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                            CARDIAC TAMPONADE

                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                            anterior chest

                                                            CARDIAC TAMPONADE

                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                            CARDIAC TAMPONADE

                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                            tamponade

                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                            HYPERTENSION

                                                            bull 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

                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                            bull Most common typebull 2 Secondary

                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                            Alterations in Blood Flow in the Systemic Circulation

                                                            Buergerrsquos Disease

                                                            bull Also known as Thromboangiitis obliterans

                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                            reaction of the vessel wall

                                                            Manifestations

                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                            Increased sensitivity to cold (due to impaired circulation

                                                            Absentdiminished peripheral pulses

                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                            gangrenous changes may arise may necessitate amputation

                                                            Diagnosis amp Treatment

                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                            bull Return to normal colorbull Note although all of the fingers are

                                                            affected symmetrically only 1-2digits may be involved

                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                            (rare occasions)

                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                            A Assessment

                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                            2 vsB Nursing Dx

                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                            2 Impaired gas exchange

                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                            C Goals

                                                            1 Relief of pain amp symptoms

                                                            2 Prevention of further cardiac damage

                                                            D Nursing Interventions

                                                            1 Pain control

                                                            2 Proper medications

                                                            3 Decrease clientrsquos anxiety

                                                            4 Health teachings (meds activities diet exercise etc)

                                                            • CARDIOVASCULAR DISEASES
                                                            • Slide 2
                                                            • GENERAL CARDIAC ASSESSMENT
                                                            • Pathophysiology
                                                            • Slide 5
                                                            • ASSESSING CHEST PAIN
                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                            • Angina Pectoris Myocardial Ischemia
                                                            • Pathophysiology
                                                            • Types
                                                            • Slide 12
                                                            • Slide 13
                                                            • Slide 14
                                                            • Conthellip
                                                            • Conthellip (2)
                                                            • Drug Therapy
                                                            • Classification
                                                            • Nursing Management
                                                            • Nursing Management (2)
                                                            • Acute Coronary Syndrome
                                                            • Slide 22
                                                            • Conthellip (3)
                                                            • Slide 24
                                                            • Conthellip(MI)
                                                            • Slide 26
                                                            • Pathophysiology (2)
                                                            • Tissue Changes After MI
                                                            • Management of MI
                                                            • Slide 30
                                                            • Slide 31
                                                            • ASSESSMENT
                                                            • ANALYSIS NURSING DIAGNOSES
                                                            • NURSING CARE PLAN
                                                            • NURSING CARE PLAN (2)
                                                            • NURSING CARE PLAN (3)
                                                            • NURSING CARE PLAN (4)
                                                            • NURSING CARE PLAN (5)
                                                            • NURSING CARE PLAN (6)
                                                            • NURSING CARE PLAN (7)
                                                            • NURSING CARE PLAN (8)
                                                            • EVALUATION
                                                            • CONGESTIVE HEART FAILURE
                                                            • PATHOPHYSIOLOGY
                                                            • ASSESSMENT (2)
                                                            • ASSESSMENT (3)
                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                            • Slide 49
                                                            • NURSING CARE PLAN (9)
                                                            • NURSING CARE PLAN (10)
                                                            • NURSING CARE PLAN (11)
                                                            • NURSING CARE PLAN (12)
                                                            • NURSING CARE PLAN (13)
                                                            • EVALUATION
                                                            • Slide 56
                                                            • Slide 57
                                                            • Slide 58
                                                            • Slide 59
                                                            • Slide 60
                                                            • Treatment of Hyperlipidemia
                                                            • Slide 62
                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                            • CARDIOMYOPATHIES
                                                            • CARDIOMYOPATHIES (2)
                                                            • CARDIOMYOPATHIES (3)
                                                            • CARDIOMYOPATHIES (4)
                                                            • CARDIOMYOPATHIES (5)
                                                            • CARDIOMYOPATHIES (6)
                                                            • Infective endocarditis
                                                            • Infective endocarditis (2)
                                                            • Infective endocarditis (3)
                                                            • Infective endocarditis (4)
                                                            • Infective endocarditis (5)
                                                            • Infective endocarditis (6)
                                                            • Infective endocarditis (7)
                                                            • Infective endocarditis (8)
                                                            • Infective endocarditis (9)
                                                            • Infective endocarditis (10)
                                                            • Infective endocarditis (11)
                                                            • Infective endocarditis (12)
                                                            • CARDIOGENIC SHOCK
                                                            • CARDIOGENIC SHOCK (2)
                                                            • CARDIOGENIC SHOCK (3)
                                                            • CARDIOGENIC SHOCK (4)
                                                            • CARDIOGENIC SHOCK (5)
                                                            • CARDIAC TAMPONADE
                                                            • CARDIAC TAMPONADE (2)
                                                            • CARDIAC TAMPONADE (3)
                                                            • CARDIAC TAMPONADE (4)
                                                            • CARDIAC TAMPONADE (5)
                                                            • CARDIAC TAMPONADE (6)
                                                            • CARDIAC TAMPONADE (7)
                                                            • Slide 100
                                                            • HYPERTENSION
                                                            • HYPERTENSION (2)
                                                            • Slide 103
                                                            • Slide 104
                                                            • Slide 105
                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                            • Buergerrsquos Disease
                                                            • Slide 108
                                                            • Manifestations
                                                            • Slide 110
                                                            • Diagnosis amp Treatment
                                                            • Rynaudrsquos Disease
                                                            • Manifestations (2)
                                                            • Slide 114
                                                            • Diagnosis amp Treatment (2)
                                                            • Slide 116
                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                            • Slide 118
                                                            • Slide 119
                                                            • Slide 120
                                                            • Slide 121

                                                              ANALYSIS NURSING DIAGNOSES

                                                              bull Decreased cardiac output related to myocardial damage

                                                              bull Impaired gas exchange related to poor perfusion shock

                                                              bull Pain related to myocardial ischemia

                                                              bull Activity intolerance related to pain or inadequate oxygenation

                                                              bull Fear related to possibility of death

                                                              NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                              bull Narcotics ndash morphine note response Avoid IM

                                                              bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                              bull Position semi-Fowlerrsquos to improve ventilation

                                                              NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                              rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                              thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                              cracklesbull Check labs troponin blood gases electrolytes

                                                              clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                              bull ROM of lower extremities antiembolic stockings

                                                              NURSING CARE PLAN

                                                              bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                              bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                              bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                              bull Anticipate needs of client call light water Reassurance

                                                              bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                              NURSING CARE PLAN

                                                              bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                              Mg)bull Monitor ECGbull Diet progressive low

                                                              calorie low sodium low cholesterol low fat without caffeine

                                                              NURSING CARE PLAN

                                                              bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                              softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                              bull Bedside commode

                                                              NURSING CARE PLAN

                                                              bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                              denial anger withdrawalbull Encourage expression of

                                                              feelings fears concernsbull Discuss rehabilitation lifestyle

                                                              changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                              NURSING CARE PLAN

                                                              bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                              activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                              bull Identify need for referral for sexual counselling

                                                              NURSING CARE PLAN

                                                              bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                              meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                              bull Information about sexual activity less fatiguing positions

                                                              bull Support groups Follow-up carebull Medications administration importance untoward

                                                              effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                              weight control stress reduction

                                                              EVALUATION

                                                              bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                              CONGESTIVE HEART FAILURE

                                                              bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                              PATHOPHYSIOLOGY

                                                              Increased cardiac workload

                                                              decreased effective myocardial contractility

                                                              Decreased cardiac output

                                                              LV failure Pulmonary congestion

                                                              RA RV failure

                                                              Systemic congestion

                                                              Peripheral edema

                                                              ASSESSMENTbull Subjective data

                                                              bull Shortness of breathbull Orthopnea (sleeps on two

                                                              or more pillows)bull Paroxysmal nocturnal

                                                              dyspnea (sudden breathlessness during sleep)

                                                              bull Dyspnea on exertion (climbing stairs)

                                                              bull Apprehension anxiety irritability

                                                              bull Fatigue weaknessbull Reported weight gain

                                                              feeling of puffiness

                                                              ASSESSMENTbull Objective data

                                                              bull VSbull BP decreasing systolic

                                                              narrowing pulse pressurebull Pulse pulsus alternans

                                                              (alternating strong-weak-strong cardiac contraction) increased

                                                              bull Respirations crackles Cheyne-Stokes

                                                              bull Edema dependent pitting (1+ to 4+ mm)

                                                              bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                              dilated pulmonary vessels lung edema

                                                              Left Ventricular Compared with Right Ventricular Heart Failure

                                                              LEFT VENTRICULAR

                                                              FAILURE

                                                              RIGHT VENTRICULAR

                                                              FAILURE

                                                              Pulmonary crackles Jugular venous distention

                                                              Tachypnea Peripheral edema

                                                              S3 gallop Perioral and peripheral cyanosis

                                                              Cardiac murmurs Congestive hepatomegaly

                                                              Paradoxical splitting of S2

                                                              Ascites

                                                              Hepatojugular reflux

                                                              ANALYSIS NURSING DIAGNOSES

                                                              bull Decreased cardiac output related to decreased myocardial contractility

                                                              bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                              bull Fatigue related to edema and poor oxygenation

                                                              bull Fluid volume excess related to compensatory mechanisms

                                                              bull Impaired gas exchange related to pulmonary congestion

                                                              bull Anxiety related to shortness of breath

                                                              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                              NURSING CARE PLAN

                                                              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                              tachycardia dyspnea edema resolved change position frequently pillows for support

                                                              bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                              bull Warm fluids if appropriate

                                                              NURSING CARE PLAN

                                                              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                              NURSING CARE PLANbull Goal 3 provide for special safety

                                                              needsbull Skin care

                                                              bull Inspect massage lubricate bony prominences

                                                              bull Use foot cradle heel protectors sheepskin

                                                              bull Side rails up if hypoxic (disoriented)

                                                              bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                              bull ROM active passive elastic stockings

                                                              NURSING CARE PLAN

                                                              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                              strict IObull Diet

                                                              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                              NURSING CARE PLAN

                                                              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                              bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                              EVALUATION

                                                              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                              distressbull Reduction in dependent edema

                                                              DAY 3 OF

                                                              CARDIOVASCULARDISEASES

                                                              bull hyperlipidemia means high lipid levels

                                                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                              Treatment of Hyperlipidemia

                                                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                              bull SYSTOLIC DYSFUNCTION

                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                              bull Pathophysiologybull 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

                                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                              CARDIOMYOPATHIES

                                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                              CARDIOMYOPATHIES

                                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                              CARDIOMYOPATHIES

                                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                              relief

                                                              CARDIOMYOPATHIES

                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                              CARDIOMYOPATHIES

                                                              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

                                                              Infective endocarditis

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

                                                              bull Can be acute or chronic

                                                              Infective endocarditis

                                                              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

                                                              Infective endocarditis

                                                              bull Pathophysiologybull 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

                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                              Infective endocarditis

                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                              retina

                                                              Infective endocarditis

                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                              Infective endocarditis

                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                              Infective endocarditis

                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                              organism

                                                              Infective endocarditis

                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                              Infective endocarditis

                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                              B

                                                              Infective endocarditis

                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                              CARDIOGENIC SHOCK

                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                              CARDIOGENIC SHOCK

                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                              CARDIOGENIC SHOCK

                                                              bull LABORATORY FINDINGSIncreased CVP

                                                              Normal is 4-10 cmH2O

                                                              CARDIOGENIC SHOCK

                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                              decreased pulmonary congestion and to relieve pain

                                                              CARDIOGENIC SHOCK

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

                                                              bull 6 Monitor urinary output BP and pulses

                                                              bull 7 cautiously administer diuretics and nitrates

                                                              CARDIAC TAMPONADE

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

                                                              CARDIAC TAMPONADE

                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                              CARDIAC TAMPONADE

                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                              CARDIAC TAMPONADE

                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                              distention hypotension and distantmuffled heart sound

                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                              CARDIAC TAMPONADE

                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                              anterior chest

                                                              CARDIAC TAMPONADE

                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                              CARDIAC TAMPONADE

                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                              tamponade

                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                              HYPERTENSION

                                                              bull 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

                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                              bull Most common typebull 2 Secondary

                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                              Alterations in Blood Flow in the Systemic Circulation

                                                              Buergerrsquos Disease

                                                              bull Also known as Thromboangiitis obliterans

                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                              reaction of the vessel wall

                                                              Manifestations

                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                              Increased sensitivity to cold (due to impaired circulation

                                                              Absentdiminished peripheral pulses

                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                              gangrenous changes may arise may necessitate amputation

                                                              Diagnosis amp Treatment

                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                              bull Return to normal colorbull Note although all of the fingers are

                                                              affected symmetrically only 1-2digits may be involved

                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                              (rare occasions)

                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                              A Assessment

                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                              2 vsB Nursing Dx

                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                              2 Impaired gas exchange

                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                              C Goals

                                                              1 Relief of pain amp symptoms

                                                              2 Prevention of further cardiac damage

                                                              D Nursing Interventions

                                                              1 Pain control

                                                              2 Proper medications

                                                              3 Decrease clientrsquos anxiety

                                                              4 Health teachings (meds activities diet exercise etc)

                                                              • CARDIOVASCULAR DISEASES
                                                              • Slide 2
                                                              • GENERAL CARDIAC ASSESSMENT
                                                              • Pathophysiology
                                                              • Slide 5
                                                              • ASSESSING CHEST PAIN
                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                              • Angina Pectoris Myocardial Ischemia
                                                              • Pathophysiology
                                                              • Types
                                                              • Slide 12
                                                              • Slide 13
                                                              • Slide 14
                                                              • Conthellip
                                                              • Conthellip (2)
                                                              • Drug Therapy
                                                              • Classification
                                                              • Nursing Management
                                                              • Nursing Management (2)
                                                              • Acute Coronary Syndrome
                                                              • Slide 22
                                                              • Conthellip (3)
                                                              • Slide 24
                                                              • Conthellip(MI)
                                                              • Slide 26
                                                              • Pathophysiology (2)
                                                              • Tissue Changes After MI
                                                              • Management of MI
                                                              • Slide 30
                                                              • Slide 31
                                                              • ASSESSMENT
                                                              • ANALYSIS NURSING DIAGNOSES
                                                              • NURSING CARE PLAN
                                                              • NURSING CARE PLAN (2)
                                                              • NURSING CARE PLAN (3)
                                                              • NURSING CARE PLAN (4)
                                                              • NURSING CARE PLAN (5)
                                                              • NURSING CARE PLAN (6)
                                                              • NURSING CARE PLAN (7)
                                                              • NURSING CARE PLAN (8)
                                                              • EVALUATION
                                                              • CONGESTIVE HEART FAILURE
                                                              • PATHOPHYSIOLOGY
                                                              • ASSESSMENT (2)
                                                              • ASSESSMENT (3)
                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                              • Slide 49
                                                              • NURSING CARE PLAN (9)
                                                              • NURSING CARE PLAN (10)
                                                              • NURSING CARE PLAN (11)
                                                              • NURSING CARE PLAN (12)
                                                              • NURSING CARE PLAN (13)
                                                              • EVALUATION
                                                              • Slide 56
                                                              • Slide 57
                                                              • Slide 58
                                                              • Slide 59
                                                              • Slide 60
                                                              • Treatment of Hyperlipidemia
                                                              • Slide 62
                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                              • CARDIOMYOPATHIES
                                                              • CARDIOMYOPATHIES (2)
                                                              • CARDIOMYOPATHIES (3)
                                                              • CARDIOMYOPATHIES (4)
                                                              • CARDIOMYOPATHIES (5)
                                                              • CARDIOMYOPATHIES (6)
                                                              • Infective endocarditis
                                                              • Infective endocarditis (2)
                                                              • Infective endocarditis (3)
                                                              • Infective endocarditis (4)
                                                              • Infective endocarditis (5)
                                                              • Infective endocarditis (6)
                                                              • Infective endocarditis (7)
                                                              • Infective endocarditis (8)
                                                              • Infective endocarditis (9)
                                                              • Infective endocarditis (10)
                                                              • Infective endocarditis (11)
                                                              • Infective endocarditis (12)
                                                              • CARDIOGENIC SHOCK
                                                              • CARDIOGENIC SHOCK (2)
                                                              • CARDIOGENIC SHOCK (3)
                                                              • CARDIOGENIC SHOCK (4)
                                                              • CARDIOGENIC SHOCK (5)
                                                              • CARDIAC TAMPONADE
                                                              • CARDIAC TAMPONADE (2)
                                                              • CARDIAC TAMPONADE (3)
                                                              • CARDIAC TAMPONADE (4)
                                                              • CARDIAC TAMPONADE (5)
                                                              • CARDIAC TAMPONADE (6)
                                                              • CARDIAC TAMPONADE (7)
                                                              • Slide 100
                                                              • HYPERTENSION
                                                              • HYPERTENSION (2)
                                                              • Slide 103
                                                              • Slide 104
                                                              • Slide 105
                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                              • Buergerrsquos Disease
                                                              • Slide 108
                                                              • Manifestations
                                                              • Slide 110
                                                              • Diagnosis amp Treatment
                                                              • Rynaudrsquos Disease
                                                              • Manifestations (2)
                                                              • Slide 114
                                                              • Diagnosis amp Treatment (2)
                                                              • Slide 116
                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                              • Slide 118
                                                              • Slide 119
                                                              • Slide 120
                                                              • Slide 121

                                                                NURSING CARE PLANbull Goal 1 reduce pain discomfort

                                                                bull Narcotics ndash morphine note response Avoid IM

                                                                bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying

                                                                bull Position semi-Fowlerrsquos to improve ventilation

                                                                NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                                rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                                thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                                cracklesbull Check labs troponin blood gases electrolytes

                                                                clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                                bull ROM of lower extremities antiembolic stockings

                                                                NURSING CARE PLAN

                                                                bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                                bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                                bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                                bull Anticipate needs of client call light water Reassurance

                                                                bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                                NURSING CARE PLAN

                                                                bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                                Mg)bull Monitor ECGbull Diet progressive low

                                                                calorie low sodium low cholesterol low fat without caffeine

                                                                NURSING CARE PLAN

                                                                bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                                softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                                bull Bedside commode

                                                                NURSING CARE PLAN

                                                                bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                denial anger withdrawalbull Encourage expression of

                                                                feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                NURSING CARE PLAN

                                                                bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                bull Identify need for referral for sexual counselling

                                                                NURSING CARE PLAN

                                                                bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                bull Information about sexual activity less fatiguing positions

                                                                bull Support groups Follow-up carebull Medications administration importance untoward

                                                                effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                weight control stress reduction

                                                                EVALUATION

                                                                bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                CONGESTIVE HEART FAILURE

                                                                bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                PATHOPHYSIOLOGY

                                                                Increased cardiac workload

                                                                decreased effective myocardial contractility

                                                                Decreased cardiac output

                                                                LV failure Pulmonary congestion

                                                                RA RV failure

                                                                Systemic congestion

                                                                Peripheral edema

                                                                ASSESSMENTbull Subjective data

                                                                bull Shortness of breathbull Orthopnea (sleeps on two

                                                                or more pillows)bull Paroxysmal nocturnal

                                                                dyspnea (sudden breathlessness during sleep)

                                                                bull Dyspnea on exertion (climbing stairs)

                                                                bull Apprehension anxiety irritability

                                                                bull Fatigue weaknessbull Reported weight gain

                                                                feeling of puffiness

                                                                ASSESSMENTbull Objective data

                                                                bull VSbull BP decreasing systolic

                                                                narrowing pulse pressurebull Pulse pulsus alternans

                                                                (alternating strong-weak-strong cardiac contraction) increased

                                                                bull Respirations crackles Cheyne-Stokes

                                                                bull Edema dependent pitting (1+ to 4+ mm)

                                                                bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                dilated pulmonary vessels lung edema

                                                                Left Ventricular Compared with Right Ventricular Heart Failure

                                                                LEFT VENTRICULAR

                                                                FAILURE

                                                                RIGHT VENTRICULAR

                                                                FAILURE

                                                                Pulmonary crackles Jugular venous distention

                                                                Tachypnea Peripheral edema

                                                                S3 gallop Perioral and peripheral cyanosis

                                                                Cardiac murmurs Congestive hepatomegaly

                                                                Paradoxical splitting of S2

                                                                Ascites

                                                                Hepatojugular reflux

                                                                ANALYSIS NURSING DIAGNOSES

                                                                bull Decreased cardiac output related to decreased myocardial contractility

                                                                bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                bull Fatigue related to edema and poor oxygenation

                                                                bull Fluid volume excess related to compensatory mechanisms

                                                                bull Impaired gas exchange related to pulmonary congestion

                                                                bull Anxiety related to shortness of breath

                                                                bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                NURSING CARE PLAN

                                                                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                bull Warm fluids if appropriate

                                                                NURSING CARE PLAN

                                                                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                NURSING CARE PLANbull Goal 3 provide for special safety

                                                                needsbull Skin care

                                                                bull Inspect massage lubricate bony prominences

                                                                bull Use foot cradle heel protectors sheepskin

                                                                bull Side rails up if hypoxic (disoriented)

                                                                bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                bull ROM active passive elastic stockings

                                                                NURSING CARE PLAN

                                                                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                strict IObull Diet

                                                                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                NURSING CARE PLAN

                                                                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                EVALUATION

                                                                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                distressbull Reduction in dependent edema

                                                                DAY 3 OF

                                                                CARDIOVASCULARDISEASES

                                                                bull hyperlipidemia means high lipid levels

                                                                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                Treatment of Hyperlipidemia

                                                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                bull SYSTOLIC DYSFUNCTION

                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                bull Pathophysiologybull 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

                                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                CARDIOMYOPATHIES

                                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                CARDIOMYOPATHIES

                                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                CARDIOMYOPATHIES

                                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                relief

                                                                CARDIOMYOPATHIES

                                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                CARDIOMYOPATHIES

                                                                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

                                                                Infective endocarditis

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

                                                                bull Can be acute or chronic

                                                                Infective endocarditis

                                                                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

                                                                Infective endocarditis

                                                                bull Pathophysiologybull 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

                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                Infective endocarditis

                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                retina

                                                                Infective endocarditis

                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                Infective endocarditis

                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                Infective endocarditis

                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                organism

                                                                Infective endocarditis

                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                Infective endocarditis

                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                B

                                                                Infective endocarditis

                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                CARDIOGENIC SHOCK

                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                CARDIOGENIC SHOCK

                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                CARDIOGENIC SHOCK

                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                Normal is 4-10 cmH2O

                                                                CARDIOGENIC SHOCK

                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                decreased pulmonary congestion and to relieve pain

                                                                CARDIOGENIC SHOCK

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

                                                                bull 6 Monitor urinary output BP and pulses

                                                                bull 7 cautiously administer diuretics and nitrates

                                                                CARDIAC TAMPONADE

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

                                                                CARDIAC TAMPONADE

                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                CARDIAC TAMPONADE

                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                CARDIAC TAMPONADE

                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                distention hypotension and distantmuffled heart sound

                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                CARDIAC TAMPONADE

                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                anterior chest

                                                                CARDIAC TAMPONADE

                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                CARDIAC TAMPONADE

                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                tamponade

                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                HYPERTENSION

                                                                bull 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

                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                bull Most common typebull 2 Secondary

                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                Buergerrsquos Disease

                                                                bull Also known as Thromboangiitis obliterans

                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                reaction of the vessel wall

                                                                Manifestations

                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                Increased sensitivity to cold (due to impaired circulation

                                                                Absentdiminished peripheral pulses

                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                gangrenous changes may arise may necessitate amputation

                                                                Diagnosis amp Treatment

                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                affected symmetrically only 1-2digits may be involved

                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                (rare occasions)

                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                A Assessment

                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                2 vsB Nursing Dx

                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                2 Impaired gas exchange

                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                C Goals

                                                                1 Relief of pain amp symptoms

                                                                2 Prevention of further cardiac damage

                                                                D Nursing Interventions

                                                                1 Pain control

                                                                2 Proper medications

                                                                3 Decrease clientrsquos anxiety

                                                                4 Health teachings (meds activities diet exercise etc)

                                                                • CARDIOVASCULAR DISEASES
                                                                • Slide 2
                                                                • GENERAL CARDIAC ASSESSMENT
                                                                • Pathophysiology
                                                                • Slide 5
                                                                • ASSESSING CHEST PAIN
                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                • Angina Pectoris Myocardial Ischemia
                                                                • Pathophysiology
                                                                • Types
                                                                • Slide 12
                                                                • Slide 13
                                                                • Slide 14
                                                                • Conthellip
                                                                • Conthellip (2)
                                                                • Drug Therapy
                                                                • Classification
                                                                • Nursing Management
                                                                • Nursing Management (2)
                                                                • Acute Coronary Syndrome
                                                                • Slide 22
                                                                • Conthellip (3)
                                                                • Slide 24
                                                                • Conthellip(MI)
                                                                • Slide 26
                                                                • Pathophysiology (2)
                                                                • Tissue Changes After MI
                                                                • Management of MI
                                                                • Slide 30
                                                                • Slide 31
                                                                • ASSESSMENT
                                                                • ANALYSIS NURSING DIAGNOSES
                                                                • NURSING CARE PLAN
                                                                • NURSING CARE PLAN (2)
                                                                • NURSING CARE PLAN (3)
                                                                • NURSING CARE PLAN (4)
                                                                • NURSING CARE PLAN (5)
                                                                • NURSING CARE PLAN (6)
                                                                • NURSING CARE PLAN (7)
                                                                • NURSING CARE PLAN (8)
                                                                • EVALUATION
                                                                • CONGESTIVE HEART FAILURE
                                                                • PATHOPHYSIOLOGY
                                                                • ASSESSMENT (2)
                                                                • ASSESSMENT (3)
                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                • Slide 49
                                                                • NURSING CARE PLAN (9)
                                                                • NURSING CARE PLAN (10)
                                                                • NURSING CARE PLAN (11)
                                                                • NURSING CARE PLAN (12)
                                                                • NURSING CARE PLAN (13)
                                                                • EVALUATION
                                                                • Slide 56
                                                                • Slide 57
                                                                • Slide 58
                                                                • Slide 59
                                                                • Slide 60
                                                                • Treatment of Hyperlipidemia
                                                                • Slide 62
                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                • CARDIOMYOPATHIES
                                                                • CARDIOMYOPATHIES (2)
                                                                • CARDIOMYOPATHIES (3)
                                                                • CARDIOMYOPATHIES (4)
                                                                • CARDIOMYOPATHIES (5)
                                                                • CARDIOMYOPATHIES (6)
                                                                • Infective endocarditis
                                                                • Infective endocarditis (2)
                                                                • Infective endocarditis (3)
                                                                • Infective endocarditis (4)
                                                                • Infective endocarditis (5)
                                                                • Infective endocarditis (6)
                                                                • Infective endocarditis (7)
                                                                • Infective endocarditis (8)
                                                                • Infective endocarditis (9)
                                                                • Infective endocarditis (10)
                                                                • Infective endocarditis (11)
                                                                • Infective endocarditis (12)
                                                                • CARDIOGENIC SHOCK
                                                                • CARDIOGENIC SHOCK (2)
                                                                • CARDIOGENIC SHOCK (3)
                                                                • CARDIOGENIC SHOCK (4)
                                                                • CARDIOGENIC SHOCK (5)
                                                                • CARDIAC TAMPONADE
                                                                • CARDIAC TAMPONADE (2)
                                                                • CARDIAC TAMPONADE (3)
                                                                • CARDIAC TAMPONADE (4)
                                                                • CARDIAC TAMPONADE (5)
                                                                • CARDIAC TAMPONADE (6)
                                                                • CARDIAC TAMPONADE (7)
                                                                • Slide 100
                                                                • HYPERTENSION
                                                                • HYPERTENSION (2)
                                                                • Slide 103
                                                                • Slide 104
                                                                • Slide 105
                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                • Buergerrsquos Disease
                                                                • Slide 108
                                                                • Manifestations
                                                                • Slide 110
                                                                • Diagnosis amp Treatment
                                                                • Rynaudrsquos Disease
                                                                • Manifestations (2)
                                                                • Slide 114
                                                                • Diagnosis amp Treatment (2)
                                                                • Slide 116
                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                • Slide 118
                                                                • Slide 119
                                                                • Slide 120
                                                                • Slide 121

                                                                  NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart

                                                                  rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants

                                                                  thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea

                                                                  cracklesbull Check labs troponin blood gases electrolytes

                                                                  clotting timebull CVP (5-15 cm H2O) increases with heart failure

                                                                  bull ROM of lower extremities antiembolic stockings

                                                                  NURSING CARE PLAN

                                                                  bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                                  bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                                  bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                                  bull Anticipate needs of client call light water Reassurance

                                                                  bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                                  NURSING CARE PLAN

                                                                  bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                                  Mg)bull Monitor ECGbull Diet progressive low

                                                                  calorie low sodium low cholesterol low fat without caffeine

                                                                  NURSING CARE PLAN

                                                                  bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                                  softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                                  bull Bedside commode

                                                                  NURSING CARE PLAN

                                                                  bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                  denial anger withdrawalbull Encourage expression of

                                                                  feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                  changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                  NURSING CARE PLAN

                                                                  bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                  activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                  bull Identify need for referral for sexual counselling

                                                                  NURSING CARE PLAN

                                                                  bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                  meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                  bull Information about sexual activity less fatiguing positions

                                                                  bull Support groups Follow-up carebull Medications administration importance untoward

                                                                  effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                  weight control stress reduction

                                                                  EVALUATION

                                                                  bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                  CONGESTIVE HEART FAILURE

                                                                  bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                  PATHOPHYSIOLOGY

                                                                  Increased cardiac workload

                                                                  decreased effective myocardial contractility

                                                                  Decreased cardiac output

                                                                  LV failure Pulmonary congestion

                                                                  RA RV failure

                                                                  Systemic congestion

                                                                  Peripheral edema

                                                                  ASSESSMENTbull Subjective data

                                                                  bull Shortness of breathbull Orthopnea (sleeps on two

                                                                  or more pillows)bull Paroxysmal nocturnal

                                                                  dyspnea (sudden breathlessness during sleep)

                                                                  bull Dyspnea on exertion (climbing stairs)

                                                                  bull Apprehension anxiety irritability

                                                                  bull Fatigue weaknessbull Reported weight gain

                                                                  feeling of puffiness

                                                                  ASSESSMENTbull Objective data

                                                                  bull VSbull BP decreasing systolic

                                                                  narrowing pulse pressurebull Pulse pulsus alternans

                                                                  (alternating strong-weak-strong cardiac contraction) increased

                                                                  bull Respirations crackles Cheyne-Stokes

                                                                  bull Edema dependent pitting (1+ to 4+ mm)

                                                                  bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                  dilated pulmonary vessels lung edema

                                                                  Left Ventricular Compared with Right Ventricular Heart Failure

                                                                  LEFT VENTRICULAR

                                                                  FAILURE

                                                                  RIGHT VENTRICULAR

                                                                  FAILURE

                                                                  Pulmonary crackles Jugular venous distention

                                                                  Tachypnea Peripheral edema

                                                                  S3 gallop Perioral and peripheral cyanosis

                                                                  Cardiac murmurs Congestive hepatomegaly

                                                                  Paradoxical splitting of S2

                                                                  Ascites

                                                                  Hepatojugular reflux

                                                                  ANALYSIS NURSING DIAGNOSES

                                                                  bull Decreased cardiac output related to decreased myocardial contractility

                                                                  bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                  bull Fatigue related to edema and poor oxygenation

                                                                  bull Fluid volume excess related to compensatory mechanisms

                                                                  bull Impaired gas exchange related to pulmonary congestion

                                                                  bull Anxiety related to shortness of breath

                                                                  bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                  NURSING CARE PLAN

                                                                  bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                  tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                  bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                  bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                  bull Warm fluids if appropriate

                                                                  NURSING CARE PLAN

                                                                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                  NURSING CARE PLANbull Goal 3 provide for special safety

                                                                  needsbull Skin care

                                                                  bull Inspect massage lubricate bony prominences

                                                                  bull Use foot cradle heel protectors sheepskin

                                                                  bull Side rails up if hypoxic (disoriented)

                                                                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                  bull ROM active passive elastic stockings

                                                                  NURSING CARE PLAN

                                                                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                  strict IObull Diet

                                                                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                  NURSING CARE PLAN

                                                                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                  EVALUATION

                                                                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                  distressbull Reduction in dependent edema

                                                                  DAY 3 OF

                                                                  CARDIOVASCULARDISEASES

                                                                  bull hyperlipidemia means high lipid levels

                                                                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                  Treatment of Hyperlipidemia

                                                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                  bull SYSTOLIC DYSFUNCTION

                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                  bull Pathophysiologybull 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

                                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                  CARDIOMYOPATHIES

                                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                  CARDIOMYOPATHIES

                                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                  CARDIOMYOPATHIES

                                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                  relief

                                                                  CARDIOMYOPATHIES

                                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                  CARDIOMYOPATHIES

                                                                  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

                                                                  Infective endocarditis

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

                                                                  bull Can be acute or chronic

                                                                  Infective endocarditis

                                                                  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

                                                                  Infective endocarditis

                                                                  bull Pathophysiologybull 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

                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                  Infective endocarditis

                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                  retina

                                                                  Infective endocarditis

                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                  Infective endocarditis

                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                  Infective endocarditis

                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                  organism

                                                                  Infective endocarditis

                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                  Infective endocarditis

                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                  B

                                                                  Infective endocarditis

                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                  CARDIOGENIC SHOCK

                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                  CARDIOGENIC SHOCK

                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                  CARDIOGENIC SHOCK

                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                  Normal is 4-10 cmH2O

                                                                  CARDIOGENIC SHOCK

                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                  decreased pulmonary congestion and to relieve pain

                                                                  CARDIOGENIC SHOCK

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

                                                                  bull 6 Monitor urinary output BP and pulses

                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                  CARDIAC TAMPONADE

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

                                                                  CARDIAC TAMPONADE

                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                  CARDIAC TAMPONADE

                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                  CARDIAC TAMPONADE

                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                  distention hypotension and distantmuffled heart sound

                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                  CARDIAC TAMPONADE

                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                  anterior chest

                                                                  CARDIAC TAMPONADE

                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                  CARDIAC TAMPONADE

                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                  tamponade

                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                  HYPERTENSION

                                                                  bull 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

                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                  bull Most common typebull 2 Secondary

                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                  Buergerrsquos Disease

                                                                  bull Also known as Thromboangiitis obliterans

                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                  reaction of the vessel wall

                                                                  Manifestations

                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                  Absentdiminished peripheral pulses

                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                  gangrenous changes may arise may necessitate amputation

                                                                  Diagnosis amp Treatment

                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                  affected symmetrically only 1-2digits may be involved

                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                  (rare occasions)

                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                  A Assessment

                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                  2 vsB Nursing Dx

                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                  2 Impaired gas exchange

                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                  C Goals

                                                                  1 Relief of pain amp symptoms

                                                                  2 Prevention of further cardiac damage

                                                                  D Nursing Interventions

                                                                  1 Pain control

                                                                  2 Proper medications

                                                                  3 Decrease clientrsquos anxiety

                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                  • CARDIOVASCULAR DISEASES
                                                                  • Slide 2
                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                  • Pathophysiology
                                                                  • Slide 5
                                                                  • ASSESSING CHEST PAIN
                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                  • Angina Pectoris Myocardial Ischemia
                                                                  • Pathophysiology
                                                                  • Types
                                                                  • Slide 12
                                                                  • Slide 13
                                                                  • Slide 14
                                                                  • Conthellip
                                                                  • Conthellip (2)
                                                                  • Drug Therapy
                                                                  • Classification
                                                                  • Nursing Management
                                                                  • Nursing Management (2)
                                                                  • Acute Coronary Syndrome
                                                                  • Slide 22
                                                                  • Conthellip (3)
                                                                  • Slide 24
                                                                  • Conthellip(MI)
                                                                  • Slide 26
                                                                  • Pathophysiology (2)
                                                                  • Tissue Changes After MI
                                                                  • Management of MI
                                                                  • Slide 30
                                                                  • Slide 31
                                                                  • ASSESSMENT
                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                  • NURSING CARE PLAN
                                                                  • NURSING CARE PLAN (2)
                                                                  • NURSING CARE PLAN (3)
                                                                  • NURSING CARE PLAN (4)
                                                                  • NURSING CARE PLAN (5)
                                                                  • NURSING CARE PLAN (6)
                                                                  • NURSING CARE PLAN (7)
                                                                  • NURSING CARE PLAN (8)
                                                                  • EVALUATION
                                                                  • CONGESTIVE HEART FAILURE
                                                                  • PATHOPHYSIOLOGY
                                                                  • ASSESSMENT (2)
                                                                  • ASSESSMENT (3)
                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                  • Slide 49
                                                                  • NURSING CARE PLAN (9)
                                                                  • NURSING CARE PLAN (10)
                                                                  • NURSING CARE PLAN (11)
                                                                  • NURSING CARE PLAN (12)
                                                                  • NURSING CARE PLAN (13)
                                                                  • EVALUATION
                                                                  • Slide 56
                                                                  • Slide 57
                                                                  • Slide 58
                                                                  • Slide 59
                                                                  • Slide 60
                                                                  • Treatment of Hyperlipidemia
                                                                  • Slide 62
                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                  • CARDIOMYOPATHIES
                                                                  • CARDIOMYOPATHIES (2)
                                                                  • CARDIOMYOPATHIES (3)
                                                                  • CARDIOMYOPATHIES (4)
                                                                  • CARDIOMYOPATHIES (5)
                                                                  • CARDIOMYOPATHIES (6)
                                                                  • Infective endocarditis
                                                                  • Infective endocarditis (2)
                                                                  • Infective endocarditis (3)
                                                                  • Infective endocarditis (4)
                                                                  • Infective endocarditis (5)
                                                                  • Infective endocarditis (6)
                                                                  • Infective endocarditis (7)
                                                                  • Infective endocarditis (8)
                                                                  • Infective endocarditis (9)
                                                                  • Infective endocarditis (10)
                                                                  • Infective endocarditis (11)
                                                                  • Infective endocarditis (12)
                                                                  • CARDIOGENIC SHOCK
                                                                  • CARDIOGENIC SHOCK (2)
                                                                  • CARDIOGENIC SHOCK (3)
                                                                  • CARDIOGENIC SHOCK (4)
                                                                  • CARDIOGENIC SHOCK (5)
                                                                  • CARDIAC TAMPONADE
                                                                  • CARDIAC TAMPONADE (2)
                                                                  • CARDIAC TAMPONADE (3)
                                                                  • CARDIAC TAMPONADE (4)
                                                                  • CARDIAC TAMPONADE (5)
                                                                  • CARDIAC TAMPONADE (6)
                                                                  • CARDIAC TAMPONADE (7)
                                                                  • Slide 100
                                                                  • HYPERTENSION
                                                                  • HYPERTENSION (2)
                                                                  • Slide 103
                                                                  • Slide 104
                                                                  • Slide 105
                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                  • Buergerrsquos Disease
                                                                  • Slide 108
                                                                  • Manifestations
                                                                  • Slide 110
                                                                  • Diagnosis amp Treatment
                                                                  • Rynaudrsquos Disease
                                                                  • Manifestations (2)
                                                                  • Slide 114
                                                                  • Diagnosis amp Treatment (2)
                                                                  • Slide 116
                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                  • Slide 118
                                                                  • Slide 119
                                                                  • Slide 120
                                                                  • Slide 121

                                                                    NURSING CARE PLAN

                                                                    bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered

                                                                    bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors

                                                                    bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return

                                                                    bull Anticipate needs of client call light water Reassurance

                                                                    bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics

                                                                    NURSING CARE PLAN

                                                                    bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                                    Mg)bull Monitor ECGbull Diet progressive low

                                                                    calorie low sodium low cholesterol low fat without caffeine

                                                                    NURSING CARE PLAN

                                                                    bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                                    softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                                    bull Bedside commode

                                                                    NURSING CARE PLAN

                                                                    bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                    denial anger withdrawalbull Encourage expression of

                                                                    feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                    changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                    NURSING CARE PLAN

                                                                    bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                    activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                    bull Identify need for referral for sexual counselling

                                                                    NURSING CARE PLAN

                                                                    bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                    meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                    bull Information about sexual activity less fatiguing positions

                                                                    bull Support groups Follow-up carebull Medications administration importance untoward

                                                                    effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                    weight control stress reduction

                                                                    EVALUATION

                                                                    bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                    CONGESTIVE HEART FAILURE

                                                                    bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                    PATHOPHYSIOLOGY

                                                                    Increased cardiac workload

                                                                    decreased effective myocardial contractility

                                                                    Decreased cardiac output

                                                                    LV failure Pulmonary congestion

                                                                    RA RV failure

                                                                    Systemic congestion

                                                                    Peripheral edema

                                                                    ASSESSMENTbull Subjective data

                                                                    bull Shortness of breathbull Orthopnea (sleeps on two

                                                                    or more pillows)bull Paroxysmal nocturnal

                                                                    dyspnea (sudden breathlessness during sleep)

                                                                    bull Dyspnea on exertion (climbing stairs)

                                                                    bull Apprehension anxiety irritability

                                                                    bull Fatigue weaknessbull Reported weight gain

                                                                    feeling of puffiness

                                                                    ASSESSMENTbull Objective data

                                                                    bull VSbull BP decreasing systolic

                                                                    narrowing pulse pressurebull Pulse pulsus alternans

                                                                    (alternating strong-weak-strong cardiac contraction) increased

                                                                    bull Respirations crackles Cheyne-Stokes

                                                                    bull Edema dependent pitting (1+ to 4+ mm)

                                                                    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                    dilated pulmonary vessels lung edema

                                                                    Left Ventricular Compared with Right Ventricular Heart Failure

                                                                    LEFT VENTRICULAR

                                                                    FAILURE

                                                                    RIGHT VENTRICULAR

                                                                    FAILURE

                                                                    Pulmonary crackles Jugular venous distention

                                                                    Tachypnea Peripheral edema

                                                                    S3 gallop Perioral and peripheral cyanosis

                                                                    Cardiac murmurs Congestive hepatomegaly

                                                                    Paradoxical splitting of S2

                                                                    Ascites

                                                                    Hepatojugular reflux

                                                                    ANALYSIS NURSING DIAGNOSES

                                                                    bull Decreased cardiac output related to decreased myocardial contractility

                                                                    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                    bull Fatigue related to edema and poor oxygenation

                                                                    bull Fluid volume excess related to compensatory mechanisms

                                                                    bull Impaired gas exchange related to pulmonary congestion

                                                                    bull Anxiety related to shortness of breath

                                                                    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                    NURSING CARE PLAN

                                                                    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                    tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                    bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                    bull Warm fluids if appropriate

                                                                    NURSING CARE PLAN

                                                                    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                    NURSING CARE PLANbull Goal 3 provide for special safety

                                                                    needsbull Skin care

                                                                    bull Inspect massage lubricate bony prominences

                                                                    bull Use foot cradle heel protectors sheepskin

                                                                    bull Side rails up if hypoxic (disoriented)

                                                                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                    bull ROM active passive elastic stockings

                                                                    NURSING CARE PLAN

                                                                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                    strict IObull Diet

                                                                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                    NURSING CARE PLAN

                                                                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                    EVALUATION

                                                                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                    distressbull Reduction in dependent edema

                                                                    DAY 3 OF

                                                                    CARDIOVASCULARDISEASES

                                                                    bull hyperlipidemia means high lipid levels

                                                                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                    Treatment of Hyperlipidemia

                                                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                    bull SYSTOLIC DYSFUNCTION

                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                    bull Pathophysiologybull 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

                                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                    CARDIOMYOPATHIES

                                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                    CARDIOMYOPATHIES

                                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                    CARDIOMYOPATHIES

                                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                    relief

                                                                    CARDIOMYOPATHIES

                                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                    CARDIOMYOPATHIES

                                                                    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

                                                                    Infective endocarditis

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

                                                                    bull Can be acute or chronic

                                                                    Infective endocarditis

                                                                    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

                                                                    Infective endocarditis

                                                                    bull Pathophysiologybull 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

                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                    Infective endocarditis

                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                    retina

                                                                    Infective endocarditis

                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                    Infective endocarditis

                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                    Infective endocarditis

                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                    organism

                                                                    Infective endocarditis

                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                    Infective endocarditis

                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                    B

                                                                    Infective endocarditis

                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                    CARDIOGENIC SHOCK

                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                    CARDIOGENIC SHOCK

                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                    CARDIOGENIC SHOCK

                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                    Normal is 4-10 cmH2O

                                                                    CARDIOGENIC SHOCK

                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                    decreased pulmonary congestion and to relieve pain

                                                                    CARDIOGENIC SHOCK

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

                                                                    bull 6 Monitor urinary output BP and pulses

                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                    CARDIAC TAMPONADE

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

                                                                    CARDIAC TAMPONADE

                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                    CARDIAC TAMPONADE

                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                    CARDIAC TAMPONADE

                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                    distention hypotension and distantmuffled heart sound

                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                    CARDIAC TAMPONADE

                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                    anterior chest

                                                                    CARDIAC TAMPONADE

                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                    CARDIAC TAMPONADE

                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                    tamponade

                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                    HYPERTENSION

                                                                    bull 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

                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                    bull Most common typebull 2 Secondary

                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                    Buergerrsquos Disease

                                                                    bull Also known as Thromboangiitis obliterans

                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                    reaction of the vessel wall

                                                                    Manifestations

                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                    Absentdiminished peripheral pulses

                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                    gangrenous changes may arise may necessitate amputation

                                                                    Diagnosis amp Treatment

                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                    affected symmetrically only 1-2digits may be involved

                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                    (rare occasions)

                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                    A Assessment

                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                    2 vsB Nursing Dx

                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                    2 Impaired gas exchange

                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                    C Goals

                                                                    1 Relief of pain amp symptoms

                                                                    2 Prevention of further cardiac damage

                                                                    D Nursing Interventions

                                                                    1 Pain control

                                                                    2 Proper medications

                                                                    3 Decrease clientrsquos anxiety

                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                    • CARDIOVASCULAR DISEASES
                                                                    • Slide 2
                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                    • Pathophysiology
                                                                    • Slide 5
                                                                    • ASSESSING CHEST PAIN
                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                    • Angina Pectoris Myocardial Ischemia
                                                                    • Pathophysiology
                                                                    • Types
                                                                    • Slide 12
                                                                    • Slide 13
                                                                    • Slide 14
                                                                    • Conthellip
                                                                    • Conthellip (2)
                                                                    • Drug Therapy
                                                                    • Classification
                                                                    • Nursing Management
                                                                    • Nursing Management (2)
                                                                    • Acute Coronary Syndrome
                                                                    • Slide 22
                                                                    • Conthellip (3)
                                                                    • Slide 24
                                                                    • Conthellip(MI)
                                                                    • Slide 26
                                                                    • Pathophysiology (2)
                                                                    • Tissue Changes After MI
                                                                    • Management of MI
                                                                    • Slide 30
                                                                    • Slide 31
                                                                    • ASSESSMENT
                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                    • NURSING CARE PLAN
                                                                    • NURSING CARE PLAN (2)
                                                                    • NURSING CARE PLAN (3)
                                                                    • NURSING CARE PLAN (4)
                                                                    • NURSING CARE PLAN (5)
                                                                    • NURSING CARE PLAN (6)
                                                                    • NURSING CARE PLAN (7)
                                                                    • NURSING CARE PLAN (8)
                                                                    • EVALUATION
                                                                    • CONGESTIVE HEART FAILURE
                                                                    • PATHOPHYSIOLOGY
                                                                    • ASSESSMENT (2)
                                                                    • ASSESSMENT (3)
                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                    • Slide 49
                                                                    • NURSING CARE PLAN (9)
                                                                    • NURSING CARE PLAN (10)
                                                                    • NURSING CARE PLAN (11)
                                                                    • NURSING CARE PLAN (12)
                                                                    • NURSING CARE PLAN (13)
                                                                    • EVALUATION
                                                                    • Slide 56
                                                                    • Slide 57
                                                                    • Slide 58
                                                                    • Slide 59
                                                                    • Slide 60
                                                                    • Treatment of Hyperlipidemia
                                                                    • Slide 62
                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                    • CARDIOMYOPATHIES
                                                                    • CARDIOMYOPATHIES (2)
                                                                    • CARDIOMYOPATHIES (3)
                                                                    • CARDIOMYOPATHIES (4)
                                                                    • CARDIOMYOPATHIES (5)
                                                                    • CARDIOMYOPATHIES (6)
                                                                    • Infective endocarditis
                                                                    • Infective endocarditis (2)
                                                                    • Infective endocarditis (3)
                                                                    • Infective endocarditis (4)
                                                                    • Infective endocarditis (5)
                                                                    • Infective endocarditis (6)
                                                                    • Infective endocarditis (7)
                                                                    • Infective endocarditis (8)
                                                                    • Infective endocarditis (9)
                                                                    • Infective endocarditis (10)
                                                                    • Infective endocarditis (11)
                                                                    • Infective endocarditis (12)
                                                                    • CARDIOGENIC SHOCK
                                                                    • CARDIOGENIC SHOCK (2)
                                                                    • CARDIOGENIC SHOCK (3)
                                                                    • CARDIOGENIC SHOCK (4)
                                                                    • CARDIOGENIC SHOCK (5)
                                                                    • CARDIAC TAMPONADE
                                                                    • CARDIAC TAMPONADE (2)
                                                                    • CARDIAC TAMPONADE (3)
                                                                    • CARDIAC TAMPONADE (4)
                                                                    • CARDIAC TAMPONADE (5)
                                                                    • CARDIAC TAMPONADE (6)
                                                                    • CARDIAC TAMPONADE (7)
                                                                    • Slide 100
                                                                    • HYPERTENSION
                                                                    • HYPERTENSION (2)
                                                                    • Slide 103
                                                                    • Slide 104
                                                                    • Slide 105
                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                    • Buergerrsquos Disease
                                                                    • Slide 108
                                                                    • Manifestations
                                                                    • Slide 110
                                                                    • Diagnosis amp Treatment
                                                                    • Rynaudrsquos Disease
                                                                    • Manifestations (2)
                                                                    • Slide 114
                                                                    • Diagnosis amp Treatment (2)
                                                                    • Slide 116
                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                    • Slide 118
                                                                    • Slide 119
                                                                    • Slide 120
                                                                    • Slide 121

                                                                      NURSING CARE PLAN

                                                                      bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K

                                                                      Mg)bull Monitor ECGbull Diet progressive low

                                                                      calorie low sodium low cholesterol low fat without caffeine

                                                                      NURSING CARE PLAN

                                                                      bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                                      softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                                      bull Bedside commode

                                                                      NURSING CARE PLAN

                                                                      bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                      denial anger withdrawalbull Encourage expression of

                                                                      feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                      changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                      NURSING CARE PLAN

                                                                      bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                      activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                      bull Identify need for referral for sexual counselling

                                                                      NURSING CARE PLAN

                                                                      bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                      meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                      bull Information about sexual activity less fatiguing positions

                                                                      bull Support groups Follow-up carebull Medications administration importance untoward

                                                                      effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                      weight control stress reduction

                                                                      EVALUATION

                                                                      bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                      CONGESTIVE HEART FAILURE

                                                                      bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                      PATHOPHYSIOLOGY

                                                                      Increased cardiac workload

                                                                      decreased effective myocardial contractility

                                                                      Decreased cardiac output

                                                                      LV failure Pulmonary congestion

                                                                      RA RV failure

                                                                      Systemic congestion

                                                                      Peripheral edema

                                                                      ASSESSMENTbull Subjective data

                                                                      bull Shortness of breathbull Orthopnea (sleeps on two

                                                                      or more pillows)bull Paroxysmal nocturnal

                                                                      dyspnea (sudden breathlessness during sleep)

                                                                      bull Dyspnea on exertion (climbing stairs)

                                                                      bull Apprehension anxiety irritability

                                                                      bull Fatigue weaknessbull Reported weight gain

                                                                      feeling of puffiness

                                                                      ASSESSMENTbull Objective data

                                                                      bull VSbull BP decreasing systolic

                                                                      narrowing pulse pressurebull Pulse pulsus alternans

                                                                      (alternating strong-weak-strong cardiac contraction) increased

                                                                      bull Respirations crackles Cheyne-Stokes

                                                                      bull Edema dependent pitting (1+ to 4+ mm)

                                                                      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                      dilated pulmonary vessels lung edema

                                                                      Left Ventricular Compared with Right Ventricular Heart Failure

                                                                      LEFT VENTRICULAR

                                                                      FAILURE

                                                                      RIGHT VENTRICULAR

                                                                      FAILURE

                                                                      Pulmonary crackles Jugular venous distention

                                                                      Tachypnea Peripheral edema

                                                                      S3 gallop Perioral and peripheral cyanosis

                                                                      Cardiac murmurs Congestive hepatomegaly

                                                                      Paradoxical splitting of S2

                                                                      Ascites

                                                                      Hepatojugular reflux

                                                                      ANALYSIS NURSING DIAGNOSES

                                                                      bull Decreased cardiac output related to decreased myocardial contractility

                                                                      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                      bull Fatigue related to edema and poor oxygenation

                                                                      bull Fluid volume excess related to compensatory mechanisms

                                                                      bull Impaired gas exchange related to pulmonary congestion

                                                                      bull Anxiety related to shortness of breath

                                                                      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                      NURSING CARE PLAN

                                                                      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                      tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                      bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                      bull Warm fluids if appropriate

                                                                      NURSING CARE PLAN

                                                                      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                      NURSING CARE PLANbull Goal 3 provide for special safety

                                                                      needsbull Skin care

                                                                      bull Inspect massage lubricate bony prominences

                                                                      bull Use foot cradle heel protectors sheepskin

                                                                      bull Side rails up if hypoxic (disoriented)

                                                                      bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                      bull ROM active passive elastic stockings

                                                                      NURSING CARE PLAN

                                                                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                      strict IObull Diet

                                                                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                      NURSING CARE PLAN

                                                                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                      EVALUATION

                                                                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                      distressbull Reduction in dependent edema

                                                                      DAY 3 OF

                                                                      CARDIOVASCULARDISEASES

                                                                      bull hyperlipidemia means high lipid levels

                                                                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                      Treatment of Hyperlipidemia

                                                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                      bull SYSTOLIC DYSFUNCTION

                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                      bull Pathophysiologybull 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

                                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                      CARDIOMYOPATHIES

                                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                      CARDIOMYOPATHIES

                                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                      CARDIOMYOPATHIES

                                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                      relief

                                                                      CARDIOMYOPATHIES

                                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                      CARDIOMYOPATHIES

                                                                      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

                                                                      Infective endocarditis

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

                                                                      bull Can be acute or chronic

                                                                      Infective endocarditis

                                                                      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

                                                                      Infective endocarditis

                                                                      bull Pathophysiologybull 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

                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                      Infective endocarditis

                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                      retina

                                                                      Infective endocarditis

                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                      Infective endocarditis

                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                      Infective endocarditis

                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                      organism

                                                                      Infective endocarditis

                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                      Infective endocarditis

                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                      B

                                                                      Infective endocarditis

                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                      CARDIOGENIC SHOCK

                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                      CARDIOGENIC SHOCK

                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                      CARDIOGENIC SHOCK

                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                      Normal is 4-10 cmH2O

                                                                      CARDIOGENIC SHOCK

                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                      decreased pulmonary congestion and to relieve pain

                                                                      CARDIOGENIC SHOCK

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

                                                                      bull 6 Monitor urinary output BP and pulses

                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                      CARDIAC TAMPONADE

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

                                                                      CARDIAC TAMPONADE

                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                      CARDIAC TAMPONADE

                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                      CARDIAC TAMPONADE

                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                      distention hypotension and distantmuffled heart sound

                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                      CARDIAC TAMPONADE

                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                      anterior chest

                                                                      CARDIAC TAMPONADE

                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                      CARDIAC TAMPONADE

                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                      tamponade

                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                      HYPERTENSION

                                                                      bull 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

                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                      bull Most common typebull 2 Secondary

                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                      Buergerrsquos Disease

                                                                      bull Also known as Thromboangiitis obliterans

                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                      reaction of the vessel wall

                                                                      Manifestations

                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                      Absentdiminished peripheral pulses

                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                      gangrenous changes may arise may necessitate amputation

                                                                      Diagnosis amp Treatment

                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                      affected symmetrically only 1-2digits may be involved

                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                      (rare occasions)

                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                      A Assessment

                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                      2 vsB Nursing Dx

                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                      2 Impaired gas exchange

                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                      C Goals

                                                                      1 Relief of pain amp symptoms

                                                                      2 Prevention of further cardiac damage

                                                                      D Nursing Interventions

                                                                      1 Pain control

                                                                      2 Proper medications

                                                                      3 Decrease clientrsquos anxiety

                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                      • CARDIOVASCULAR DISEASES
                                                                      • Slide 2
                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                      • Pathophysiology
                                                                      • Slide 5
                                                                      • ASSESSING CHEST PAIN
                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                      • Angina Pectoris Myocardial Ischemia
                                                                      • Pathophysiology
                                                                      • Types
                                                                      • Slide 12
                                                                      • Slide 13
                                                                      • Slide 14
                                                                      • Conthellip
                                                                      • Conthellip (2)
                                                                      • Drug Therapy
                                                                      • Classification
                                                                      • Nursing Management
                                                                      • Nursing Management (2)
                                                                      • Acute Coronary Syndrome
                                                                      • Slide 22
                                                                      • Conthellip (3)
                                                                      • Slide 24
                                                                      • Conthellip(MI)
                                                                      • Slide 26
                                                                      • Pathophysiology (2)
                                                                      • Tissue Changes After MI
                                                                      • Management of MI
                                                                      • Slide 30
                                                                      • Slide 31
                                                                      • ASSESSMENT
                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                      • NURSING CARE PLAN
                                                                      • NURSING CARE PLAN (2)
                                                                      • NURSING CARE PLAN (3)
                                                                      • NURSING CARE PLAN (4)
                                                                      • NURSING CARE PLAN (5)
                                                                      • NURSING CARE PLAN (6)
                                                                      • NURSING CARE PLAN (7)
                                                                      • NURSING CARE PLAN (8)
                                                                      • EVALUATION
                                                                      • CONGESTIVE HEART FAILURE
                                                                      • PATHOPHYSIOLOGY
                                                                      • ASSESSMENT (2)
                                                                      • ASSESSMENT (3)
                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                      • Slide 49
                                                                      • NURSING CARE PLAN (9)
                                                                      • NURSING CARE PLAN (10)
                                                                      • NURSING CARE PLAN (11)
                                                                      • NURSING CARE PLAN (12)
                                                                      • NURSING CARE PLAN (13)
                                                                      • EVALUATION
                                                                      • Slide 56
                                                                      • Slide 57
                                                                      • Slide 58
                                                                      • Slide 59
                                                                      • Slide 60
                                                                      • Treatment of Hyperlipidemia
                                                                      • Slide 62
                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                      • CARDIOMYOPATHIES
                                                                      • CARDIOMYOPATHIES (2)
                                                                      • CARDIOMYOPATHIES (3)
                                                                      • CARDIOMYOPATHIES (4)
                                                                      • CARDIOMYOPATHIES (5)
                                                                      • CARDIOMYOPATHIES (6)
                                                                      • Infective endocarditis
                                                                      • Infective endocarditis (2)
                                                                      • Infective endocarditis (3)
                                                                      • Infective endocarditis (4)
                                                                      • Infective endocarditis (5)
                                                                      • Infective endocarditis (6)
                                                                      • Infective endocarditis (7)
                                                                      • Infective endocarditis (8)
                                                                      • Infective endocarditis (9)
                                                                      • Infective endocarditis (10)
                                                                      • Infective endocarditis (11)
                                                                      • Infective endocarditis (12)
                                                                      • CARDIOGENIC SHOCK
                                                                      • CARDIOGENIC SHOCK (2)
                                                                      • CARDIOGENIC SHOCK (3)
                                                                      • CARDIOGENIC SHOCK (4)
                                                                      • CARDIOGENIC SHOCK (5)
                                                                      • CARDIAC TAMPONADE
                                                                      • CARDIAC TAMPONADE (2)
                                                                      • CARDIAC TAMPONADE (3)
                                                                      • CARDIAC TAMPONADE (4)
                                                                      • CARDIAC TAMPONADE (5)
                                                                      • CARDIAC TAMPONADE (6)
                                                                      • CARDIAC TAMPONADE (7)
                                                                      • Slide 100
                                                                      • HYPERTENSION
                                                                      • HYPERTENSION (2)
                                                                      • Slide 103
                                                                      • Slide 104
                                                                      • Slide 105
                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                      • Buergerrsquos Disease
                                                                      • Slide 108
                                                                      • Manifestations
                                                                      • Slide 110
                                                                      • Diagnosis amp Treatment
                                                                      • Rynaudrsquos Disease
                                                                      • Manifestations (2)
                                                                      • Slide 114
                                                                      • Diagnosis amp Treatment (2)
                                                                      • Slide 116
                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                      • Slide 118
                                                                      • Slide 119
                                                                      • Slide 120
                                                                      • Slide 121

                                                                        NURSING CARE PLAN

                                                                        bull Goal 5 facilitate fecal eliminationbull Medications stool

                                                                        softeners to prevent Valsalva maneuver mouth breathing during bowel movement

                                                                        bull Bedside commode

                                                                        NURSING CARE PLAN

                                                                        bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                        denial anger withdrawalbull Encourage expression of

                                                                        feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                        changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                        NURSING CARE PLAN

                                                                        bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                        activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                        bull Identify need for referral for sexual counselling

                                                                        NURSING CARE PLAN

                                                                        bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                        meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                        bull Information about sexual activity less fatiguing positions

                                                                        bull Support groups Follow-up carebull Medications administration importance untoward

                                                                        effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                        weight control stress reduction

                                                                        EVALUATION

                                                                        bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                        CONGESTIVE HEART FAILURE

                                                                        bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                        PATHOPHYSIOLOGY

                                                                        Increased cardiac workload

                                                                        decreased effective myocardial contractility

                                                                        Decreased cardiac output

                                                                        LV failure Pulmonary congestion

                                                                        RA RV failure

                                                                        Systemic congestion

                                                                        Peripheral edema

                                                                        ASSESSMENTbull Subjective data

                                                                        bull Shortness of breathbull Orthopnea (sleeps on two

                                                                        or more pillows)bull Paroxysmal nocturnal

                                                                        dyspnea (sudden breathlessness during sleep)

                                                                        bull Dyspnea on exertion (climbing stairs)

                                                                        bull Apprehension anxiety irritability

                                                                        bull Fatigue weaknessbull Reported weight gain

                                                                        feeling of puffiness

                                                                        ASSESSMENTbull Objective data

                                                                        bull VSbull BP decreasing systolic

                                                                        narrowing pulse pressurebull Pulse pulsus alternans

                                                                        (alternating strong-weak-strong cardiac contraction) increased

                                                                        bull Respirations crackles Cheyne-Stokes

                                                                        bull Edema dependent pitting (1+ to 4+ mm)

                                                                        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                        dilated pulmonary vessels lung edema

                                                                        Left Ventricular Compared with Right Ventricular Heart Failure

                                                                        LEFT VENTRICULAR

                                                                        FAILURE

                                                                        RIGHT VENTRICULAR

                                                                        FAILURE

                                                                        Pulmonary crackles Jugular venous distention

                                                                        Tachypnea Peripheral edema

                                                                        S3 gallop Perioral and peripheral cyanosis

                                                                        Cardiac murmurs Congestive hepatomegaly

                                                                        Paradoxical splitting of S2

                                                                        Ascites

                                                                        Hepatojugular reflux

                                                                        ANALYSIS NURSING DIAGNOSES

                                                                        bull Decreased cardiac output related to decreased myocardial contractility

                                                                        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                        bull Fatigue related to edema and poor oxygenation

                                                                        bull Fluid volume excess related to compensatory mechanisms

                                                                        bull Impaired gas exchange related to pulmonary congestion

                                                                        bull Anxiety related to shortness of breath

                                                                        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                        NURSING CARE PLAN

                                                                        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                        tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                        bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                        bull Warm fluids if appropriate

                                                                        NURSING CARE PLAN

                                                                        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                        NURSING CARE PLANbull Goal 3 provide for special safety

                                                                        needsbull Skin care

                                                                        bull Inspect massage lubricate bony prominences

                                                                        bull Use foot cradle heel protectors sheepskin

                                                                        bull Side rails up if hypoxic (disoriented)

                                                                        bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                        bull ROM active passive elastic stockings

                                                                        NURSING CARE PLAN

                                                                        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                        strict IObull Diet

                                                                        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                        NURSING CARE PLAN

                                                                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                        EVALUATION

                                                                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                        distressbull Reduction in dependent edema

                                                                        DAY 3 OF

                                                                        CARDIOVASCULARDISEASES

                                                                        bull hyperlipidemia means high lipid levels

                                                                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                        Treatment of Hyperlipidemia

                                                                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                        bull SYSTOLIC DYSFUNCTION

                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                        bull Pathophysiologybull 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

                                                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                        CARDIOMYOPATHIES

                                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                        CARDIOMYOPATHIES

                                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                        CARDIOMYOPATHIES

                                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                        relief

                                                                        CARDIOMYOPATHIES

                                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                        CARDIOMYOPATHIES

                                                                        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

                                                                        Infective endocarditis

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

                                                                        bull Can be acute or chronic

                                                                        Infective endocarditis

                                                                        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

                                                                        Infective endocarditis

                                                                        bull Pathophysiologybull 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

                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                        Infective endocarditis

                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                        retina

                                                                        Infective endocarditis

                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                        Infective endocarditis

                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                        Infective endocarditis

                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                        organism

                                                                        Infective endocarditis

                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                        Infective endocarditis

                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                        B

                                                                        Infective endocarditis

                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                        CARDIOGENIC SHOCK

                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                        CARDIOGENIC SHOCK

                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                        CARDIOGENIC SHOCK

                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                        Normal is 4-10 cmH2O

                                                                        CARDIOGENIC SHOCK

                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                        decreased pulmonary congestion and to relieve pain

                                                                        CARDIOGENIC SHOCK

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

                                                                        bull 6 Monitor urinary output BP and pulses

                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                        CARDIAC TAMPONADE

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

                                                                        CARDIAC TAMPONADE

                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                        CARDIAC TAMPONADE

                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                        CARDIAC TAMPONADE

                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                        distention hypotension and distantmuffled heart sound

                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                        CARDIAC TAMPONADE

                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                        anterior chest

                                                                        CARDIAC TAMPONADE

                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                        CARDIAC TAMPONADE

                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                        tamponade

                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                        HYPERTENSION

                                                                        bull 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

                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                        bull Most common typebull 2 Secondary

                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                        Buergerrsquos Disease

                                                                        bull Also known as Thromboangiitis obliterans

                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                        reaction of the vessel wall

                                                                        Manifestations

                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                        Absentdiminished peripheral pulses

                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                        gangrenous changes may arise may necessitate amputation

                                                                        Diagnosis amp Treatment

                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                        affected symmetrically only 1-2digits may be involved

                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                        (rare occasions)

                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                        A Assessment

                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                        2 vsB Nursing Dx

                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                        2 Impaired gas exchange

                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                        C Goals

                                                                        1 Relief of pain amp symptoms

                                                                        2 Prevention of further cardiac damage

                                                                        D Nursing Interventions

                                                                        1 Pain control

                                                                        2 Proper medications

                                                                        3 Decrease clientrsquos anxiety

                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                        • CARDIOVASCULAR DISEASES
                                                                        • Slide 2
                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                        • Pathophysiology
                                                                        • Slide 5
                                                                        • ASSESSING CHEST PAIN
                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                        • Angina Pectoris Myocardial Ischemia
                                                                        • Pathophysiology
                                                                        • Types
                                                                        • Slide 12
                                                                        • Slide 13
                                                                        • Slide 14
                                                                        • Conthellip
                                                                        • Conthellip (2)
                                                                        • Drug Therapy
                                                                        • Classification
                                                                        • Nursing Management
                                                                        • Nursing Management (2)
                                                                        • Acute Coronary Syndrome
                                                                        • Slide 22
                                                                        • Conthellip (3)
                                                                        • Slide 24
                                                                        • Conthellip(MI)
                                                                        • Slide 26
                                                                        • Pathophysiology (2)
                                                                        • Tissue Changes After MI
                                                                        • Management of MI
                                                                        • Slide 30
                                                                        • Slide 31
                                                                        • ASSESSMENT
                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                        • NURSING CARE PLAN
                                                                        • NURSING CARE PLAN (2)
                                                                        • NURSING CARE PLAN (3)
                                                                        • NURSING CARE PLAN (4)
                                                                        • NURSING CARE PLAN (5)
                                                                        • NURSING CARE PLAN (6)
                                                                        • NURSING CARE PLAN (7)
                                                                        • NURSING CARE PLAN (8)
                                                                        • EVALUATION
                                                                        • CONGESTIVE HEART FAILURE
                                                                        • PATHOPHYSIOLOGY
                                                                        • ASSESSMENT (2)
                                                                        • ASSESSMENT (3)
                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                        • Slide 49
                                                                        • NURSING CARE PLAN (9)
                                                                        • NURSING CARE PLAN (10)
                                                                        • NURSING CARE PLAN (11)
                                                                        • NURSING CARE PLAN (12)
                                                                        • NURSING CARE PLAN (13)
                                                                        • EVALUATION
                                                                        • Slide 56
                                                                        • Slide 57
                                                                        • Slide 58
                                                                        • Slide 59
                                                                        • Slide 60
                                                                        • Treatment of Hyperlipidemia
                                                                        • Slide 62
                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                        • CARDIOMYOPATHIES
                                                                        • CARDIOMYOPATHIES (2)
                                                                        • CARDIOMYOPATHIES (3)
                                                                        • CARDIOMYOPATHIES (4)
                                                                        • CARDIOMYOPATHIES (5)
                                                                        • CARDIOMYOPATHIES (6)
                                                                        • Infective endocarditis
                                                                        • Infective endocarditis (2)
                                                                        • Infective endocarditis (3)
                                                                        • Infective endocarditis (4)
                                                                        • Infective endocarditis (5)
                                                                        • Infective endocarditis (6)
                                                                        • Infective endocarditis (7)
                                                                        • Infective endocarditis (8)
                                                                        • Infective endocarditis (9)
                                                                        • Infective endocarditis (10)
                                                                        • Infective endocarditis (11)
                                                                        • Infective endocarditis (12)
                                                                        • CARDIOGENIC SHOCK
                                                                        • CARDIOGENIC SHOCK (2)
                                                                        • CARDIOGENIC SHOCK (3)
                                                                        • CARDIOGENIC SHOCK (4)
                                                                        • CARDIOGENIC SHOCK (5)
                                                                        • CARDIAC TAMPONADE
                                                                        • CARDIAC TAMPONADE (2)
                                                                        • CARDIAC TAMPONADE (3)
                                                                        • CARDIAC TAMPONADE (4)
                                                                        • CARDIAC TAMPONADE (5)
                                                                        • CARDIAC TAMPONADE (6)
                                                                        • CARDIAC TAMPONADE (7)
                                                                        • Slide 100
                                                                        • HYPERTENSION
                                                                        • HYPERTENSION (2)
                                                                        • Slide 103
                                                                        • Slide 104
                                                                        • Slide 105
                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                        • Buergerrsquos Disease
                                                                        • Slide 108
                                                                        • Manifestations
                                                                        • Slide 110
                                                                        • Diagnosis amp Treatment
                                                                        • Rynaudrsquos Disease
                                                                        • Manifestations (2)
                                                                        • Slide 114
                                                                        • Diagnosis amp Treatment (2)
                                                                        • Slide 116
                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                        • Slide 118
                                                                        • Slide 119
                                                                        • Slide 120
                                                                        • Slide 121

                                                                          NURSING CARE PLAN

                                                                          bull Goal 6 provide emotional supportbull Recognize fear of dying

                                                                          denial anger withdrawalbull Encourage expression of

                                                                          feelings fears concernsbull Discuss rehabilitation lifestyle

                                                                          changes prevent cardiac-invalid syndrome by promoting self-care activities independence

                                                                          NURSING CARE PLAN

                                                                          bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                          activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                          bull Identify need for referral for sexual counselling

                                                                          NURSING CARE PLAN

                                                                          bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                          meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                          bull Information about sexual activity less fatiguing positions

                                                                          bull Support groups Follow-up carebull Medications administration importance untoward

                                                                          effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                          weight control stress reduction

                                                                          EVALUATION

                                                                          bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                          CONGESTIVE HEART FAILURE

                                                                          bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                          PATHOPHYSIOLOGY

                                                                          Increased cardiac workload

                                                                          decreased effective myocardial contractility

                                                                          Decreased cardiac output

                                                                          LV failure Pulmonary congestion

                                                                          RA RV failure

                                                                          Systemic congestion

                                                                          Peripheral edema

                                                                          ASSESSMENTbull Subjective data

                                                                          bull Shortness of breathbull Orthopnea (sleeps on two

                                                                          or more pillows)bull Paroxysmal nocturnal

                                                                          dyspnea (sudden breathlessness during sleep)

                                                                          bull Dyspnea on exertion (climbing stairs)

                                                                          bull Apprehension anxiety irritability

                                                                          bull Fatigue weaknessbull Reported weight gain

                                                                          feeling of puffiness

                                                                          ASSESSMENTbull Objective data

                                                                          bull VSbull BP decreasing systolic

                                                                          narrowing pulse pressurebull Pulse pulsus alternans

                                                                          (alternating strong-weak-strong cardiac contraction) increased

                                                                          bull Respirations crackles Cheyne-Stokes

                                                                          bull Edema dependent pitting (1+ to 4+ mm)

                                                                          bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                          dilated pulmonary vessels lung edema

                                                                          Left Ventricular Compared with Right Ventricular Heart Failure

                                                                          LEFT VENTRICULAR

                                                                          FAILURE

                                                                          RIGHT VENTRICULAR

                                                                          FAILURE

                                                                          Pulmonary crackles Jugular venous distention

                                                                          Tachypnea Peripheral edema

                                                                          S3 gallop Perioral and peripheral cyanosis

                                                                          Cardiac murmurs Congestive hepatomegaly

                                                                          Paradoxical splitting of S2

                                                                          Ascites

                                                                          Hepatojugular reflux

                                                                          ANALYSIS NURSING DIAGNOSES

                                                                          bull Decreased cardiac output related to decreased myocardial contractility

                                                                          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                          bull Fatigue related to edema and poor oxygenation

                                                                          bull Fluid volume excess related to compensatory mechanisms

                                                                          bull Impaired gas exchange related to pulmonary congestion

                                                                          bull Anxiety related to shortness of breath

                                                                          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                          NURSING CARE PLAN

                                                                          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                          tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                          bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                          bull Warm fluids if appropriate

                                                                          NURSING CARE PLAN

                                                                          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                          NURSING CARE PLANbull Goal 3 provide for special safety

                                                                          needsbull Skin care

                                                                          bull Inspect massage lubricate bony prominences

                                                                          bull Use foot cradle heel protectors sheepskin

                                                                          bull Side rails up if hypoxic (disoriented)

                                                                          bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                          bull ROM active passive elastic stockings

                                                                          NURSING CARE PLAN

                                                                          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                          strict IObull Diet

                                                                          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                          NURSING CARE PLAN

                                                                          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                          bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                          EVALUATION

                                                                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                          distressbull Reduction in dependent edema

                                                                          DAY 3 OF

                                                                          CARDIOVASCULARDISEASES

                                                                          bull hyperlipidemia means high lipid levels

                                                                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                          Treatment of Hyperlipidemia

                                                                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                          bull SYSTOLIC DYSFUNCTION

                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                          bull Pathophysiologybull 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

                                                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                          CARDIOMYOPATHIES

                                                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                          CARDIOMYOPATHIES

                                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                          CARDIOMYOPATHIES

                                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                          relief

                                                                          CARDIOMYOPATHIES

                                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                          CARDIOMYOPATHIES

                                                                          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

                                                                          Infective endocarditis

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

                                                                          bull Can be acute or chronic

                                                                          Infective endocarditis

                                                                          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

                                                                          Infective endocarditis

                                                                          bull Pathophysiologybull 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

                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                          Infective endocarditis

                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                          retina

                                                                          Infective endocarditis

                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                          Infective endocarditis

                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                          Infective endocarditis

                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                          organism

                                                                          Infective endocarditis

                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                          Infective endocarditis

                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                          B

                                                                          Infective endocarditis

                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                          CARDIOGENIC SHOCK

                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                          CARDIOGENIC SHOCK

                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                          CARDIOGENIC SHOCK

                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                          Normal is 4-10 cmH2O

                                                                          CARDIOGENIC SHOCK

                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                          decreased pulmonary congestion and to relieve pain

                                                                          CARDIOGENIC SHOCK

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

                                                                          bull 6 Monitor urinary output BP and pulses

                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                          CARDIAC TAMPONADE

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

                                                                          CARDIAC TAMPONADE

                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                          CARDIAC TAMPONADE

                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                          CARDIAC TAMPONADE

                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                          distention hypotension and distantmuffled heart sound

                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                          CARDIAC TAMPONADE

                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                          anterior chest

                                                                          CARDIAC TAMPONADE

                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                          CARDIAC TAMPONADE

                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                          tamponade

                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                          HYPERTENSION

                                                                          bull 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

                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                          bull Most common typebull 2 Secondary

                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                          Buergerrsquos Disease

                                                                          bull Also known as Thromboangiitis obliterans

                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                          reaction of the vessel wall

                                                                          Manifestations

                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                          Absentdiminished peripheral pulses

                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                          gangrenous changes may arise may necessitate amputation

                                                                          Diagnosis amp Treatment

                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                          affected symmetrically only 1-2digits may be involved

                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                          (rare occasions)

                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                          A Assessment

                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                          2 vsB Nursing Dx

                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                          2 Impaired gas exchange

                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                          C Goals

                                                                          1 Relief of pain amp symptoms

                                                                          2 Prevention of further cardiac damage

                                                                          D Nursing Interventions

                                                                          1 Pain control

                                                                          2 Proper medications

                                                                          3 Decrease clientrsquos anxiety

                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                          • CARDIOVASCULAR DISEASES
                                                                          • Slide 2
                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                          • Pathophysiology
                                                                          • Slide 5
                                                                          • ASSESSING CHEST PAIN
                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                          • Angina Pectoris Myocardial Ischemia
                                                                          • Pathophysiology
                                                                          • Types
                                                                          • Slide 12
                                                                          • Slide 13
                                                                          • Slide 14
                                                                          • Conthellip
                                                                          • Conthellip (2)
                                                                          • Drug Therapy
                                                                          • Classification
                                                                          • Nursing Management
                                                                          • Nursing Management (2)
                                                                          • Acute Coronary Syndrome
                                                                          • Slide 22
                                                                          • Conthellip (3)
                                                                          • Slide 24
                                                                          • Conthellip(MI)
                                                                          • Slide 26
                                                                          • Pathophysiology (2)
                                                                          • Tissue Changes After MI
                                                                          • Management of MI
                                                                          • Slide 30
                                                                          • Slide 31
                                                                          • ASSESSMENT
                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                          • NURSING CARE PLAN
                                                                          • NURSING CARE PLAN (2)
                                                                          • NURSING CARE PLAN (3)
                                                                          • NURSING CARE PLAN (4)
                                                                          • NURSING CARE PLAN (5)
                                                                          • NURSING CARE PLAN (6)
                                                                          • NURSING CARE PLAN (7)
                                                                          • NURSING CARE PLAN (8)
                                                                          • EVALUATION
                                                                          • CONGESTIVE HEART FAILURE
                                                                          • PATHOPHYSIOLOGY
                                                                          • ASSESSMENT (2)
                                                                          • ASSESSMENT (3)
                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                          • Slide 49
                                                                          • NURSING CARE PLAN (9)
                                                                          • NURSING CARE PLAN (10)
                                                                          • NURSING CARE PLAN (11)
                                                                          • NURSING CARE PLAN (12)
                                                                          • NURSING CARE PLAN (13)
                                                                          • EVALUATION
                                                                          • Slide 56
                                                                          • Slide 57
                                                                          • Slide 58
                                                                          • Slide 59
                                                                          • Slide 60
                                                                          • Treatment of Hyperlipidemia
                                                                          • Slide 62
                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                          • CARDIOMYOPATHIES
                                                                          • CARDIOMYOPATHIES (2)
                                                                          • CARDIOMYOPATHIES (3)
                                                                          • CARDIOMYOPATHIES (4)
                                                                          • CARDIOMYOPATHIES (5)
                                                                          • CARDIOMYOPATHIES (6)
                                                                          • Infective endocarditis
                                                                          • Infective endocarditis (2)
                                                                          • Infective endocarditis (3)
                                                                          • Infective endocarditis (4)
                                                                          • Infective endocarditis (5)
                                                                          • Infective endocarditis (6)
                                                                          • Infective endocarditis (7)
                                                                          • Infective endocarditis (8)
                                                                          • Infective endocarditis (9)
                                                                          • Infective endocarditis (10)
                                                                          • Infective endocarditis (11)
                                                                          • Infective endocarditis (12)
                                                                          • CARDIOGENIC SHOCK
                                                                          • CARDIOGENIC SHOCK (2)
                                                                          • CARDIOGENIC SHOCK (3)
                                                                          • CARDIOGENIC SHOCK (4)
                                                                          • CARDIOGENIC SHOCK (5)
                                                                          • CARDIAC TAMPONADE
                                                                          • CARDIAC TAMPONADE (2)
                                                                          • CARDIAC TAMPONADE (3)
                                                                          • CARDIAC TAMPONADE (4)
                                                                          • CARDIAC TAMPONADE (5)
                                                                          • CARDIAC TAMPONADE (6)
                                                                          • CARDIAC TAMPONADE (7)
                                                                          • Slide 100
                                                                          • HYPERTENSION
                                                                          • HYPERTENSION (2)
                                                                          • Slide 103
                                                                          • Slide 104
                                                                          • Slide 105
                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                          • Buergerrsquos Disease
                                                                          • Slide 108
                                                                          • Manifestations
                                                                          • Slide 110
                                                                          • Diagnosis amp Treatment
                                                                          • Rynaudrsquos Disease
                                                                          • Manifestations (2)
                                                                          • Slide 114
                                                                          • Diagnosis amp Treatment (2)
                                                                          • Slide 116
                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                          • Slide 118
                                                                          • Slide 119
                                                                          • Slide 120
                                                                          • Slide 121

                                                                            NURSING CARE PLAN

                                                                            bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding

                                                                            activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs

                                                                            bull Identify need for referral for sexual counselling

                                                                            NURSING CARE PLAN

                                                                            bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                            meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                            bull Information about sexual activity less fatiguing positions

                                                                            bull Support groups Follow-up carebull Medications administration importance untoward

                                                                            effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                            weight control stress reduction

                                                                            EVALUATION

                                                                            bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                            CONGESTIVE HEART FAILURE

                                                                            bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                            PATHOPHYSIOLOGY

                                                                            Increased cardiac workload

                                                                            decreased effective myocardial contractility

                                                                            Decreased cardiac output

                                                                            LV failure Pulmonary congestion

                                                                            RA RV failure

                                                                            Systemic congestion

                                                                            Peripheral edema

                                                                            ASSESSMENTbull Subjective data

                                                                            bull Shortness of breathbull Orthopnea (sleeps on two

                                                                            or more pillows)bull Paroxysmal nocturnal

                                                                            dyspnea (sudden breathlessness during sleep)

                                                                            bull Dyspnea on exertion (climbing stairs)

                                                                            bull Apprehension anxiety irritability

                                                                            bull Fatigue weaknessbull Reported weight gain

                                                                            feeling of puffiness

                                                                            ASSESSMENTbull Objective data

                                                                            bull VSbull BP decreasing systolic

                                                                            narrowing pulse pressurebull Pulse pulsus alternans

                                                                            (alternating strong-weak-strong cardiac contraction) increased

                                                                            bull Respirations crackles Cheyne-Stokes

                                                                            bull Edema dependent pitting (1+ to 4+ mm)

                                                                            bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                            dilated pulmonary vessels lung edema

                                                                            Left Ventricular Compared with Right Ventricular Heart Failure

                                                                            LEFT VENTRICULAR

                                                                            FAILURE

                                                                            RIGHT VENTRICULAR

                                                                            FAILURE

                                                                            Pulmonary crackles Jugular venous distention

                                                                            Tachypnea Peripheral edema

                                                                            S3 gallop Perioral and peripheral cyanosis

                                                                            Cardiac murmurs Congestive hepatomegaly

                                                                            Paradoxical splitting of S2

                                                                            Ascites

                                                                            Hepatojugular reflux

                                                                            ANALYSIS NURSING DIAGNOSES

                                                                            bull Decreased cardiac output related to decreased myocardial contractility

                                                                            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                            bull Fatigue related to edema and poor oxygenation

                                                                            bull Fluid volume excess related to compensatory mechanisms

                                                                            bull Impaired gas exchange related to pulmonary congestion

                                                                            bull Anxiety related to shortness of breath

                                                                            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                            NURSING CARE PLAN

                                                                            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                            tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                            bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                            bull Warm fluids if appropriate

                                                                            NURSING CARE PLAN

                                                                            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                            NURSING CARE PLANbull Goal 3 provide for special safety

                                                                            needsbull Skin care

                                                                            bull Inspect massage lubricate bony prominences

                                                                            bull Use foot cradle heel protectors sheepskin

                                                                            bull Side rails up if hypoxic (disoriented)

                                                                            bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                            bull ROM active passive elastic stockings

                                                                            NURSING CARE PLAN

                                                                            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                            strict IObull Diet

                                                                            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                            NURSING CARE PLAN

                                                                            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                            bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                            EVALUATION

                                                                            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                            distressbull Reduction in dependent edema

                                                                            DAY 3 OF

                                                                            CARDIOVASCULARDISEASES

                                                                            bull hyperlipidemia means high lipid levels

                                                                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                            Treatment of Hyperlipidemia

                                                                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                            bull SYSTOLIC DYSFUNCTION

                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                            bull Pathophysiologybull 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

                                                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                            CARDIOMYOPATHIES

                                                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                            CARDIOMYOPATHIES

                                                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                            CARDIOMYOPATHIES

                                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                            relief

                                                                            CARDIOMYOPATHIES

                                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                            CARDIOMYOPATHIES

                                                                            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

                                                                            Infective endocarditis

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

                                                                            bull Can be acute or chronic

                                                                            Infective endocarditis

                                                                            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

                                                                            Infective endocarditis

                                                                            bull Pathophysiologybull 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

                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                            Infective endocarditis

                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                            retina

                                                                            Infective endocarditis

                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                            Infective endocarditis

                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                            Infective endocarditis

                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                            organism

                                                                            Infective endocarditis

                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                            Infective endocarditis

                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                            B

                                                                            Infective endocarditis

                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                            CARDIOGENIC SHOCK

                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                            CARDIOGENIC SHOCK

                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                            CARDIOGENIC SHOCK

                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                            Normal is 4-10 cmH2O

                                                                            CARDIOGENIC SHOCK

                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                            decreased pulmonary congestion and to relieve pain

                                                                            CARDIOGENIC SHOCK

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

                                                                            bull 6 Monitor urinary output BP and pulses

                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                            CARDIAC TAMPONADE

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

                                                                            CARDIAC TAMPONADE

                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                            CARDIAC TAMPONADE

                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                            CARDIAC TAMPONADE

                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                            distention hypotension and distantmuffled heart sound

                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                            CARDIAC TAMPONADE

                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                            anterior chest

                                                                            CARDIAC TAMPONADE

                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                            CARDIAC TAMPONADE

                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                            tamponade

                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                            HYPERTENSION

                                                                            bull 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

                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                            bull Most common typebull 2 Secondary

                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                            Buergerrsquos Disease

                                                                            bull Also known as Thromboangiitis obliterans

                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                            reaction of the vessel wall

                                                                            Manifestations

                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                            Absentdiminished peripheral pulses

                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                            gangrenous changes may arise may necessitate amputation

                                                                            Diagnosis amp Treatment

                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                            affected symmetrically only 1-2digits may be involved

                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                            (rare occasions)

                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                            A Assessment

                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                            2 vsB Nursing Dx

                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                            2 Impaired gas exchange

                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                            C Goals

                                                                            1 Relief of pain amp symptoms

                                                                            2 Prevention of further cardiac damage

                                                                            D Nursing Interventions

                                                                            1 Pain control

                                                                            2 Proper medications

                                                                            3 Decrease clientrsquos anxiety

                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                            • CARDIOVASCULAR DISEASES
                                                                            • Slide 2
                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                            • Pathophysiology
                                                                            • Slide 5
                                                                            • ASSESSING CHEST PAIN
                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                            • Angina Pectoris Myocardial Ischemia
                                                                            • Pathophysiology
                                                                            • Types
                                                                            • Slide 12
                                                                            • Slide 13
                                                                            • Slide 14
                                                                            • Conthellip
                                                                            • Conthellip (2)
                                                                            • Drug Therapy
                                                                            • Classification
                                                                            • Nursing Management
                                                                            • Nursing Management (2)
                                                                            • Acute Coronary Syndrome
                                                                            • Slide 22
                                                                            • Conthellip (3)
                                                                            • Slide 24
                                                                            • Conthellip(MI)
                                                                            • Slide 26
                                                                            • Pathophysiology (2)
                                                                            • Tissue Changes After MI
                                                                            • Management of MI
                                                                            • Slide 30
                                                                            • Slide 31
                                                                            • ASSESSMENT
                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                            • NURSING CARE PLAN
                                                                            • NURSING CARE PLAN (2)
                                                                            • NURSING CARE PLAN (3)
                                                                            • NURSING CARE PLAN (4)
                                                                            • NURSING CARE PLAN (5)
                                                                            • NURSING CARE PLAN (6)
                                                                            • NURSING CARE PLAN (7)
                                                                            • NURSING CARE PLAN (8)
                                                                            • EVALUATION
                                                                            • CONGESTIVE HEART FAILURE
                                                                            • PATHOPHYSIOLOGY
                                                                            • ASSESSMENT (2)
                                                                            • ASSESSMENT (3)
                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                            • Slide 49
                                                                            • NURSING CARE PLAN (9)
                                                                            • NURSING CARE PLAN (10)
                                                                            • NURSING CARE PLAN (11)
                                                                            • NURSING CARE PLAN (12)
                                                                            • NURSING CARE PLAN (13)
                                                                            • EVALUATION
                                                                            • Slide 56
                                                                            • Slide 57
                                                                            • Slide 58
                                                                            • Slide 59
                                                                            • Slide 60
                                                                            • Treatment of Hyperlipidemia
                                                                            • Slide 62
                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                            • CARDIOMYOPATHIES
                                                                            • CARDIOMYOPATHIES (2)
                                                                            • CARDIOMYOPATHIES (3)
                                                                            • CARDIOMYOPATHIES (4)
                                                                            • CARDIOMYOPATHIES (5)
                                                                            • CARDIOMYOPATHIES (6)
                                                                            • Infective endocarditis
                                                                            • Infective endocarditis (2)
                                                                            • Infective endocarditis (3)
                                                                            • Infective endocarditis (4)
                                                                            • Infective endocarditis (5)
                                                                            • Infective endocarditis (6)
                                                                            • Infective endocarditis (7)
                                                                            • Infective endocarditis (8)
                                                                            • Infective endocarditis (9)
                                                                            • Infective endocarditis (10)
                                                                            • Infective endocarditis (11)
                                                                            • Infective endocarditis (12)
                                                                            • CARDIOGENIC SHOCK
                                                                            • CARDIOGENIC SHOCK (2)
                                                                            • CARDIOGENIC SHOCK (3)
                                                                            • CARDIOGENIC SHOCK (4)
                                                                            • CARDIOGENIC SHOCK (5)
                                                                            • CARDIAC TAMPONADE
                                                                            • CARDIAC TAMPONADE (2)
                                                                            • CARDIAC TAMPONADE (3)
                                                                            • CARDIAC TAMPONADE (4)
                                                                            • CARDIAC TAMPONADE (5)
                                                                            • CARDIAC TAMPONADE (6)
                                                                            • CARDIAC TAMPONADE (7)
                                                                            • Slide 100
                                                                            • HYPERTENSION
                                                                            • HYPERTENSION (2)
                                                                            • Slide 103
                                                                            • Slide 104
                                                                            • Slide 105
                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                            • Buergerrsquos Disease
                                                                            • Slide 108
                                                                            • Manifestations
                                                                            • Slide 110
                                                                            • Diagnosis amp Treatment
                                                                            • Rynaudrsquos Disease
                                                                            • Manifestations (2)
                                                                            • Slide 114
                                                                            • Diagnosis amp Treatment (2)
                                                                            • Slide 116
                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                            • Slide 118
                                                                            • Slide 119
                                                                            • Slide 120
                                                                            • Slide 121

                                                                              NURSING CARE PLAN

                                                                              bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy

                                                                              meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures

                                                                              bull Information about sexual activity less fatiguing positions

                                                                              bull Support groups Follow-up carebull Medications administration importance untoward

                                                                              effects pulse takingbull Control risk factors rest diet exercise no smoking

                                                                              weight control stress reduction

                                                                              EVALUATION

                                                                              bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                              CONGESTIVE HEART FAILURE

                                                                              bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                              PATHOPHYSIOLOGY

                                                                              Increased cardiac workload

                                                                              decreased effective myocardial contractility

                                                                              Decreased cardiac output

                                                                              LV failure Pulmonary congestion

                                                                              RA RV failure

                                                                              Systemic congestion

                                                                              Peripheral edema

                                                                              ASSESSMENTbull Subjective data

                                                                              bull Shortness of breathbull Orthopnea (sleeps on two

                                                                              or more pillows)bull Paroxysmal nocturnal

                                                                              dyspnea (sudden breathlessness during sleep)

                                                                              bull Dyspnea on exertion (climbing stairs)

                                                                              bull Apprehension anxiety irritability

                                                                              bull Fatigue weaknessbull Reported weight gain

                                                                              feeling of puffiness

                                                                              ASSESSMENTbull Objective data

                                                                              bull VSbull BP decreasing systolic

                                                                              narrowing pulse pressurebull Pulse pulsus alternans

                                                                              (alternating strong-weak-strong cardiac contraction) increased

                                                                              bull Respirations crackles Cheyne-Stokes

                                                                              bull Edema dependent pitting (1+ to 4+ mm)

                                                                              bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                              dilated pulmonary vessels lung edema

                                                                              Left Ventricular Compared with Right Ventricular Heart Failure

                                                                              LEFT VENTRICULAR

                                                                              FAILURE

                                                                              RIGHT VENTRICULAR

                                                                              FAILURE

                                                                              Pulmonary crackles Jugular venous distention

                                                                              Tachypnea Peripheral edema

                                                                              S3 gallop Perioral and peripheral cyanosis

                                                                              Cardiac murmurs Congestive hepatomegaly

                                                                              Paradoxical splitting of S2

                                                                              Ascites

                                                                              Hepatojugular reflux

                                                                              ANALYSIS NURSING DIAGNOSES

                                                                              bull Decreased cardiac output related to decreased myocardial contractility

                                                                              bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                              bull Fatigue related to edema and poor oxygenation

                                                                              bull Fluid volume excess related to compensatory mechanisms

                                                                              bull Impaired gas exchange related to pulmonary congestion

                                                                              bull Anxiety related to shortness of breath

                                                                              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                              NURSING CARE PLAN

                                                                              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                              tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                              bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                              bull Warm fluids if appropriate

                                                                              NURSING CARE PLAN

                                                                              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                              NURSING CARE PLANbull Goal 3 provide for special safety

                                                                              needsbull Skin care

                                                                              bull Inspect massage lubricate bony prominences

                                                                              bull Use foot cradle heel protectors sheepskin

                                                                              bull Side rails up if hypoxic (disoriented)

                                                                              bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                              bull ROM active passive elastic stockings

                                                                              NURSING CARE PLAN

                                                                              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                              strict IObull Diet

                                                                              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                              NURSING CARE PLAN

                                                                              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                              bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                              EVALUATION

                                                                              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                              distressbull Reduction in dependent edema

                                                                              DAY 3 OF

                                                                              CARDIOVASCULARDISEASES

                                                                              bull hyperlipidemia means high lipid levels

                                                                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                              Treatment of Hyperlipidemia

                                                                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                              bull SYSTOLIC DYSFUNCTION

                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                              bull Pathophysiologybull 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

                                                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                              CARDIOMYOPATHIES

                                                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                              CARDIOMYOPATHIES

                                                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                              CARDIOMYOPATHIES

                                                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                              relief

                                                                              CARDIOMYOPATHIES

                                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                              CARDIOMYOPATHIES

                                                                              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

                                                                              Infective endocarditis

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

                                                                              bull Can be acute or chronic

                                                                              Infective endocarditis

                                                                              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

                                                                              Infective endocarditis

                                                                              bull Pathophysiologybull 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

                                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                              Infective endocarditis

                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                              retina

                                                                              Infective endocarditis

                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                              Infective endocarditis

                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                              Infective endocarditis

                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                              organism

                                                                              Infective endocarditis

                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                              Infective endocarditis

                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                              B

                                                                              Infective endocarditis

                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                              CARDIOGENIC SHOCK

                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                              CARDIOGENIC SHOCK

                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                              CARDIOGENIC SHOCK

                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                              Normal is 4-10 cmH2O

                                                                              CARDIOGENIC SHOCK

                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                              decreased pulmonary congestion and to relieve pain

                                                                              CARDIOGENIC SHOCK

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

                                                                              bull 6 Monitor urinary output BP and pulses

                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                              CARDIAC TAMPONADE

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

                                                                              CARDIAC TAMPONADE

                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                              CARDIAC TAMPONADE

                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                              CARDIAC TAMPONADE

                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                              distention hypotension and distantmuffled heart sound

                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                              CARDIAC TAMPONADE

                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                              anterior chest

                                                                              CARDIAC TAMPONADE

                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                              CARDIAC TAMPONADE

                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                              tamponade

                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                              HYPERTENSION

                                                                              bull 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

                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                              bull Most common typebull 2 Secondary

                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                              Buergerrsquos Disease

                                                                              bull Also known as Thromboangiitis obliterans

                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                              reaction of the vessel wall

                                                                              Manifestations

                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                              Absentdiminished peripheral pulses

                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                              gangrenous changes may arise may necessitate amputation

                                                                              Diagnosis amp Treatment

                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                              affected symmetrically only 1-2digits may be involved

                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                              (rare occasions)

                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                              A Assessment

                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                              2 vsB Nursing Dx

                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                              2 Impaired gas exchange

                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                              C Goals

                                                                              1 Relief of pain amp symptoms

                                                                              2 Prevention of further cardiac damage

                                                                              D Nursing Interventions

                                                                              1 Pain control

                                                                              2 Proper medications

                                                                              3 Decrease clientrsquos anxiety

                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                              • CARDIOVASCULAR DISEASES
                                                                              • Slide 2
                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                              • Pathophysiology
                                                                              • Slide 5
                                                                              • ASSESSING CHEST PAIN
                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                              • Angina Pectoris Myocardial Ischemia
                                                                              • Pathophysiology
                                                                              • Types
                                                                              • Slide 12
                                                                              • Slide 13
                                                                              • Slide 14
                                                                              • Conthellip
                                                                              • Conthellip (2)
                                                                              • Drug Therapy
                                                                              • Classification
                                                                              • Nursing Management
                                                                              • Nursing Management (2)
                                                                              • Acute Coronary Syndrome
                                                                              • Slide 22
                                                                              • Conthellip (3)
                                                                              • Slide 24
                                                                              • Conthellip(MI)
                                                                              • Slide 26
                                                                              • Pathophysiology (2)
                                                                              • Tissue Changes After MI
                                                                              • Management of MI
                                                                              • Slide 30
                                                                              • Slide 31
                                                                              • ASSESSMENT
                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                              • NURSING CARE PLAN
                                                                              • NURSING CARE PLAN (2)
                                                                              • NURSING CARE PLAN (3)
                                                                              • NURSING CARE PLAN (4)
                                                                              • NURSING CARE PLAN (5)
                                                                              • NURSING CARE PLAN (6)
                                                                              • NURSING CARE PLAN (7)
                                                                              • NURSING CARE PLAN (8)
                                                                              • EVALUATION
                                                                              • CONGESTIVE HEART FAILURE
                                                                              • PATHOPHYSIOLOGY
                                                                              • ASSESSMENT (2)
                                                                              • ASSESSMENT (3)
                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                              • Slide 49
                                                                              • NURSING CARE PLAN (9)
                                                                              • NURSING CARE PLAN (10)
                                                                              • NURSING CARE PLAN (11)
                                                                              • NURSING CARE PLAN (12)
                                                                              • NURSING CARE PLAN (13)
                                                                              • EVALUATION
                                                                              • Slide 56
                                                                              • Slide 57
                                                                              • Slide 58
                                                                              • Slide 59
                                                                              • Slide 60
                                                                              • Treatment of Hyperlipidemia
                                                                              • Slide 62
                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                              • CARDIOMYOPATHIES
                                                                              • CARDIOMYOPATHIES (2)
                                                                              • CARDIOMYOPATHIES (3)
                                                                              • CARDIOMYOPATHIES (4)
                                                                              • CARDIOMYOPATHIES (5)
                                                                              • CARDIOMYOPATHIES (6)
                                                                              • Infective endocarditis
                                                                              • Infective endocarditis (2)
                                                                              • Infective endocarditis (3)
                                                                              • Infective endocarditis (4)
                                                                              • Infective endocarditis (5)
                                                                              • Infective endocarditis (6)
                                                                              • Infective endocarditis (7)
                                                                              • Infective endocarditis (8)
                                                                              • Infective endocarditis (9)
                                                                              • Infective endocarditis (10)
                                                                              • Infective endocarditis (11)
                                                                              • Infective endocarditis (12)
                                                                              • CARDIOGENIC SHOCK
                                                                              • CARDIOGENIC SHOCK (2)
                                                                              • CARDIOGENIC SHOCK (3)
                                                                              • CARDIOGENIC SHOCK (4)
                                                                              • CARDIOGENIC SHOCK (5)
                                                                              • CARDIAC TAMPONADE
                                                                              • CARDIAC TAMPONADE (2)
                                                                              • CARDIAC TAMPONADE (3)
                                                                              • CARDIAC TAMPONADE (4)
                                                                              • CARDIAC TAMPONADE (5)
                                                                              • CARDIAC TAMPONADE (6)
                                                                              • CARDIAC TAMPONADE (7)
                                                                              • Slide 100
                                                                              • HYPERTENSION
                                                                              • HYPERTENSION (2)
                                                                              • Slide 103
                                                                              • Slide 104
                                                                              • Slide 105
                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                              • Buergerrsquos Disease
                                                                              • Slide 108
                                                                              • Manifestations
                                                                              • Slide 110
                                                                              • Diagnosis amp Treatment
                                                                              • Rynaudrsquos Disease
                                                                              • Manifestations (2)
                                                                              • Slide 114
                                                                              • Diagnosis amp Treatment (2)
                                                                              • Slide 116
                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                              • Slide 118
                                                                              • Slide 119
                                                                              • Slide 120
                                                                              • Slide 121

                                                                                EVALUATION

                                                                                bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors

                                                                                CONGESTIVE HEART FAILURE

                                                                                bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                                PATHOPHYSIOLOGY

                                                                                Increased cardiac workload

                                                                                decreased effective myocardial contractility

                                                                                Decreased cardiac output

                                                                                LV failure Pulmonary congestion

                                                                                RA RV failure

                                                                                Systemic congestion

                                                                                Peripheral edema

                                                                                ASSESSMENTbull Subjective data

                                                                                bull Shortness of breathbull Orthopnea (sleeps on two

                                                                                or more pillows)bull Paroxysmal nocturnal

                                                                                dyspnea (sudden breathlessness during sleep)

                                                                                bull Dyspnea on exertion (climbing stairs)

                                                                                bull Apprehension anxiety irritability

                                                                                bull Fatigue weaknessbull Reported weight gain

                                                                                feeling of puffiness

                                                                                ASSESSMENTbull Objective data

                                                                                bull VSbull BP decreasing systolic

                                                                                narrowing pulse pressurebull Pulse pulsus alternans

                                                                                (alternating strong-weak-strong cardiac contraction) increased

                                                                                bull Respirations crackles Cheyne-Stokes

                                                                                bull Edema dependent pitting (1+ to 4+ mm)

                                                                                bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                                dilated pulmonary vessels lung edema

                                                                                Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                LEFT VENTRICULAR

                                                                                FAILURE

                                                                                RIGHT VENTRICULAR

                                                                                FAILURE

                                                                                Pulmonary crackles Jugular venous distention

                                                                                Tachypnea Peripheral edema

                                                                                S3 gallop Perioral and peripheral cyanosis

                                                                                Cardiac murmurs Congestive hepatomegaly

                                                                                Paradoxical splitting of S2

                                                                                Ascites

                                                                                Hepatojugular reflux

                                                                                ANALYSIS NURSING DIAGNOSES

                                                                                bull Decreased cardiac output related to decreased myocardial contractility

                                                                                bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                bull Fatigue related to edema and poor oxygenation

                                                                                bull Fluid volume excess related to compensatory mechanisms

                                                                                bull Impaired gas exchange related to pulmonary congestion

                                                                                bull Anxiety related to shortness of breath

                                                                                bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                NURSING CARE PLAN

                                                                                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                bull Warm fluids if appropriate

                                                                                NURSING CARE PLAN

                                                                                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                needsbull Skin care

                                                                                bull Inspect massage lubricate bony prominences

                                                                                bull Use foot cradle heel protectors sheepskin

                                                                                bull Side rails up if hypoxic (disoriented)

                                                                                bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                bull ROM active passive elastic stockings

                                                                                NURSING CARE PLAN

                                                                                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                strict IObull Diet

                                                                                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                NURSING CARE PLAN

                                                                                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                EVALUATION

                                                                                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                distressbull Reduction in dependent edema

                                                                                DAY 3 OF

                                                                                CARDIOVASCULARDISEASES

                                                                                bull hyperlipidemia means high lipid levels

                                                                                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                Treatment of Hyperlipidemia

                                                                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                bull SYSTOLIC DYSFUNCTION

                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                bull Pathophysiologybull 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

                                                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                CARDIOMYOPATHIES

                                                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                CARDIOMYOPATHIES

                                                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                CARDIOMYOPATHIES

                                                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                relief

                                                                                CARDIOMYOPATHIES

                                                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                CARDIOMYOPATHIES

                                                                                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

                                                                                Infective endocarditis

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

                                                                                bull Can be acute or chronic

                                                                                Infective endocarditis

                                                                                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

                                                                                Infective endocarditis

                                                                                bull Pathophysiologybull 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

                                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                Infective endocarditis

                                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                retina

                                                                                Infective endocarditis

                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                Infective endocarditis

                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                Infective endocarditis

                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                organism

                                                                                Infective endocarditis

                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                Infective endocarditis

                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                B

                                                                                Infective endocarditis

                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                CARDIOGENIC SHOCK

                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                CARDIOGENIC SHOCK

                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                CARDIOGENIC SHOCK

                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                Normal is 4-10 cmH2O

                                                                                CARDIOGENIC SHOCK

                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                decreased pulmonary congestion and to relieve pain

                                                                                CARDIOGENIC SHOCK

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

                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                CARDIAC TAMPONADE

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

                                                                                CARDIAC TAMPONADE

                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                CARDIAC TAMPONADE

                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                CARDIAC TAMPONADE

                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                distention hypotension and distantmuffled heart sound

                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                CARDIAC TAMPONADE

                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                anterior chest

                                                                                CARDIAC TAMPONADE

                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                CARDIAC TAMPONADE

                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                tamponade

                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                HYPERTENSION

                                                                                bull 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

                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                bull Most common typebull 2 Secondary

                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                Buergerrsquos Disease

                                                                                bull Also known as Thromboangiitis obliterans

                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                reaction of the vessel wall

                                                                                Manifestations

                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                Absentdiminished peripheral pulses

                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                gangrenous changes may arise may necessitate amputation

                                                                                Diagnosis amp Treatment

                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                affected symmetrically only 1-2digits may be involved

                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                (rare occasions)

                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                A Assessment

                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                2 vsB Nursing Dx

                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                2 Impaired gas exchange

                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                C Goals

                                                                                1 Relief of pain amp symptoms

                                                                                2 Prevention of further cardiac damage

                                                                                D Nursing Interventions

                                                                                1 Pain control

                                                                                2 Proper medications

                                                                                3 Decrease clientrsquos anxiety

                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                • CARDIOVASCULAR DISEASES
                                                                                • Slide 2
                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                • Pathophysiology
                                                                                • Slide 5
                                                                                • ASSESSING CHEST PAIN
                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                • Pathophysiology
                                                                                • Types
                                                                                • Slide 12
                                                                                • Slide 13
                                                                                • Slide 14
                                                                                • Conthellip
                                                                                • Conthellip (2)
                                                                                • Drug Therapy
                                                                                • Classification
                                                                                • Nursing Management
                                                                                • Nursing Management (2)
                                                                                • Acute Coronary Syndrome
                                                                                • Slide 22
                                                                                • Conthellip (3)
                                                                                • Slide 24
                                                                                • Conthellip(MI)
                                                                                • Slide 26
                                                                                • Pathophysiology (2)
                                                                                • Tissue Changes After MI
                                                                                • Management of MI
                                                                                • Slide 30
                                                                                • Slide 31
                                                                                • ASSESSMENT
                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                • NURSING CARE PLAN
                                                                                • NURSING CARE PLAN (2)
                                                                                • NURSING CARE PLAN (3)
                                                                                • NURSING CARE PLAN (4)
                                                                                • NURSING CARE PLAN (5)
                                                                                • NURSING CARE PLAN (6)
                                                                                • NURSING CARE PLAN (7)
                                                                                • NURSING CARE PLAN (8)
                                                                                • EVALUATION
                                                                                • CONGESTIVE HEART FAILURE
                                                                                • PATHOPHYSIOLOGY
                                                                                • ASSESSMENT (2)
                                                                                • ASSESSMENT (3)
                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                • Slide 49
                                                                                • NURSING CARE PLAN (9)
                                                                                • NURSING CARE PLAN (10)
                                                                                • NURSING CARE PLAN (11)
                                                                                • NURSING CARE PLAN (12)
                                                                                • NURSING CARE PLAN (13)
                                                                                • EVALUATION
                                                                                • Slide 56
                                                                                • Slide 57
                                                                                • Slide 58
                                                                                • Slide 59
                                                                                • Slide 60
                                                                                • Treatment of Hyperlipidemia
                                                                                • Slide 62
                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                • CARDIOMYOPATHIES
                                                                                • CARDIOMYOPATHIES (2)
                                                                                • CARDIOMYOPATHIES (3)
                                                                                • CARDIOMYOPATHIES (4)
                                                                                • CARDIOMYOPATHIES (5)
                                                                                • CARDIOMYOPATHIES (6)
                                                                                • Infective endocarditis
                                                                                • Infective endocarditis (2)
                                                                                • Infective endocarditis (3)
                                                                                • Infective endocarditis (4)
                                                                                • Infective endocarditis (5)
                                                                                • Infective endocarditis (6)
                                                                                • Infective endocarditis (7)
                                                                                • Infective endocarditis (8)
                                                                                • Infective endocarditis (9)
                                                                                • Infective endocarditis (10)
                                                                                • Infective endocarditis (11)
                                                                                • Infective endocarditis (12)
                                                                                • CARDIOGENIC SHOCK
                                                                                • CARDIOGENIC SHOCK (2)
                                                                                • CARDIOGENIC SHOCK (3)
                                                                                • CARDIOGENIC SHOCK (4)
                                                                                • CARDIOGENIC SHOCK (5)
                                                                                • CARDIAC TAMPONADE
                                                                                • CARDIAC TAMPONADE (2)
                                                                                • CARDIAC TAMPONADE (3)
                                                                                • CARDIAC TAMPONADE (4)
                                                                                • CARDIAC TAMPONADE (5)
                                                                                • CARDIAC TAMPONADE (6)
                                                                                • CARDIAC TAMPONADE (7)
                                                                                • Slide 100
                                                                                • HYPERTENSION
                                                                                • HYPERTENSION (2)
                                                                                • Slide 103
                                                                                • Slide 104
                                                                                • Slide 105
                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                • Buergerrsquos Disease
                                                                                • Slide 108
                                                                                • Manifestations
                                                                                • Slide 110
                                                                                • Diagnosis amp Treatment
                                                                                • Rynaudrsquos Disease
                                                                                • Manifestations (2)
                                                                                • Slide 114
                                                                                • Diagnosis amp Treatment (2)
                                                                                • Slide 116
                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                • Slide 118
                                                                                • Slide 119
                                                                                • Slide 120
                                                                                • Slide 121

                                                                                  CONGESTIVE HEART FAILURE

                                                                                  bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient

                                                                                  PATHOPHYSIOLOGY

                                                                                  Increased cardiac workload

                                                                                  decreased effective myocardial contractility

                                                                                  Decreased cardiac output

                                                                                  LV failure Pulmonary congestion

                                                                                  RA RV failure

                                                                                  Systemic congestion

                                                                                  Peripheral edema

                                                                                  ASSESSMENTbull Subjective data

                                                                                  bull Shortness of breathbull Orthopnea (sleeps on two

                                                                                  or more pillows)bull Paroxysmal nocturnal

                                                                                  dyspnea (sudden breathlessness during sleep)

                                                                                  bull Dyspnea on exertion (climbing stairs)

                                                                                  bull Apprehension anxiety irritability

                                                                                  bull Fatigue weaknessbull Reported weight gain

                                                                                  feeling of puffiness

                                                                                  ASSESSMENTbull Objective data

                                                                                  bull VSbull BP decreasing systolic

                                                                                  narrowing pulse pressurebull Pulse pulsus alternans

                                                                                  (alternating strong-weak-strong cardiac contraction) increased

                                                                                  bull Respirations crackles Cheyne-Stokes

                                                                                  bull Edema dependent pitting (1+ to 4+ mm)

                                                                                  bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                                  dilated pulmonary vessels lung edema

                                                                                  Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                  LEFT VENTRICULAR

                                                                                  FAILURE

                                                                                  RIGHT VENTRICULAR

                                                                                  FAILURE

                                                                                  Pulmonary crackles Jugular venous distention

                                                                                  Tachypnea Peripheral edema

                                                                                  S3 gallop Perioral and peripheral cyanosis

                                                                                  Cardiac murmurs Congestive hepatomegaly

                                                                                  Paradoxical splitting of S2

                                                                                  Ascites

                                                                                  Hepatojugular reflux

                                                                                  ANALYSIS NURSING DIAGNOSES

                                                                                  bull Decreased cardiac output related to decreased myocardial contractility

                                                                                  bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                  bull Fatigue related to edema and poor oxygenation

                                                                                  bull Fluid volume excess related to compensatory mechanisms

                                                                                  bull Impaired gas exchange related to pulmonary congestion

                                                                                  bull Anxiety related to shortness of breath

                                                                                  bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                  NURSING CARE PLAN

                                                                                  bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                  tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                  bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                  bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                  bull Warm fluids if appropriate

                                                                                  NURSING CARE PLAN

                                                                                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                  NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                  needsbull Skin care

                                                                                  bull Inspect massage lubricate bony prominences

                                                                                  bull Use foot cradle heel protectors sheepskin

                                                                                  bull Side rails up if hypoxic (disoriented)

                                                                                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                  bull ROM active passive elastic stockings

                                                                                  NURSING CARE PLAN

                                                                                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                  strict IObull Diet

                                                                                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                  NURSING CARE PLAN

                                                                                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                  EVALUATION

                                                                                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                  distressbull Reduction in dependent edema

                                                                                  DAY 3 OF

                                                                                  CARDIOVASCULARDISEASES

                                                                                  bull hyperlipidemia means high lipid levels

                                                                                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                  Treatment of Hyperlipidemia

                                                                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                  bull SYSTOLIC DYSFUNCTION

                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                  bull Pathophysiologybull 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

                                                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                  CARDIOMYOPATHIES

                                                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                  CARDIOMYOPATHIES

                                                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                  CARDIOMYOPATHIES

                                                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                  relief

                                                                                  CARDIOMYOPATHIES

                                                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                  CARDIOMYOPATHIES

                                                                                  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

                                                                                  Infective endocarditis

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

                                                                                  bull Can be acute or chronic

                                                                                  Infective endocarditis

                                                                                  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

                                                                                  Infective endocarditis

                                                                                  bull Pathophysiologybull 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

                                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                  Infective endocarditis

                                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                  retina

                                                                                  Infective endocarditis

                                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                  Infective endocarditis

                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                  Infective endocarditis

                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                  organism

                                                                                  Infective endocarditis

                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                  Infective endocarditis

                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                  B

                                                                                  Infective endocarditis

                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                  CARDIOGENIC SHOCK

                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                  CARDIOGENIC SHOCK

                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                  CARDIOGENIC SHOCK

                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                  Normal is 4-10 cmH2O

                                                                                  CARDIOGENIC SHOCK

                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                  CARDIOGENIC SHOCK

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

                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                  CARDIAC TAMPONADE

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

                                                                                  CARDIAC TAMPONADE

                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                  CARDIAC TAMPONADE

                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                  CARDIAC TAMPONADE

                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                  distention hypotension and distantmuffled heart sound

                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                  CARDIAC TAMPONADE

                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                  anterior chest

                                                                                  CARDIAC TAMPONADE

                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                  CARDIAC TAMPONADE

                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                  tamponade

                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                  HYPERTENSION

                                                                                  bull 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

                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                  bull Most common typebull 2 Secondary

                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                  Buergerrsquos Disease

                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                  reaction of the vessel wall

                                                                                  Manifestations

                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                  Absentdiminished peripheral pulses

                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                  Diagnosis amp Treatment

                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                  (rare occasions)

                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                  A Assessment

                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                  2 vsB Nursing Dx

                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                  2 Impaired gas exchange

                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                  C Goals

                                                                                  1 Relief of pain amp symptoms

                                                                                  2 Prevention of further cardiac damage

                                                                                  D Nursing Interventions

                                                                                  1 Pain control

                                                                                  2 Proper medications

                                                                                  3 Decrease clientrsquos anxiety

                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                  • CARDIOVASCULAR DISEASES
                                                                                  • Slide 2
                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                  • Pathophysiology
                                                                                  • Slide 5
                                                                                  • ASSESSING CHEST PAIN
                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                  • Pathophysiology
                                                                                  • Types
                                                                                  • Slide 12
                                                                                  • Slide 13
                                                                                  • Slide 14
                                                                                  • Conthellip
                                                                                  • Conthellip (2)
                                                                                  • Drug Therapy
                                                                                  • Classification
                                                                                  • Nursing Management
                                                                                  • Nursing Management (2)
                                                                                  • Acute Coronary Syndrome
                                                                                  • Slide 22
                                                                                  • Conthellip (3)
                                                                                  • Slide 24
                                                                                  • Conthellip(MI)
                                                                                  • Slide 26
                                                                                  • Pathophysiology (2)
                                                                                  • Tissue Changes After MI
                                                                                  • Management of MI
                                                                                  • Slide 30
                                                                                  • Slide 31
                                                                                  • ASSESSMENT
                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                  • NURSING CARE PLAN
                                                                                  • NURSING CARE PLAN (2)
                                                                                  • NURSING CARE PLAN (3)
                                                                                  • NURSING CARE PLAN (4)
                                                                                  • NURSING CARE PLAN (5)
                                                                                  • NURSING CARE PLAN (6)
                                                                                  • NURSING CARE PLAN (7)
                                                                                  • NURSING CARE PLAN (8)
                                                                                  • EVALUATION
                                                                                  • CONGESTIVE HEART FAILURE
                                                                                  • PATHOPHYSIOLOGY
                                                                                  • ASSESSMENT (2)
                                                                                  • ASSESSMENT (3)
                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                  • Slide 49
                                                                                  • NURSING CARE PLAN (9)
                                                                                  • NURSING CARE PLAN (10)
                                                                                  • NURSING CARE PLAN (11)
                                                                                  • NURSING CARE PLAN (12)
                                                                                  • NURSING CARE PLAN (13)
                                                                                  • EVALUATION
                                                                                  • Slide 56
                                                                                  • Slide 57
                                                                                  • Slide 58
                                                                                  • Slide 59
                                                                                  • Slide 60
                                                                                  • Treatment of Hyperlipidemia
                                                                                  • Slide 62
                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                  • CARDIOMYOPATHIES
                                                                                  • CARDIOMYOPATHIES (2)
                                                                                  • CARDIOMYOPATHIES (3)
                                                                                  • CARDIOMYOPATHIES (4)
                                                                                  • CARDIOMYOPATHIES (5)
                                                                                  • CARDIOMYOPATHIES (6)
                                                                                  • Infective endocarditis
                                                                                  • Infective endocarditis (2)
                                                                                  • Infective endocarditis (3)
                                                                                  • Infective endocarditis (4)
                                                                                  • Infective endocarditis (5)
                                                                                  • Infective endocarditis (6)
                                                                                  • Infective endocarditis (7)
                                                                                  • Infective endocarditis (8)
                                                                                  • Infective endocarditis (9)
                                                                                  • Infective endocarditis (10)
                                                                                  • Infective endocarditis (11)
                                                                                  • Infective endocarditis (12)
                                                                                  • CARDIOGENIC SHOCK
                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                  • CARDIAC TAMPONADE
                                                                                  • CARDIAC TAMPONADE (2)
                                                                                  • CARDIAC TAMPONADE (3)
                                                                                  • CARDIAC TAMPONADE (4)
                                                                                  • CARDIAC TAMPONADE (5)
                                                                                  • CARDIAC TAMPONADE (6)
                                                                                  • CARDIAC TAMPONADE (7)
                                                                                  • Slide 100
                                                                                  • HYPERTENSION
                                                                                  • HYPERTENSION (2)
                                                                                  • Slide 103
                                                                                  • Slide 104
                                                                                  • Slide 105
                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                  • Buergerrsquos Disease
                                                                                  • Slide 108
                                                                                  • Manifestations
                                                                                  • Slide 110
                                                                                  • Diagnosis amp Treatment
                                                                                  • Rynaudrsquos Disease
                                                                                  • Manifestations (2)
                                                                                  • Slide 114
                                                                                  • Diagnosis amp Treatment (2)
                                                                                  • Slide 116
                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                  • Slide 118
                                                                                  • Slide 119
                                                                                  • Slide 120
                                                                                  • Slide 121

                                                                                    PATHOPHYSIOLOGY

                                                                                    Increased cardiac workload

                                                                                    decreased effective myocardial contractility

                                                                                    Decreased cardiac output

                                                                                    LV failure Pulmonary congestion

                                                                                    RA RV failure

                                                                                    Systemic congestion

                                                                                    Peripheral edema

                                                                                    ASSESSMENTbull Subjective data

                                                                                    bull Shortness of breathbull Orthopnea (sleeps on two

                                                                                    or more pillows)bull Paroxysmal nocturnal

                                                                                    dyspnea (sudden breathlessness during sleep)

                                                                                    bull Dyspnea on exertion (climbing stairs)

                                                                                    bull Apprehension anxiety irritability

                                                                                    bull Fatigue weaknessbull Reported weight gain

                                                                                    feeling of puffiness

                                                                                    ASSESSMENTbull Objective data

                                                                                    bull VSbull BP decreasing systolic

                                                                                    narrowing pulse pressurebull Pulse pulsus alternans

                                                                                    (alternating strong-weak-strong cardiac contraction) increased

                                                                                    bull Respirations crackles Cheyne-Stokes

                                                                                    bull Edema dependent pitting (1+ to 4+ mm)

                                                                                    bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                                    dilated pulmonary vessels lung edema

                                                                                    Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                    LEFT VENTRICULAR

                                                                                    FAILURE

                                                                                    RIGHT VENTRICULAR

                                                                                    FAILURE

                                                                                    Pulmonary crackles Jugular venous distention

                                                                                    Tachypnea Peripheral edema

                                                                                    S3 gallop Perioral and peripheral cyanosis

                                                                                    Cardiac murmurs Congestive hepatomegaly

                                                                                    Paradoxical splitting of S2

                                                                                    Ascites

                                                                                    Hepatojugular reflux

                                                                                    ANALYSIS NURSING DIAGNOSES

                                                                                    bull Decreased cardiac output related to decreased myocardial contractility

                                                                                    bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                    bull Fatigue related to edema and poor oxygenation

                                                                                    bull Fluid volume excess related to compensatory mechanisms

                                                                                    bull Impaired gas exchange related to pulmonary congestion

                                                                                    bull Anxiety related to shortness of breath

                                                                                    bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                    NURSING CARE PLAN

                                                                                    bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                    tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                    bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                    bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                    bull Warm fluids if appropriate

                                                                                    NURSING CARE PLAN

                                                                                    bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                    deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                    bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                    bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                    NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                    needsbull Skin care

                                                                                    bull Inspect massage lubricate bony prominences

                                                                                    bull Use foot cradle heel protectors sheepskin

                                                                                    bull Side rails up if hypoxic (disoriented)

                                                                                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                    bull ROM active passive elastic stockings

                                                                                    NURSING CARE PLAN

                                                                                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                    strict IObull Diet

                                                                                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                    NURSING CARE PLAN

                                                                                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                    EVALUATION

                                                                                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                    distressbull Reduction in dependent edema

                                                                                    DAY 3 OF

                                                                                    CARDIOVASCULARDISEASES

                                                                                    bull hyperlipidemia means high lipid levels

                                                                                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                    Treatment of Hyperlipidemia

                                                                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                    bull SYSTOLIC DYSFUNCTION

                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                    bull Pathophysiologybull 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

                                                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                    CARDIOMYOPATHIES

                                                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                    CARDIOMYOPATHIES

                                                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                    CARDIOMYOPATHIES

                                                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                    relief

                                                                                    CARDIOMYOPATHIES

                                                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                    CARDIOMYOPATHIES

                                                                                    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

                                                                                    Infective endocarditis

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

                                                                                    bull Can be acute or chronic

                                                                                    Infective endocarditis

                                                                                    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

                                                                                    Infective endocarditis

                                                                                    bull Pathophysiologybull 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

                                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                    Infective endocarditis

                                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                    retina

                                                                                    Infective endocarditis

                                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                    Infective endocarditis

                                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                    Infective endocarditis

                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                    organism

                                                                                    Infective endocarditis

                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                    Infective endocarditis

                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                    B

                                                                                    Infective endocarditis

                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                    CARDIOGENIC SHOCK

                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                    CARDIOGENIC SHOCK

                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                    CARDIOGENIC SHOCK

                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                    Normal is 4-10 cmH2O

                                                                                    CARDIOGENIC SHOCK

                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                    CARDIOGENIC SHOCK

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

                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                    CARDIAC TAMPONADE

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

                                                                                    CARDIAC TAMPONADE

                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                    CARDIAC TAMPONADE

                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                    CARDIAC TAMPONADE

                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                    distention hypotension and distantmuffled heart sound

                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                    CARDIAC TAMPONADE

                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                    anterior chest

                                                                                    CARDIAC TAMPONADE

                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                    CARDIAC TAMPONADE

                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                    tamponade

                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                    HYPERTENSION

                                                                                    bull 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

                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                    bull Most common typebull 2 Secondary

                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                    Buergerrsquos Disease

                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                    reaction of the vessel wall

                                                                                    Manifestations

                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                    Absentdiminished peripheral pulses

                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                    Diagnosis amp Treatment

                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                    (rare occasions)

                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                    A Assessment

                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                    2 vsB Nursing Dx

                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                    2 Impaired gas exchange

                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                    C Goals

                                                                                    1 Relief of pain amp symptoms

                                                                                    2 Prevention of further cardiac damage

                                                                                    D Nursing Interventions

                                                                                    1 Pain control

                                                                                    2 Proper medications

                                                                                    3 Decrease clientrsquos anxiety

                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                    • CARDIOVASCULAR DISEASES
                                                                                    • Slide 2
                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                    • Pathophysiology
                                                                                    • Slide 5
                                                                                    • ASSESSING CHEST PAIN
                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                    • Pathophysiology
                                                                                    • Types
                                                                                    • Slide 12
                                                                                    • Slide 13
                                                                                    • Slide 14
                                                                                    • Conthellip
                                                                                    • Conthellip (2)
                                                                                    • Drug Therapy
                                                                                    • Classification
                                                                                    • Nursing Management
                                                                                    • Nursing Management (2)
                                                                                    • Acute Coronary Syndrome
                                                                                    • Slide 22
                                                                                    • Conthellip (3)
                                                                                    • Slide 24
                                                                                    • Conthellip(MI)
                                                                                    • Slide 26
                                                                                    • Pathophysiology (2)
                                                                                    • Tissue Changes After MI
                                                                                    • Management of MI
                                                                                    • Slide 30
                                                                                    • Slide 31
                                                                                    • ASSESSMENT
                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                    • NURSING CARE PLAN
                                                                                    • NURSING CARE PLAN (2)
                                                                                    • NURSING CARE PLAN (3)
                                                                                    • NURSING CARE PLAN (4)
                                                                                    • NURSING CARE PLAN (5)
                                                                                    • NURSING CARE PLAN (6)
                                                                                    • NURSING CARE PLAN (7)
                                                                                    • NURSING CARE PLAN (8)
                                                                                    • EVALUATION
                                                                                    • CONGESTIVE HEART FAILURE
                                                                                    • PATHOPHYSIOLOGY
                                                                                    • ASSESSMENT (2)
                                                                                    • ASSESSMENT (3)
                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                    • Slide 49
                                                                                    • NURSING CARE PLAN (9)
                                                                                    • NURSING CARE PLAN (10)
                                                                                    • NURSING CARE PLAN (11)
                                                                                    • NURSING CARE PLAN (12)
                                                                                    • NURSING CARE PLAN (13)
                                                                                    • EVALUATION
                                                                                    • Slide 56
                                                                                    • Slide 57
                                                                                    • Slide 58
                                                                                    • Slide 59
                                                                                    • Slide 60
                                                                                    • Treatment of Hyperlipidemia
                                                                                    • Slide 62
                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                    • CARDIOMYOPATHIES
                                                                                    • CARDIOMYOPATHIES (2)
                                                                                    • CARDIOMYOPATHIES (3)
                                                                                    • CARDIOMYOPATHIES (4)
                                                                                    • CARDIOMYOPATHIES (5)
                                                                                    • CARDIOMYOPATHIES (6)
                                                                                    • Infective endocarditis
                                                                                    • Infective endocarditis (2)
                                                                                    • Infective endocarditis (3)
                                                                                    • Infective endocarditis (4)
                                                                                    • Infective endocarditis (5)
                                                                                    • Infective endocarditis (6)
                                                                                    • Infective endocarditis (7)
                                                                                    • Infective endocarditis (8)
                                                                                    • Infective endocarditis (9)
                                                                                    • Infective endocarditis (10)
                                                                                    • Infective endocarditis (11)
                                                                                    • Infective endocarditis (12)
                                                                                    • CARDIOGENIC SHOCK
                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                    • CARDIAC TAMPONADE
                                                                                    • CARDIAC TAMPONADE (2)
                                                                                    • CARDIAC TAMPONADE (3)
                                                                                    • CARDIAC TAMPONADE (4)
                                                                                    • CARDIAC TAMPONADE (5)
                                                                                    • CARDIAC TAMPONADE (6)
                                                                                    • CARDIAC TAMPONADE (7)
                                                                                    • Slide 100
                                                                                    • HYPERTENSION
                                                                                    • HYPERTENSION (2)
                                                                                    • Slide 103
                                                                                    • Slide 104
                                                                                    • Slide 105
                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                    • Buergerrsquos Disease
                                                                                    • Slide 108
                                                                                    • Manifestations
                                                                                    • Slide 110
                                                                                    • Diagnosis amp Treatment
                                                                                    • Rynaudrsquos Disease
                                                                                    • Manifestations (2)
                                                                                    • Slide 114
                                                                                    • Diagnosis amp Treatment (2)
                                                                                    • Slide 116
                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                    • Slide 118
                                                                                    • Slide 119
                                                                                    • Slide 120
                                                                                    • Slide 121

                                                                                      ASSESSMENTbull Subjective data

                                                                                      bull Shortness of breathbull Orthopnea (sleeps on two

                                                                                      or more pillows)bull Paroxysmal nocturnal

                                                                                      dyspnea (sudden breathlessness during sleep)

                                                                                      bull Dyspnea on exertion (climbing stairs)

                                                                                      bull Apprehension anxiety irritability

                                                                                      bull Fatigue weaknessbull Reported weight gain

                                                                                      feeling of puffiness

                                                                                      ASSESSMENTbull Objective data

                                                                                      bull VSbull BP decreasing systolic

                                                                                      narrowing pulse pressurebull Pulse pulsus alternans

                                                                                      (alternating strong-weak-strong cardiac contraction) increased

                                                                                      bull Respirations crackles Cheyne-Stokes

                                                                                      bull Edema dependent pitting (1+ to 4+ mm)

                                                                                      bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                                      dilated pulmonary vessels lung edema

                                                                                      Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                      LEFT VENTRICULAR

                                                                                      FAILURE

                                                                                      RIGHT VENTRICULAR

                                                                                      FAILURE

                                                                                      Pulmonary crackles Jugular venous distention

                                                                                      Tachypnea Peripheral edema

                                                                                      S3 gallop Perioral and peripheral cyanosis

                                                                                      Cardiac murmurs Congestive hepatomegaly

                                                                                      Paradoxical splitting of S2

                                                                                      Ascites

                                                                                      Hepatojugular reflux

                                                                                      ANALYSIS NURSING DIAGNOSES

                                                                                      bull Decreased cardiac output related to decreased myocardial contractility

                                                                                      bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                      bull Fatigue related to edema and poor oxygenation

                                                                                      bull Fluid volume excess related to compensatory mechanisms

                                                                                      bull Impaired gas exchange related to pulmonary congestion

                                                                                      bull Anxiety related to shortness of breath

                                                                                      bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                      NURSING CARE PLAN

                                                                                      bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                      tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                      bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                      bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                      bull Warm fluids if appropriate

                                                                                      NURSING CARE PLAN

                                                                                      bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                      deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                      bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                      bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                      NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                      needsbull Skin care

                                                                                      bull Inspect massage lubricate bony prominences

                                                                                      bull Use foot cradle heel protectors sheepskin

                                                                                      bull Side rails up if hypoxic (disoriented)

                                                                                      bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                      bull ROM active passive elastic stockings

                                                                                      NURSING CARE PLAN

                                                                                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                      strict IObull Diet

                                                                                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                      NURSING CARE PLAN

                                                                                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                      EVALUATION

                                                                                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                      distressbull Reduction in dependent edema

                                                                                      DAY 3 OF

                                                                                      CARDIOVASCULARDISEASES

                                                                                      bull hyperlipidemia means high lipid levels

                                                                                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                      Treatment of Hyperlipidemia

                                                                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                      bull SYSTOLIC DYSFUNCTION

                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                      bull Pathophysiologybull 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

                                                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                      CARDIOMYOPATHIES

                                                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                      CARDIOMYOPATHIES

                                                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                      CARDIOMYOPATHIES

                                                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                      relief

                                                                                      CARDIOMYOPATHIES

                                                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                      CARDIOMYOPATHIES

                                                                                      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

                                                                                      Infective endocarditis

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

                                                                                      bull Can be acute or chronic

                                                                                      Infective endocarditis

                                                                                      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

                                                                                      Infective endocarditis

                                                                                      bull Pathophysiologybull 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

                                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                      Infective endocarditis

                                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                      retina

                                                                                      Infective endocarditis

                                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                      Infective endocarditis

                                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                      Infective endocarditis

                                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                      organism

                                                                                      Infective endocarditis

                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                      Infective endocarditis

                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                      B

                                                                                      Infective endocarditis

                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                      CARDIOGENIC SHOCK

                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                      CARDIOGENIC SHOCK

                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                      CARDIOGENIC SHOCK

                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                      Normal is 4-10 cmH2O

                                                                                      CARDIOGENIC SHOCK

                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                      CARDIOGENIC SHOCK

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

                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                      CARDIAC TAMPONADE

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

                                                                                      CARDIAC TAMPONADE

                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                      CARDIAC TAMPONADE

                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                      CARDIAC TAMPONADE

                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                      distention hypotension and distantmuffled heart sound

                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                      CARDIAC TAMPONADE

                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                      anterior chest

                                                                                      CARDIAC TAMPONADE

                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                      CARDIAC TAMPONADE

                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                      tamponade

                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                      HYPERTENSION

                                                                                      bull 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

                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                      bull Most common typebull 2 Secondary

                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                      Buergerrsquos Disease

                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                      reaction of the vessel wall

                                                                                      Manifestations

                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                      Absentdiminished peripheral pulses

                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                      Diagnosis amp Treatment

                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                      (rare occasions)

                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                      A Assessment

                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                      2 vsB Nursing Dx

                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                      2 Impaired gas exchange

                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                      C Goals

                                                                                      1 Relief of pain amp symptoms

                                                                                      2 Prevention of further cardiac damage

                                                                                      D Nursing Interventions

                                                                                      1 Pain control

                                                                                      2 Proper medications

                                                                                      3 Decrease clientrsquos anxiety

                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                      • CARDIOVASCULAR DISEASES
                                                                                      • Slide 2
                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                      • Pathophysiology
                                                                                      • Slide 5
                                                                                      • ASSESSING CHEST PAIN
                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                      • Pathophysiology
                                                                                      • Types
                                                                                      • Slide 12
                                                                                      • Slide 13
                                                                                      • Slide 14
                                                                                      • Conthellip
                                                                                      • Conthellip (2)
                                                                                      • Drug Therapy
                                                                                      • Classification
                                                                                      • Nursing Management
                                                                                      • Nursing Management (2)
                                                                                      • Acute Coronary Syndrome
                                                                                      • Slide 22
                                                                                      • Conthellip (3)
                                                                                      • Slide 24
                                                                                      • Conthellip(MI)
                                                                                      • Slide 26
                                                                                      • Pathophysiology (2)
                                                                                      • Tissue Changes After MI
                                                                                      • Management of MI
                                                                                      • Slide 30
                                                                                      • Slide 31
                                                                                      • ASSESSMENT
                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                      • NURSING CARE PLAN
                                                                                      • NURSING CARE PLAN (2)
                                                                                      • NURSING CARE PLAN (3)
                                                                                      • NURSING CARE PLAN (4)
                                                                                      • NURSING CARE PLAN (5)
                                                                                      • NURSING CARE PLAN (6)
                                                                                      • NURSING CARE PLAN (7)
                                                                                      • NURSING CARE PLAN (8)
                                                                                      • EVALUATION
                                                                                      • CONGESTIVE HEART FAILURE
                                                                                      • PATHOPHYSIOLOGY
                                                                                      • ASSESSMENT (2)
                                                                                      • ASSESSMENT (3)
                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                      • Slide 49
                                                                                      • NURSING CARE PLAN (9)
                                                                                      • NURSING CARE PLAN (10)
                                                                                      • NURSING CARE PLAN (11)
                                                                                      • NURSING CARE PLAN (12)
                                                                                      • NURSING CARE PLAN (13)
                                                                                      • EVALUATION
                                                                                      • Slide 56
                                                                                      • Slide 57
                                                                                      • Slide 58
                                                                                      • Slide 59
                                                                                      • Slide 60
                                                                                      • Treatment of Hyperlipidemia
                                                                                      • Slide 62
                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                      • CARDIOMYOPATHIES
                                                                                      • CARDIOMYOPATHIES (2)
                                                                                      • CARDIOMYOPATHIES (3)
                                                                                      • CARDIOMYOPATHIES (4)
                                                                                      • CARDIOMYOPATHIES (5)
                                                                                      • CARDIOMYOPATHIES (6)
                                                                                      • Infective endocarditis
                                                                                      • Infective endocarditis (2)
                                                                                      • Infective endocarditis (3)
                                                                                      • Infective endocarditis (4)
                                                                                      • Infective endocarditis (5)
                                                                                      • Infective endocarditis (6)
                                                                                      • Infective endocarditis (7)
                                                                                      • Infective endocarditis (8)
                                                                                      • Infective endocarditis (9)
                                                                                      • Infective endocarditis (10)
                                                                                      • Infective endocarditis (11)
                                                                                      • Infective endocarditis (12)
                                                                                      • CARDIOGENIC SHOCK
                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                      • CARDIAC TAMPONADE
                                                                                      • CARDIAC TAMPONADE (2)
                                                                                      • CARDIAC TAMPONADE (3)
                                                                                      • CARDIAC TAMPONADE (4)
                                                                                      • CARDIAC TAMPONADE (5)
                                                                                      • CARDIAC TAMPONADE (6)
                                                                                      • CARDIAC TAMPONADE (7)
                                                                                      • Slide 100
                                                                                      • HYPERTENSION
                                                                                      • HYPERTENSION (2)
                                                                                      • Slide 103
                                                                                      • Slide 104
                                                                                      • Slide 105
                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                      • Buergerrsquos Disease
                                                                                      • Slide 108
                                                                                      • Manifestations
                                                                                      • Slide 110
                                                                                      • Diagnosis amp Treatment
                                                                                      • Rynaudrsquos Disease
                                                                                      • Manifestations (2)
                                                                                      • Slide 114
                                                                                      • Diagnosis amp Treatment (2)
                                                                                      • Slide 116
                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                      • Slide 118
                                                                                      • Slide 119
                                                                                      • Slide 120
                                                                                      • Slide 121

                                                                                        ASSESSMENTbull Objective data

                                                                                        bull VSbull BP decreasing systolic

                                                                                        narrowing pulse pressurebull Pulse pulsus alternans

                                                                                        (alternating strong-weak-strong cardiac contraction) increased

                                                                                        bull Respirations crackles Cheyne-Stokes

                                                                                        bull Edema dependent pitting (1+ to 4+ mm)

                                                                                        bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart

                                                                                        dilated pulmonary vessels lung edema

                                                                                        Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                        LEFT VENTRICULAR

                                                                                        FAILURE

                                                                                        RIGHT VENTRICULAR

                                                                                        FAILURE

                                                                                        Pulmonary crackles Jugular venous distention

                                                                                        Tachypnea Peripheral edema

                                                                                        S3 gallop Perioral and peripheral cyanosis

                                                                                        Cardiac murmurs Congestive hepatomegaly

                                                                                        Paradoxical splitting of S2

                                                                                        Ascites

                                                                                        Hepatojugular reflux

                                                                                        ANALYSIS NURSING DIAGNOSES

                                                                                        bull Decreased cardiac output related to decreased myocardial contractility

                                                                                        bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                        bull Fatigue related to edema and poor oxygenation

                                                                                        bull Fluid volume excess related to compensatory mechanisms

                                                                                        bull Impaired gas exchange related to pulmonary congestion

                                                                                        bull Anxiety related to shortness of breath

                                                                                        bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                        NURSING CARE PLAN

                                                                                        bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                        tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                        bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                        bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                        bull Warm fluids if appropriate

                                                                                        NURSING CARE PLAN

                                                                                        bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                        deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                        bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                        bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                        NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                        needsbull Skin care

                                                                                        bull Inspect massage lubricate bony prominences

                                                                                        bull Use foot cradle heel protectors sheepskin

                                                                                        bull Side rails up if hypoxic (disoriented)

                                                                                        bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                        bull ROM active passive elastic stockings

                                                                                        NURSING CARE PLAN

                                                                                        bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                        loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                        bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                        strict IObull Diet

                                                                                        bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                        NURSING CARE PLAN

                                                                                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                        EVALUATION

                                                                                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                        distressbull Reduction in dependent edema

                                                                                        DAY 3 OF

                                                                                        CARDIOVASCULARDISEASES

                                                                                        bull hyperlipidemia means high lipid levels

                                                                                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                        Treatment of Hyperlipidemia

                                                                                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                        bull SYSTOLIC DYSFUNCTION

                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                        bull Pathophysiologybull 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

                                                                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                        CARDIOMYOPATHIES

                                                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                        CARDIOMYOPATHIES

                                                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                        CARDIOMYOPATHIES

                                                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                        relief

                                                                                        CARDIOMYOPATHIES

                                                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                        CARDIOMYOPATHIES

                                                                                        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

                                                                                        Infective endocarditis

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

                                                                                        bull Can be acute or chronic

                                                                                        Infective endocarditis

                                                                                        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

                                                                                        Infective endocarditis

                                                                                        bull Pathophysiologybull 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

                                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                        Infective endocarditis

                                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                        retina

                                                                                        Infective endocarditis

                                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                        Infective endocarditis

                                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                        Infective endocarditis

                                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                        organism

                                                                                        Infective endocarditis

                                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                        Infective endocarditis

                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                        B

                                                                                        Infective endocarditis

                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                        CARDIOGENIC SHOCK

                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                        CARDIOGENIC SHOCK

                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                        CARDIOGENIC SHOCK

                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                        Normal is 4-10 cmH2O

                                                                                        CARDIOGENIC SHOCK

                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                        CARDIOGENIC SHOCK

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

                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                        CARDIAC TAMPONADE

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

                                                                                        CARDIAC TAMPONADE

                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                        CARDIAC TAMPONADE

                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                        CARDIAC TAMPONADE

                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                        distention hypotension and distantmuffled heart sound

                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                        CARDIAC TAMPONADE

                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                        anterior chest

                                                                                        CARDIAC TAMPONADE

                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                        CARDIAC TAMPONADE

                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                        tamponade

                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                        HYPERTENSION

                                                                                        bull 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

                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                        bull Most common typebull 2 Secondary

                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                        Buergerrsquos Disease

                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                        reaction of the vessel wall

                                                                                        Manifestations

                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                        Absentdiminished peripheral pulses

                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                        Diagnosis amp Treatment

                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                        (rare occasions)

                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                        A Assessment

                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                        2 vsB Nursing Dx

                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                        2 Impaired gas exchange

                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                        C Goals

                                                                                        1 Relief of pain amp symptoms

                                                                                        2 Prevention of further cardiac damage

                                                                                        D Nursing Interventions

                                                                                        1 Pain control

                                                                                        2 Proper medications

                                                                                        3 Decrease clientrsquos anxiety

                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                        • CARDIOVASCULAR DISEASES
                                                                                        • Slide 2
                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                        • Pathophysiology
                                                                                        • Slide 5
                                                                                        • ASSESSING CHEST PAIN
                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                        • Pathophysiology
                                                                                        • Types
                                                                                        • Slide 12
                                                                                        • Slide 13
                                                                                        • Slide 14
                                                                                        • Conthellip
                                                                                        • Conthellip (2)
                                                                                        • Drug Therapy
                                                                                        • Classification
                                                                                        • Nursing Management
                                                                                        • Nursing Management (2)
                                                                                        • Acute Coronary Syndrome
                                                                                        • Slide 22
                                                                                        • Conthellip (3)
                                                                                        • Slide 24
                                                                                        • Conthellip(MI)
                                                                                        • Slide 26
                                                                                        • Pathophysiology (2)
                                                                                        • Tissue Changes After MI
                                                                                        • Management of MI
                                                                                        • Slide 30
                                                                                        • Slide 31
                                                                                        • ASSESSMENT
                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                        • NURSING CARE PLAN
                                                                                        • NURSING CARE PLAN (2)
                                                                                        • NURSING CARE PLAN (3)
                                                                                        • NURSING CARE PLAN (4)
                                                                                        • NURSING CARE PLAN (5)
                                                                                        • NURSING CARE PLAN (6)
                                                                                        • NURSING CARE PLAN (7)
                                                                                        • NURSING CARE PLAN (8)
                                                                                        • EVALUATION
                                                                                        • CONGESTIVE HEART FAILURE
                                                                                        • PATHOPHYSIOLOGY
                                                                                        • ASSESSMENT (2)
                                                                                        • ASSESSMENT (3)
                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                        • Slide 49
                                                                                        • NURSING CARE PLAN (9)
                                                                                        • NURSING CARE PLAN (10)
                                                                                        • NURSING CARE PLAN (11)
                                                                                        • NURSING CARE PLAN (12)
                                                                                        • NURSING CARE PLAN (13)
                                                                                        • EVALUATION
                                                                                        • Slide 56
                                                                                        • Slide 57
                                                                                        • Slide 58
                                                                                        • Slide 59
                                                                                        • Slide 60
                                                                                        • Treatment of Hyperlipidemia
                                                                                        • Slide 62
                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                        • CARDIOMYOPATHIES
                                                                                        • CARDIOMYOPATHIES (2)
                                                                                        • CARDIOMYOPATHIES (3)
                                                                                        • CARDIOMYOPATHIES (4)
                                                                                        • CARDIOMYOPATHIES (5)
                                                                                        • CARDIOMYOPATHIES (6)
                                                                                        • Infective endocarditis
                                                                                        • Infective endocarditis (2)
                                                                                        • Infective endocarditis (3)
                                                                                        • Infective endocarditis (4)
                                                                                        • Infective endocarditis (5)
                                                                                        • Infective endocarditis (6)
                                                                                        • Infective endocarditis (7)
                                                                                        • Infective endocarditis (8)
                                                                                        • Infective endocarditis (9)
                                                                                        • Infective endocarditis (10)
                                                                                        • Infective endocarditis (11)
                                                                                        • Infective endocarditis (12)
                                                                                        • CARDIOGENIC SHOCK
                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                        • CARDIAC TAMPONADE
                                                                                        • CARDIAC TAMPONADE (2)
                                                                                        • CARDIAC TAMPONADE (3)
                                                                                        • CARDIAC TAMPONADE (4)
                                                                                        • CARDIAC TAMPONADE (5)
                                                                                        • CARDIAC TAMPONADE (6)
                                                                                        • CARDIAC TAMPONADE (7)
                                                                                        • Slide 100
                                                                                        • HYPERTENSION
                                                                                        • HYPERTENSION (2)
                                                                                        • Slide 103
                                                                                        • Slide 104
                                                                                        • Slide 105
                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                        • Buergerrsquos Disease
                                                                                        • Slide 108
                                                                                        • Manifestations
                                                                                        • Slide 110
                                                                                        • Diagnosis amp Treatment
                                                                                        • Rynaudrsquos Disease
                                                                                        • Manifestations (2)
                                                                                        • Slide 114
                                                                                        • Diagnosis amp Treatment (2)
                                                                                        • Slide 116
                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                        • Slide 118
                                                                                        • Slide 119
                                                                                        • Slide 120
                                                                                        • Slide 121

                                                                                          Left Ventricular Compared with Right Ventricular Heart Failure

                                                                                          LEFT VENTRICULAR

                                                                                          FAILURE

                                                                                          RIGHT VENTRICULAR

                                                                                          FAILURE

                                                                                          Pulmonary crackles Jugular venous distention

                                                                                          Tachypnea Peripheral edema

                                                                                          S3 gallop Perioral and peripheral cyanosis

                                                                                          Cardiac murmurs Congestive hepatomegaly

                                                                                          Paradoxical splitting of S2

                                                                                          Ascites

                                                                                          Hepatojugular reflux

                                                                                          ANALYSIS NURSING DIAGNOSES

                                                                                          bull Decreased cardiac output related to decreased myocardial contractility

                                                                                          bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                          bull Fatigue related to edema and poor oxygenation

                                                                                          bull Fluid volume excess related to compensatory mechanisms

                                                                                          bull Impaired gas exchange related to pulmonary congestion

                                                                                          bull Anxiety related to shortness of breath

                                                                                          bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                          NURSING CARE PLAN

                                                                                          bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                          tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                          bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                          bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                          bull Warm fluids if appropriate

                                                                                          NURSING CARE PLAN

                                                                                          bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                          deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                          bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                          bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                          NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                          needsbull Skin care

                                                                                          bull Inspect massage lubricate bony prominences

                                                                                          bull Use foot cradle heel protectors sheepskin

                                                                                          bull Side rails up if hypoxic (disoriented)

                                                                                          bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                          bull ROM active passive elastic stockings

                                                                                          NURSING CARE PLAN

                                                                                          bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                          loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                          bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                          strict IObull Diet

                                                                                          bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                          NURSING CARE PLAN

                                                                                          bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                          morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                          bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                          EVALUATION

                                                                                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                          distressbull Reduction in dependent edema

                                                                                          DAY 3 OF

                                                                                          CARDIOVASCULARDISEASES

                                                                                          bull hyperlipidemia means high lipid levels

                                                                                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                          Treatment of Hyperlipidemia

                                                                                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                          bull SYSTOLIC DYSFUNCTION

                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                          bull Pathophysiologybull 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

                                                                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                          CARDIOMYOPATHIES

                                                                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                          CARDIOMYOPATHIES

                                                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                          CARDIOMYOPATHIES

                                                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                          relief

                                                                                          CARDIOMYOPATHIES

                                                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                          CARDIOMYOPATHIES

                                                                                          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

                                                                                          Infective endocarditis

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

                                                                                          bull Can be acute or chronic

                                                                                          Infective endocarditis

                                                                                          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

                                                                                          Infective endocarditis

                                                                                          bull Pathophysiologybull 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

                                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                          Infective endocarditis

                                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                          retina

                                                                                          Infective endocarditis

                                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                          Infective endocarditis

                                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                          Infective endocarditis

                                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                          organism

                                                                                          Infective endocarditis

                                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                          Infective endocarditis

                                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                          B

                                                                                          Infective endocarditis

                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                          CARDIOGENIC SHOCK

                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                          CARDIOGENIC SHOCK

                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                          CARDIOGENIC SHOCK

                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                          Normal is 4-10 cmH2O

                                                                                          CARDIOGENIC SHOCK

                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                          CARDIOGENIC SHOCK

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

                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                          CARDIAC TAMPONADE

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

                                                                                          CARDIAC TAMPONADE

                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                          CARDIAC TAMPONADE

                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                          CARDIAC TAMPONADE

                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                          distention hypotension and distantmuffled heart sound

                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                          CARDIAC TAMPONADE

                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                          anterior chest

                                                                                          CARDIAC TAMPONADE

                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                          CARDIAC TAMPONADE

                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                          tamponade

                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                          HYPERTENSION

                                                                                          bull 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

                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                          bull Most common typebull 2 Secondary

                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                          Buergerrsquos Disease

                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                          reaction of the vessel wall

                                                                                          Manifestations

                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                          Absentdiminished peripheral pulses

                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                          Diagnosis amp Treatment

                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                          (rare occasions)

                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                          A Assessment

                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                          2 vsB Nursing Dx

                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                          2 Impaired gas exchange

                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                          C Goals

                                                                                          1 Relief of pain amp symptoms

                                                                                          2 Prevention of further cardiac damage

                                                                                          D Nursing Interventions

                                                                                          1 Pain control

                                                                                          2 Proper medications

                                                                                          3 Decrease clientrsquos anxiety

                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                          • CARDIOVASCULAR DISEASES
                                                                                          • Slide 2
                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                          • Pathophysiology
                                                                                          • Slide 5
                                                                                          • ASSESSING CHEST PAIN
                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                          • Pathophysiology
                                                                                          • Types
                                                                                          • Slide 12
                                                                                          • Slide 13
                                                                                          • Slide 14
                                                                                          • Conthellip
                                                                                          • Conthellip (2)
                                                                                          • Drug Therapy
                                                                                          • Classification
                                                                                          • Nursing Management
                                                                                          • Nursing Management (2)
                                                                                          • Acute Coronary Syndrome
                                                                                          • Slide 22
                                                                                          • Conthellip (3)
                                                                                          • Slide 24
                                                                                          • Conthellip(MI)
                                                                                          • Slide 26
                                                                                          • Pathophysiology (2)
                                                                                          • Tissue Changes After MI
                                                                                          • Management of MI
                                                                                          • Slide 30
                                                                                          • Slide 31
                                                                                          • ASSESSMENT
                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                          • NURSING CARE PLAN
                                                                                          • NURSING CARE PLAN (2)
                                                                                          • NURSING CARE PLAN (3)
                                                                                          • NURSING CARE PLAN (4)
                                                                                          • NURSING CARE PLAN (5)
                                                                                          • NURSING CARE PLAN (6)
                                                                                          • NURSING CARE PLAN (7)
                                                                                          • NURSING CARE PLAN (8)
                                                                                          • EVALUATION
                                                                                          • CONGESTIVE HEART FAILURE
                                                                                          • PATHOPHYSIOLOGY
                                                                                          • ASSESSMENT (2)
                                                                                          • ASSESSMENT (3)
                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                          • Slide 49
                                                                                          • NURSING CARE PLAN (9)
                                                                                          • NURSING CARE PLAN (10)
                                                                                          • NURSING CARE PLAN (11)
                                                                                          • NURSING CARE PLAN (12)
                                                                                          • NURSING CARE PLAN (13)
                                                                                          • EVALUATION
                                                                                          • Slide 56
                                                                                          • Slide 57
                                                                                          • Slide 58
                                                                                          • Slide 59
                                                                                          • Slide 60
                                                                                          • Treatment of Hyperlipidemia
                                                                                          • Slide 62
                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                          • CARDIOMYOPATHIES
                                                                                          • CARDIOMYOPATHIES (2)
                                                                                          • CARDIOMYOPATHIES (3)
                                                                                          • CARDIOMYOPATHIES (4)
                                                                                          • CARDIOMYOPATHIES (5)
                                                                                          • CARDIOMYOPATHIES (6)
                                                                                          • Infective endocarditis
                                                                                          • Infective endocarditis (2)
                                                                                          • Infective endocarditis (3)
                                                                                          • Infective endocarditis (4)
                                                                                          • Infective endocarditis (5)
                                                                                          • Infective endocarditis (6)
                                                                                          • Infective endocarditis (7)
                                                                                          • Infective endocarditis (8)
                                                                                          • Infective endocarditis (9)
                                                                                          • Infective endocarditis (10)
                                                                                          • Infective endocarditis (11)
                                                                                          • Infective endocarditis (12)
                                                                                          • CARDIOGENIC SHOCK
                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                          • CARDIAC TAMPONADE
                                                                                          • CARDIAC TAMPONADE (2)
                                                                                          • CARDIAC TAMPONADE (3)
                                                                                          • CARDIAC TAMPONADE (4)
                                                                                          • CARDIAC TAMPONADE (5)
                                                                                          • CARDIAC TAMPONADE (6)
                                                                                          • CARDIAC TAMPONADE (7)
                                                                                          • Slide 100
                                                                                          • HYPERTENSION
                                                                                          • HYPERTENSION (2)
                                                                                          • Slide 103
                                                                                          • Slide 104
                                                                                          • Slide 105
                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                          • Buergerrsquos Disease
                                                                                          • Slide 108
                                                                                          • Manifestations
                                                                                          • Slide 110
                                                                                          • Diagnosis amp Treatment
                                                                                          • Rynaudrsquos Disease
                                                                                          • Manifestations (2)
                                                                                          • Slide 114
                                                                                          • Diagnosis amp Treatment (2)
                                                                                          • Slide 116
                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                          • Slide 118
                                                                                          • Slide 119
                                                                                          • Slide 120
                                                                                          • Slide 121

                                                                                            ANALYSIS NURSING DIAGNOSES

                                                                                            bull Decreased cardiac output related to decreased myocardial contractility

                                                                                            bull Activity intolerance related to generalized body weakness and inadequate oxygenation

                                                                                            bull Fatigue related to edema and poor oxygenation

                                                                                            bull Fluid volume excess related to compensatory mechanisms

                                                                                            bull Impaired gas exchange related to pulmonary congestion

                                                                                            bull Anxiety related to shortness of breath

                                                                                            bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                            NURSING CARE PLAN

                                                                                            bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                            tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                            bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                            bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                            bull Warm fluids if appropriate

                                                                                            NURSING CARE PLAN

                                                                                            bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                            deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                            bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                            bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                            NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                            needsbull Skin care

                                                                                            bull Inspect massage lubricate bony prominences

                                                                                            bull Use foot cradle heel protectors sheepskin

                                                                                            bull Side rails up if hypoxic (disoriented)

                                                                                            bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                            bull ROM active passive elastic stockings

                                                                                            NURSING CARE PLAN

                                                                                            bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                            loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                            bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                            strict IObull Diet

                                                                                            bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                            NURSING CARE PLAN

                                                                                            bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                            morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                            bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                            EVALUATION

                                                                                            bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                            distressbull Reduction in dependent edema

                                                                                            DAY 3 OF

                                                                                            CARDIOVASCULARDISEASES

                                                                                            bull hyperlipidemia means high lipid levels

                                                                                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                            Treatment of Hyperlipidemia

                                                                                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                            bull SYSTOLIC DYSFUNCTION

                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                            bull Pathophysiologybull 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

                                                                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                            CARDIOMYOPATHIES

                                                                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                            CARDIOMYOPATHIES

                                                                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                            CARDIOMYOPATHIES

                                                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                            relief

                                                                                            CARDIOMYOPATHIES

                                                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                            CARDIOMYOPATHIES

                                                                                            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

                                                                                            Infective endocarditis

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

                                                                                            bull Can be acute or chronic

                                                                                            Infective endocarditis

                                                                                            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

                                                                                            Infective endocarditis

                                                                                            bull Pathophysiologybull 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

                                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                            Infective endocarditis

                                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                            retina

                                                                                            Infective endocarditis

                                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                            Infective endocarditis

                                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                            Infective endocarditis

                                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                            organism

                                                                                            Infective endocarditis

                                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                            Infective endocarditis

                                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                            B

                                                                                            Infective endocarditis

                                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                            CARDIOGENIC SHOCK

                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                            CARDIOGENIC SHOCK

                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                            CARDIOGENIC SHOCK

                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                            Normal is 4-10 cmH2O

                                                                                            CARDIOGENIC SHOCK

                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                            CARDIOGENIC SHOCK

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

                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                            CARDIAC TAMPONADE

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

                                                                                            CARDIAC TAMPONADE

                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                            CARDIAC TAMPONADE

                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                            CARDIAC TAMPONADE

                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                            distention hypotension and distantmuffled heart sound

                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                            CARDIAC TAMPONADE

                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                            anterior chest

                                                                                            CARDIAC TAMPONADE

                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                            CARDIAC TAMPONADE

                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                            tamponade

                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                            HYPERTENSION

                                                                                            bull 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

                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                            bull Most common typebull 2 Secondary

                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                            Buergerrsquos Disease

                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                            reaction of the vessel wall

                                                                                            Manifestations

                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                            Absentdiminished peripheral pulses

                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                            Diagnosis amp Treatment

                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                            (rare occasions)

                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                            A Assessment

                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                            2 vsB Nursing Dx

                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                            2 Impaired gas exchange

                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                            C Goals

                                                                                            1 Relief of pain amp symptoms

                                                                                            2 Prevention of further cardiac damage

                                                                                            D Nursing Interventions

                                                                                            1 Pain control

                                                                                            2 Proper medications

                                                                                            3 Decrease clientrsquos anxiety

                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                            • CARDIOVASCULAR DISEASES
                                                                                            • Slide 2
                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                            • Pathophysiology
                                                                                            • Slide 5
                                                                                            • ASSESSING CHEST PAIN
                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                            • Pathophysiology
                                                                                            • Types
                                                                                            • Slide 12
                                                                                            • Slide 13
                                                                                            • Slide 14
                                                                                            • Conthellip
                                                                                            • Conthellip (2)
                                                                                            • Drug Therapy
                                                                                            • Classification
                                                                                            • Nursing Management
                                                                                            • Nursing Management (2)
                                                                                            • Acute Coronary Syndrome
                                                                                            • Slide 22
                                                                                            • Conthellip (3)
                                                                                            • Slide 24
                                                                                            • Conthellip(MI)
                                                                                            • Slide 26
                                                                                            • Pathophysiology (2)
                                                                                            • Tissue Changes After MI
                                                                                            • Management of MI
                                                                                            • Slide 30
                                                                                            • Slide 31
                                                                                            • ASSESSMENT
                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                            • NURSING CARE PLAN
                                                                                            • NURSING CARE PLAN (2)
                                                                                            • NURSING CARE PLAN (3)
                                                                                            • NURSING CARE PLAN (4)
                                                                                            • NURSING CARE PLAN (5)
                                                                                            • NURSING CARE PLAN (6)
                                                                                            • NURSING CARE PLAN (7)
                                                                                            • NURSING CARE PLAN (8)
                                                                                            • EVALUATION
                                                                                            • CONGESTIVE HEART FAILURE
                                                                                            • PATHOPHYSIOLOGY
                                                                                            • ASSESSMENT (2)
                                                                                            • ASSESSMENT (3)
                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                            • Slide 49
                                                                                            • NURSING CARE PLAN (9)
                                                                                            • NURSING CARE PLAN (10)
                                                                                            • NURSING CARE PLAN (11)
                                                                                            • NURSING CARE PLAN (12)
                                                                                            • NURSING CARE PLAN (13)
                                                                                            • EVALUATION
                                                                                            • Slide 56
                                                                                            • Slide 57
                                                                                            • Slide 58
                                                                                            • Slide 59
                                                                                            • Slide 60
                                                                                            • Treatment of Hyperlipidemia
                                                                                            • Slide 62
                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                            • CARDIOMYOPATHIES
                                                                                            • CARDIOMYOPATHIES (2)
                                                                                            • CARDIOMYOPATHIES (3)
                                                                                            • CARDIOMYOPATHIES (4)
                                                                                            • CARDIOMYOPATHIES (5)
                                                                                            • CARDIOMYOPATHIES (6)
                                                                                            • Infective endocarditis
                                                                                            • Infective endocarditis (2)
                                                                                            • Infective endocarditis (3)
                                                                                            • Infective endocarditis (4)
                                                                                            • Infective endocarditis (5)
                                                                                            • Infective endocarditis (6)
                                                                                            • Infective endocarditis (7)
                                                                                            • Infective endocarditis (8)
                                                                                            • Infective endocarditis (9)
                                                                                            • Infective endocarditis (10)
                                                                                            • Infective endocarditis (11)
                                                                                            • Infective endocarditis (12)
                                                                                            • CARDIOGENIC SHOCK
                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                            • CARDIAC TAMPONADE
                                                                                            • CARDIAC TAMPONADE (2)
                                                                                            • CARDIAC TAMPONADE (3)
                                                                                            • CARDIAC TAMPONADE (4)
                                                                                            • CARDIAC TAMPONADE (5)
                                                                                            • CARDIAC TAMPONADE (6)
                                                                                            • CARDIAC TAMPONADE (7)
                                                                                            • Slide 100
                                                                                            • HYPERTENSION
                                                                                            • HYPERTENSION (2)
                                                                                            • Slide 103
                                                                                            • Slide 104
                                                                                            • Slide 105
                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                            • Buergerrsquos Disease
                                                                                            • Slide 108
                                                                                            • Manifestations
                                                                                            • Slide 110
                                                                                            • Diagnosis amp Treatment
                                                                                            • Rynaudrsquos Disease
                                                                                            • Manifestations (2)
                                                                                            • Slide 114
                                                                                            • Diagnosis amp Treatment (2)
                                                                                            • Slide 116
                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                            • Slide 118
                                                                                            • Slide 119
                                                                                            • Slide 120
                                                                                            • Slide 121

                                                                                              bull Fluid volume excess related to compensatory mechanisms

                                                                                              bull Impaired gas exchange related to pulmonary congestion

                                                                                              bull Anxiety related to shortness of breath

                                                                                              bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance

                                                                                              NURSING CARE PLAN

                                                                                              bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                              tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                              bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                              bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                              bull Warm fluids if appropriate

                                                                                              NURSING CARE PLAN

                                                                                              bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                              deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                              bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                              bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                              NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                              needsbull Skin care

                                                                                              bull Inspect massage lubricate bony prominences

                                                                                              bull Use foot cradle heel protectors sheepskin

                                                                                              bull Side rails up if hypoxic (disoriented)

                                                                                              bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                              bull ROM active passive elastic stockings

                                                                                              NURSING CARE PLAN

                                                                                              bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                              loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                              bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                              strict IObull Diet

                                                                                              bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                              NURSING CARE PLAN

                                                                                              bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                              morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                              bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                              EVALUATION

                                                                                              bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                              distressbull Reduction in dependent edema

                                                                                              DAY 3 OF

                                                                                              CARDIOVASCULARDISEASES

                                                                                              bull hyperlipidemia means high lipid levels

                                                                                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                              Treatment of Hyperlipidemia

                                                                                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                              bull SYSTOLIC DYSFUNCTION

                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                              bull Pathophysiologybull 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

                                                                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                              CARDIOMYOPATHIES

                                                                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                              CARDIOMYOPATHIES

                                                                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                              CARDIOMYOPATHIES

                                                                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                              relief

                                                                                              CARDIOMYOPATHIES

                                                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                              CARDIOMYOPATHIES

                                                                                              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

                                                                                              Infective endocarditis

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

                                                                                              bull Can be acute or chronic

                                                                                              Infective endocarditis

                                                                                              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

                                                                                              Infective endocarditis

                                                                                              bull Pathophysiologybull 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

                                                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                              Infective endocarditis

                                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                              retina

                                                                                              Infective endocarditis

                                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                              Infective endocarditis

                                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                              Infective endocarditis

                                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                              organism

                                                                                              Infective endocarditis

                                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                              Infective endocarditis

                                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                              B

                                                                                              Infective endocarditis

                                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                              CARDIOGENIC SHOCK

                                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                              CARDIOGENIC SHOCK

                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                              CARDIOGENIC SHOCK

                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                              Normal is 4-10 cmH2O

                                                                                              CARDIOGENIC SHOCK

                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                              CARDIOGENIC SHOCK

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

                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                              CARDIAC TAMPONADE

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

                                                                                              CARDIAC TAMPONADE

                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                              CARDIAC TAMPONADE

                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                              CARDIAC TAMPONADE

                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                              distention hypotension and distantmuffled heart sound

                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                              CARDIAC TAMPONADE

                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                              anterior chest

                                                                                              CARDIAC TAMPONADE

                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                              CARDIAC TAMPONADE

                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                              tamponade

                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                              HYPERTENSION

                                                                                              bull 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

                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                              bull Most common typebull 2 Secondary

                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                              Buergerrsquos Disease

                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                              reaction of the vessel wall

                                                                                              Manifestations

                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                              Absentdiminished peripheral pulses

                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                              Diagnosis amp Treatment

                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                              (rare occasions)

                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                              A Assessment

                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                              2 vsB Nursing Dx

                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                              2 Impaired gas exchange

                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                              C Goals

                                                                                              1 Relief of pain amp symptoms

                                                                                              2 Prevention of further cardiac damage

                                                                                              D Nursing Interventions

                                                                                              1 Pain control

                                                                                              2 Proper medications

                                                                                              3 Decrease clientrsquos anxiety

                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                              • CARDIOVASCULAR DISEASES
                                                                                              • Slide 2
                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                              • Pathophysiology
                                                                                              • Slide 5
                                                                                              • ASSESSING CHEST PAIN
                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                              • Pathophysiology
                                                                                              • Types
                                                                                              • Slide 12
                                                                                              • Slide 13
                                                                                              • Slide 14
                                                                                              • Conthellip
                                                                                              • Conthellip (2)
                                                                                              • Drug Therapy
                                                                                              • Classification
                                                                                              • Nursing Management
                                                                                              • Nursing Management (2)
                                                                                              • Acute Coronary Syndrome
                                                                                              • Slide 22
                                                                                              • Conthellip (3)
                                                                                              • Slide 24
                                                                                              • Conthellip(MI)
                                                                                              • Slide 26
                                                                                              • Pathophysiology (2)
                                                                                              • Tissue Changes After MI
                                                                                              • Management of MI
                                                                                              • Slide 30
                                                                                              • Slide 31
                                                                                              • ASSESSMENT
                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                              • NURSING CARE PLAN
                                                                                              • NURSING CARE PLAN (2)
                                                                                              • NURSING CARE PLAN (3)
                                                                                              • NURSING CARE PLAN (4)
                                                                                              • NURSING CARE PLAN (5)
                                                                                              • NURSING CARE PLAN (6)
                                                                                              • NURSING CARE PLAN (7)
                                                                                              • NURSING CARE PLAN (8)
                                                                                              • EVALUATION
                                                                                              • CONGESTIVE HEART FAILURE
                                                                                              • PATHOPHYSIOLOGY
                                                                                              • ASSESSMENT (2)
                                                                                              • ASSESSMENT (3)
                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                              • Slide 49
                                                                                              • NURSING CARE PLAN (9)
                                                                                              • NURSING CARE PLAN (10)
                                                                                              • NURSING CARE PLAN (11)
                                                                                              • NURSING CARE PLAN (12)
                                                                                              • NURSING CARE PLAN (13)
                                                                                              • EVALUATION
                                                                                              • Slide 56
                                                                                              • Slide 57
                                                                                              • Slide 58
                                                                                              • Slide 59
                                                                                              • Slide 60
                                                                                              • Treatment of Hyperlipidemia
                                                                                              • Slide 62
                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                              • CARDIOMYOPATHIES
                                                                                              • CARDIOMYOPATHIES (2)
                                                                                              • CARDIOMYOPATHIES (3)
                                                                                              • CARDIOMYOPATHIES (4)
                                                                                              • CARDIOMYOPATHIES (5)
                                                                                              • CARDIOMYOPATHIES (6)
                                                                                              • Infective endocarditis
                                                                                              • Infective endocarditis (2)
                                                                                              • Infective endocarditis (3)
                                                                                              • Infective endocarditis (4)
                                                                                              • Infective endocarditis (5)
                                                                                              • Infective endocarditis (6)
                                                                                              • Infective endocarditis (7)
                                                                                              • Infective endocarditis (8)
                                                                                              • Infective endocarditis (9)
                                                                                              • Infective endocarditis (10)
                                                                                              • Infective endocarditis (11)
                                                                                              • Infective endocarditis (12)
                                                                                              • CARDIOGENIC SHOCK
                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                              • CARDIAC TAMPONADE
                                                                                              • CARDIAC TAMPONADE (2)
                                                                                              • CARDIAC TAMPONADE (3)
                                                                                              • CARDIAC TAMPONADE (4)
                                                                                              • CARDIAC TAMPONADE (5)
                                                                                              • CARDIAC TAMPONADE (6)
                                                                                              • CARDIAC TAMPONADE (7)
                                                                                              • Slide 100
                                                                                              • HYPERTENSION
                                                                                              • HYPERTENSION (2)
                                                                                              • Slide 103
                                                                                              • Slide 104
                                                                                              • Slide 105
                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                              • Buergerrsquos Disease
                                                                                              • Slide 108
                                                                                              • Manifestations
                                                                                              • Slide 110
                                                                                              • Diagnosis amp Treatment
                                                                                              • Rynaudrsquos Disease
                                                                                              • Manifestations (2)
                                                                                              • Slide 114
                                                                                              • Diagnosis amp Treatment (2)
                                                                                              • Slide 116
                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                              • Slide 118
                                                                                              • Slide 119
                                                                                              • Slide 120
                                                                                              • Slide 121

                                                                                                NURSING CARE PLAN

                                                                                                bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until

                                                                                                tachycardia dyspnea edema resolved change position frequently pillows for support

                                                                                                bull Rest planned periods limit visitors activity noise Chair and commode privileges

                                                                                                bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered

                                                                                                bull Warm fluids if appropriate

                                                                                                NURSING CARE PLAN

                                                                                                bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                                deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                                bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                                bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                                NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                                needsbull Skin care

                                                                                                bull Inspect massage lubricate bony prominences

                                                                                                bull Use foot cradle heel protectors sheepskin

                                                                                                bull Side rails up if hypoxic (disoriented)

                                                                                                bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                                bull ROM active passive elastic stockings

                                                                                                NURSING CARE PLAN

                                                                                                bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                                loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                                bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                                strict IObull Diet

                                                                                                bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                                NURSING CARE PLAN

                                                                                                bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                                morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                                bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                                EVALUATION

                                                                                                bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                distressbull Reduction in dependent edema

                                                                                                DAY 3 OF

                                                                                                CARDIOVASCULARDISEASES

                                                                                                bull hyperlipidemia means high lipid levels

                                                                                                bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                Treatment of Hyperlipidemia

                                                                                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                bull SYSTOLIC DYSFUNCTION

                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                bull Pathophysiologybull 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

                                                                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                CARDIOMYOPATHIES

                                                                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                CARDIOMYOPATHIES

                                                                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                CARDIOMYOPATHIES

                                                                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                relief

                                                                                                CARDIOMYOPATHIES

                                                                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                CARDIOMYOPATHIES

                                                                                                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

                                                                                                Infective endocarditis

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

                                                                                                bull Can be acute or chronic

                                                                                                Infective endocarditis

                                                                                                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

                                                                                                Infective endocarditis

                                                                                                bull Pathophysiologybull 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

                                                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                Infective endocarditis

                                                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                retina

                                                                                                Infective endocarditis

                                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                Infective endocarditis

                                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                Infective endocarditis

                                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                organism

                                                                                                Infective endocarditis

                                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                Infective endocarditis

                                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                B

                                                                                                Infective endocarditis

                                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                CARDIOGENIC SHOCK

                                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                CARDIOGENIC SHOCK

                                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                CARDIOGENIC SHOCK

                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                Normal is 4-10 cmH2O

                                                                                                CARDIOGENIC SHOCK

                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                CARDIOGENIC SHOCK

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

                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                CARDIAC TAMPONADE

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

                                                                                                CARDIAC TAMPONADE

                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                CARDIAC TAMPONADE

                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                CARDIAC TAMPONADE

                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                CARDIAC TAMPONADE

                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                anterior chest

                                                                                                CARDIAC TAMPONADE

                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                CARDIAC TAMPONADE

                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                tamponade

                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                HYPERTENSION

                                                                                                bull 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

                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                bull Most common typebull 2 Secondary

                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                Buergerrsquos Disease

                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                reaction of the vessel wall

                                                                                                Manifestations

                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                Absentdiminished peripheral pulses

                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                Diagnosis amp Treatment

                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                (rare occasions)

                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                A Assessment

                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                2 vsB Nursing Dx

                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                2 Impaired gas exchange

                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                C Goals

                                                                                                1 Relief of pain amp symptoms

                                                                                                2 Prevention of further cardiac damage

                                                                                                D Nursing Interventions

                                                                                                1 Pain control

                                                                                                2 Proper medications

                                                                                                3 Decrease clientrsquos anxiety

                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                • Slide 2
                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                • Pathophysiology
                                                                                                • Slide 5
                                                                                                • ASSESSING CHEST PAIN
                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                • Pathophysiology
                                                                                                • Types
                                                                                                • Slide 12
                                                                                                • Slide 13
                                                                                                • Slide 14
                                                                                                • Conthellip
                                                                                                • Conthellip (2)
                                                                                                • Drug Therapy
                                                                                                • Classification
                                                                                                • Nursing Management
                                                                                                • Nursing Management (2)
                                                                                                • Acute Coronary Syndrome
                                                                                                • Slide 22
                                                                                                • Conthellip (3)
                                                                                                • Slide 24
                                                                                                • Conthellip(MI)
                                                                                                • Slide 26
                                                                                                • Pathophysiology (2)
                                                                                                • Tissue Changes After MI
                                                                                                • Management of MI
                                                                                                • Slide 30
                                                                                                • Slide 31
                                                                                                • ASSESSMENT
                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                • NURSING CARE PLAN
                                                                                                • NURSING CARE PLAN (2)
                                                                                                • NURSING CARE PLAN (3)
                                                                                                • NURSING CARE PLAN (4)
                                                                                                • NURSING CARE PLAN (5)
                                                                                                • NURSING CARE PLAN (6)
                                                                                                • NURSING CARE PLAN (7)
                                                                                                • NURSING CARE PLAN (8)
                                                                                                • EVALUATION
                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                • PATHOPHYSIOLOGY
                                                                                                • ASSESSMENT (2)
                                                                                                • ASSESSMENT (3)
                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                • Slide 49
                                                                                                • NURSING CARE PLAN (9)
                                                                                                • NURSING CARE PLAN (10)
                                                                                                • NURSING CARE PLAN (11)
                                                                                                • NURSING CARE PLAN (12)
                                                                                                • NURSING CARE PLAN (13)
                                                                                                • EVALUATION
                                                                                                • Slide 56
                                                                                                • Slide 57
                                                                                                • Slide 58
                                                                                                • Slide 59
                                                                                                • Slide 60
                                                                                                • Treatment of Hyperlipidemia
                                                                                                • Slide 62
                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                • CARDIOMYOPATHIES
                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                • Infective endocarditis
                                                                                                • Infective endocarditis (2)
                                                                                                • Infective endocarditis (3)
                                                                                                • Infective endocarditis (4)
                                                                                                • Infective endocarditis (5)
                                                                                                • Infective endocarditis (6)
                                                                                                • Infective endocarditis (7)
                                                                                                • Infective endocarditis (8)
                                                                                                • Infective endocarditis (9)
                                                                                                • Infective endocarditis (10)
                                                                                                • Infective endocarditis (11)
                                                                                                • Infective endocarditis (12)
                                                                                                • CARDIOGENIC SHOCK
                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                • CARDIAC TAMPONADE
                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                • Slide 100
                                                                                                • HYPERTENSION
                                                                                                • HYPERTENSION (2)
                                                                                                • Slide 103
                                                                                                • Slide 104
                                                                                                • Slide 105
                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                • Buergerrsquos Disease
                                                                                                • Slide 108
                                                                                                • Manifestations
                                                                                                • Slide 110
                                                                                                • Diagnosis amp Treatment
                                                                                                • Rynaudrsquos Disease
                                                                                                • Manifestations (2)
                                                                                                • Slide 114
                                                                                                • Diagnosis amp Treatment (2)
                                                                                                • Slide 116
                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                • Slide 118
                                                                                                • Slide 119
                                                                                                • Slide 120
                                                                                                • Slide 121

                                                                                                  NURSING CARE PLAN

                                                                                                  bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage

                                                                                                  deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema

                                                                                                  bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion

                                                                                                  bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators

                                                                                                  NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                                  needsbull Skin care

                                                                                                  bull Inspect massage lubricate bony prominences

                                                                                                  bull Use foot cradle heel protectors sheepskin

                                                                                                  bull Side rails up if hypoxic (disoriented)

                                                                                                  bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                                  bull ROM active passive elastic stockings

                                                                                                  NURSING CARE PLAN

                                                                                                  bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                                  loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                                  bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                                  strict IObull Diet

                                                                                                  bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                                  NURSING CARE PLAN

                                                                                                  bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                                  morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                                  bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                                  EVALUATION

                                                                                                  bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                  distressbull Reduction in dependent edema

                                                                                                  DAY 3 OF

                                                                                                  CARDIOVASCULARDISEASES

                                                                                                  bull hyperlipidemia means high lipid levels

                                                                                                  bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                  bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                  Treatment of Hyperlipidemia

                                                                                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                  bull SYSTOLIC DYSFUNCTION

                                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                                  bull Pathophysiologybull 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

                                                                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                  CARDIOMYOPATHIES

                                                                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                  CARDIOMYOPATHIES

                                                                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                  CARDIOMYOPATHIES

                                                                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                  relief

                                                                                                  CARDIOMYOPATHIES

                                                                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                  CARDIOMYOPATHIES

                                                                                                  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

                                                                                                  Infective endocarditis

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

                                                                                                  bull Can be acute or chronic

                                                                                                  Infective endocarditis

                                                                                                  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

                                                                                                  Infective endocarditis

                                                                                                  bull Pathophysiologybull 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

                                                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                  Infective endocarditis

                                                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                  retina

                                                                                                  Infective endocarditis

                                                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                  Infective endocarditis

                                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                  Infective endocarditis

                                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                  organism

                                                                                                  Infective endocarditis

                                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                  Infective endocarditis

                                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                  B

                                                                                                  Infective endocarditis

                                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                  CARDIOGENIC SHOCK

                                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                  CARDIOGENIC SHOCK

                                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                  CARDIOGENIC SHOCK

                                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                                  Normal is 4-10 cmH2O

                                                                                                  CARDIOGENIC SHOCK

                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                  CARDIAC TAMPONADE

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

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                  anterior chest

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                  CARDIAC TAMPONADE

                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                  tamponade

                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                  HYPERTENSION

                                                                                                  bull 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

                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                  bull Most common typebull 2 Secondary

                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                  Buergerrsquos Disease

                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                  reaction of the vessel wall

                                                                                                  Manifestations

                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                  Absentdiminished peripheral pulses

                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                  Diagnosis amp Treatment

                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                  (rare occasions)

                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                  A Assessment

                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                  2 vsB Nursing Dx

                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                  2 Impaired gas exchange

                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                  C Goals

                                                                                                  1 Relief of pain amp symptoms

                                                                                                  2 Prevention of further cardiac damage

                                                                                                  D Nursing Interventions

                                                                                                  1 Pain control

                                                                                                  2 Proper medications

                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                  • Slide 2
                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                  • Pathophysiology
                                                                                                  • Slide 5
                                                                                                  • ASSESSING CHEST PAIN
                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                  • Pathophysiology
                                                                                                  • Types
                                                                                                  • Slide 12
                                                                                                  • Slide 13
                                                                                                  • Slide 14
                                                                                                  • Conthellip
                                                                                                  • Conthellip (2)
                                                                                                  • Drug Therapy
                                                                                                  • Classification
                                                                                                  • Nursing Management
                                                                                                  • Nursing Management (2)
                                                                                                  • Acute Coronary Syndrome
                                                                                                  • Slide 22
                                                                                                  • Conthellip (3)
                                                                                                  • Slide 24
                                                                                                  • Conthellip(MI)
                                                                                                  • Slide 26
                                                                                                  • Pathophysiology (2)
                                                                                                  • Tissue Changes After MI
                                                                                                  • Management of MI
                                                                                                  • Slide 30
                                                                                                  • Slide 31
                                                                                                  • ASSESSMENT
                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                  • NURSING CARE PLAN
                                                                                                  • NURSING CARE PLAN (2)
                                                                                                  • NURSING CARE PLAN (3)
                                                                                                  • NURSING CARE PLAN (4)
                                                                                                  • NURSING CARE PLAN (5)
                                                                                                  • NURSING CARE PLAN (6)
                                                                                                  • NURSING CARE PLAN (7)
                                                                                                  • NURSING CARE PLAN (8)
                                                                                                  • EVALUATION
                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                  • PATHOPHYSIOLOGY
                                                                                                  • ASSESSMENT (2)
                                                                                                  • ASSESSMENT (3)
                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                  • Slide 49
                                                                                                  • NURSING CARE PLAN (9)
                                                                                                  • NURSING CARE PLAN (10)
                                                                                                  • NURSING CARE PLAN (11)
                                                                                                  • NURSING CARE PLAN (12)
                                                                                                  • NURSING CARE PLAN (13)
                                                                                                  • EVALUATION
                                                                                                  • Slide 56
                                                                                                  • Slide 57
                                                                                                  • Slide 58
                                                                                                  • Slide 59
                                                                                                  • Slide 60
                                                                                                  • Treatment of Hyperlipidemia
                                                                                                  • Slide 62
                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                  • CARDIOMYOPATHIES
                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                  • Infective endocarditis
                                                                                                  • Infective endocarditis (2)
                                                                                                  • Infective endocarditis (3)
                                                                                                  • Infective endocarditis (4)
                                                                                                  • Infective endocarditis (5)
                                                                                                  • Infective endocarditis (6)
                                                                                                  • Infective endocarditis (7)
                                                                                                  • Infective endocarditis (8)
                                                                                                  • Infective endocarditis (9)
                                                                                                  • Infective endocarditis (10)
                                                                                                  • Infective endocarditis (11)
                                                                                                  • Infective endocarditis (12)
                                                                                                  • CARDIOGENIC SHOCK
                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                  • CARDIAC TAMPONADE
                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                  • Slide 100
                                                                                                  • HYPERTENSION
                                                                                                  • HYPERTENSION (2)
                                                                                                  • Slide 103
                                                                                                  • Slide 104
                                                                                                  • Slide 105
                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                  • Buergerrsquos Disease
                                                                                                  • Slide 108
                                                                                                  • Manifestations
                                                                                                  • Slide 110
                                                                                                  • Diagnosis amp Treatment
                                                                                                  • Rynaudrsquos Disease
                                                                                                  • Manifestations (2)
                                                                                                  • Slide 114
                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                  • Slide 116
                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                  • Slide 118
                                                                                                  • Slide 119
                                                                                                  • Slide 120
                                                                                                  • Slide 121

                                                                                                    NURSING CARE PLANbull Goal 3 provide for special safety

                                                                                                    needsbull Skin care

                                                                                                    bull Inspect massage lubricate bony prominences

                                                                                                    bull Use foot cradle heel protectors sheepskin

                                                                                                    bull Side rails up if hypoxic (disoriented)

                                                                                                    bull Vital signs monitor for signs of fatigue pulmonary emboli

                                                                                                    bull ROM active passive elastic stockings

                                                                                                    NURSING CARE PLAN

                                                                                                    bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                                    loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                                    bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                                    strict IObull Diet

                                                                                                    bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                                    NURSING CARE PLAN

                                                                                                    bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                                    morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                                    bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                                    EVALUATION

                                                                                                    bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                    distressbull Reduction in dependent edema

                                                                                                    DAY 3 OF

                                                                                                    CARDIOVASCULARDISEASES

                                                                                                    bull hyperlipidemia means high lipid levels

                                                                                                    bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                    bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                    bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                    Treatment of Hyperlipidemia

                                                                                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                    bull SYSTOLIC DYSFUNCTION

                                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                                    bull Pathophysiologybull 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

                                                                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                    CARDIOMYOPATHIES

                                                                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                    CARDIOMYOPATHIES

                                                                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                    CARDIOMYOPATHIES

                                                                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                    relief

                                                                                                    CARDIOMYOPATHIES

                                                                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                    CARDIOMYOPATHIES

                                                                                                    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

                                                                                                    Infective endocarditis

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

                                                                                                    bull Can be acute or chronic

                                                                                                    Infective endocarditis

                                                                                                    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

                                                                                                    Infective endocarditis

                                                                                                    bull Pathophysiologybull 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

                                                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                    Infective endocarditis

                                                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                    retina

                                                                                                    Infective endocarditis

                                                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                    Infective endocarditis

                                                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                    Infective endocarditis

                                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                    organism

                                                                                                    Infective endocarditis

                                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                    Infective endocarditis

                                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                    B

                                                                                                    Infective endocarditis

                                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                    CARDIOGENIC SHOCK

                                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                    CARDIOGENIC SHOCK

                                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                    CARDIOGENIC SHOCK

                                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                                    Normal is 4-10 cmH2O

                                                                                                    CARDIOGENIC SHOCK

                                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                    CARDIAC TAMPONADE

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

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                    anterior chest

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                    CARDIAC TAMPONADE

                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                    tamponade

                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                    HYPERTENSION

                                                                                                    bull 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

                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                    bull Most common typebull 2 Secondary

                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                    Buergerrsquos Disease

                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                    reaction of the vessel wall

                                                                                                    Manifestations

                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                    Absentdiminished peripheral pulses

                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                    Diagnosis amp Treatment

                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                    (rare occasions)

                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                    A Assessment

                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                    2 vsB Nursing Dx

                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                    2 Impaired gas exchange

                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                    C Goals

                                                                                                    1 Relief of pain amp symptoms

                                                                                                    2 Prevention of further cardiac damage

                                                                                                    D Nursing Interventions

                                                                                                    1 Pain control

                                                                                                    2 Proper medications

                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                    • Slide 2
                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                    • Pathophysiology
                                                                                                    • Slide 5
                                                                                                    • ASSESSING CHEST PAIN
                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                    • Pathophysiology
                                                                                                    • Types
                                                                                                    • Slide 12
                                                                                                    • Slide 13
                                                                                                    • Slide 14
                                                                                                    • Conthellip
                                                                                                    • Conthellip (2)
                                                                                                    • Drug Therapy
                                                                                                    • Classification
                                                                                                    • Nursing Management
                                                                                                    • Nursing Management (2)
                                                                                                    • Acute Coronary Syndrome
                                                                                                    • Slide 22
                                                                                                    • Conthellip (3)
                                                                                                    • Slide 24
                                                                                                    • Conthellip(MI)
                                                                                                    • Slide 26
                                                                                                    • Pathophysiology (2)
                                                                                                    • Tissue Changes After MI
                                                                                                    • Management of MI
                                                                                                    • Slide 30
                                                                                                    • Slide 31
                                                                                                    • ASSESSMENT
                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                    • NURSING CARE PLAN
                                                                                                    • NURSING CARE PLAN (2)
                                                                                                    • NURSING CARE PLAN (3)
                                                                                                    • NURSING CARE PLAN (4)
                                                                                                    • NURSING CARE PLAN (5)
                                                                                                    • NURSING CARE PLAN (6)
                                                                                                    • NURSING CARE PLAN (7)
                                                                                                    • NURSING CARE PLAN (8)
                                                                                                    • EVALUATION
                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                    • PATHOPHYSIOLOGY
                                                                                                    • ASSESSMENT (2)
                                                                                                    • ASSESSMENT (3)
                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                    • Slide 49
                                                                                                    • NURSING CARE PLAN (9)
                                                                                                    • NURSING CARE PLAN (10)
                                                                                                    • NURSING CARE PLAN (11)
                                                                                                    • NURSING CARE PLAN (12)
                                                                                                    • NURSING CARE PLAN (13)
                                                                                                    • EVALUATION
                                                                                                    • Slide 56
                                                                                                    • Slide 57
                                                                                                    • Slide 58
                                                                                                    • Slide 59
                                                                                                    • Slide 60
                                                                                                    • Treatment of Hyperlipidemia
                                                                                                    • Slide 62
                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                    • CARDIOMYOPATHIES
                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                    • Infective endocarditis
                                                                                                    • Infective endocarditis (2)
                                                                                                    • Infective endocarditis (3)
                                                                                                    • Infective endocarditis (4)
                                                                                                    • Infective endocarditis (5)
                                                                                                    • Infective endocarditis (6)
                                                                                                    • Infective endocarditis (7)
                                                                                                    • Infective endocarditis (8)
                                                                                                    • Infective endocarditis (9)
                                                                                                    • Infective endocarditis (10)
                                                                                                    • Infective endocarditis (11)
                                                                                                    • Infective endocarditis (12)
                                                                                                    • CARDIOGENIC SHOCK
                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                    • CARDIAC TAMPONADE
                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                    • Slide 100
                                                                                                    • HYPERTENSION
                                                                                                    • HYPERTENSION (2)
                                                                                                    • Slide 103
                                                                                                    • Slide 104
                                                                                                    • Slide 105
                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                    • Buergerrsquos Disease
                                                                                                    • Slide 108
                                                                                                    • Manifestations
                                                                                                    • Slide 110
                                                                                                    • Diagnosis amp Treatment
                                                                                                    • Rynaudrsquos Disease
                                                                                                    • Manifestations (2)
                                                                                                    • Slide 114
                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                    • Slide 116
                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                    • Slide 118
                                                                                                    • Slide 119
                                                                                                    • Slide 120
                                                                                                    • Slide 121

                                                                                                      NURSING CARE PLAN

                                                                                                      bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible

                                                                                                      loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes

                                                                                                      bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload

                                                                                                      strict IObull Diet

                                                                                                      bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client

                                                                                                      NURSING CARE PLAN

                                                                                                      bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                                      morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                                      bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                                      EVALUATION

                                                                                                      bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                      distressbull Reduction in dependent edema

                                                                                                      DAY 3 OF

                                                                                                      CARDIOVASCULARDISEASES

                                                                                                      bull hyperlipidemia means high lipid levels

                                                                                                      bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                      bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                      bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                      bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                      Treatment of Hyperlipidemia

                                                                                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                      bull SYSTOLIC DYSFUNCTION

                                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                                      bull Pathophysiologybull 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

                                                                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                      CARDIOMYOPATHIES

                                                                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                      CARDIOMYOPATHIES

                                                                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                      CARDIOMYOPATHIES

                                                                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                      relief

                                                                                                      CARDIOMYOPATHIES

                                                                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                      CARDIOMYOPATHIES

                                                                                                      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

                                                                                                      Infective endocarditis

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

                                                                                                      bull Can be acute or chronic

                                                                                                      Infective endocarditis

                                                                                                      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

                                                                                                      Infective endocarditis

                                                                                                      bull Pathophysiologybull 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

                                                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                      Infective endocarditis

                                                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                      retina

                                                                                                      Infective endocarditis

                                                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                      Infective endocarditis

                                                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                      Infective endocarditis

                                                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                      organism

                                                                                                      Infective endocarditis

                                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                      Infective endocarditis

                                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                      B

                                                                                                      Infective endocarditis

                                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                      CARDIOGENIC SHOCK

                                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                      CARDIOGENIC SHOCK

                                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                      CARDIOGENIC SHOCK

                                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                                      Normal is 4-10 cmH2O

                                                                                                      CARDIOGENIC SHOCK

                                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                                      CARDIOGENIC SHOCK

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

                                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                                      CARDIAC TAMPONADE

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

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                      anterior chest

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                      CARDIAC TAMPONADE

                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                      tamponade

                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                      HYPERTENSION

                                                                                                      bull 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

                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                      bull Most common typebull 2 Secondary

                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                      Buergerrsquos Disease

                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                      reaction of the vessel wall

                                                                                                      Manifestations

                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                      Absentdiminished peripheral pulses

                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                      Diagnosis amp Treatment

                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                      (rare occasions)

                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                      A Assessment

                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                      2 vsB Nursing Dx

                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                      2 Impaired gas exchange

                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                      C Goals

                                                                                                      1 Relief of pain amp symptoms

                                                                                                      2 Prevention of further cardiac damage

                                                                                                      D Nursing Interventions

                                                                                                      1 Pain control

                                                                                                      2 Proper medications

                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                      • Slide 2
                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                      • Pathophysiology
                                                                                                      • Slide 5
                                                                                                      • ASSESSING CHEST PAIN
                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                      • Pathophysiology
                                                                                                      • Types
                                                                                                      • Slide 12
                                                                                                      • Slide 13
                                                                                                      • Slide 14
                                                                                                      • Conthellip
                                                                                                      • Conthellip (2)
                                                                                                      • Drug Therapy
                                                                                                      • Classification
                                                                                                      • Nursing Management
                                                                                                      • Nursing Management (2)
                                                                                                      • Acute Coronary Syndrome
                                                                                                      • Slide 22
                                                                                                      • Conthellip (3)
                                                                                                      • Slide 24
                                                                                                      • Conthellip(MI)
                                                                                                      • Slide 26
                                                                                                      • Pathophysiology (2)
                                                                                                      • Tissue Changes After MI
                                                                                                      • Management of MI
                                                                                                      • Slide 30
                                                                                                      • Slide 31
                                                                                                      • ASSESSMENT
                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                      • NURSING CARE PLAN
                                                                                                      • NURSING CARE PLAN (2)
                                                                                                      • NURSING CARE PLAN (3)
                                                                                                      • NURSING CARE PLAN (4)
                                                                                                      • NURSING CARE PLAN (5)
                                                                                                      • NURSING CARE PLAN (6)
                                                                                                      • NURSING CARE PLAN (7)
                                                                                                      • NURSING CARE PLAN (8)
                                                                                                      • EVALUATION
                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                      • PATHOPHYSIOLOGY
                                                                                                      • ASSESSMENT (2)
                                                                                                      • ASSESSMENT (3)
                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                      • Slide 49
                                                                                                      • NURSING CARE PLAN (9)
                                                                                                      • NURSING CARE PLAN (10)
                                                                                                      • NURSING CARE PLAN (11)
                                                                                                      • NURSING CARE PLAN (12)
                                                                                                      • NURSING CARE PLAN (13)
                                                                                                      • EVALUATION
                                                                                                      • Slide 56
                                                                                                      • Slide 57
                                                                                                      • Slide 58
                                                                                                      • Slide 59
                                                                                                      • Slide 60
                                                                                                      • Treatment of Hyperlipidemia
                                                                                                      • Slide 62
                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                      • CARDIOMYOPATHIES
                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                      • Infective endocarditis
                                                                                                      • Infective endocarditis (2)
                                                                                                      • Infective endocarditis (3)
                                                                                                      • Infective endocarditis (4)
                                                                                                      • Infective endocarditis (5)
                                                                                                      • Infective endocarditis (6)
                                                                                                      • Infective endocarditis (7)
                                                                                                      • Infective endocarditis (8)
                                                                                                      • Infective endocarditis (9)
                                                                                                      • Infective endocarditis (10)
                                                                                                      • Infective endocarditis (11)
                                                                                                      • Infective endocarditis (12)
                                                                                                      • CARDIOGENIC SHOCK
                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                      • CARDIAC TAMPONADE
                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                      • Slide 100
                                                                                                      • HYPERTENSION
                                                                                                      • HYPERTENSION (2)
                                                                                                      • Slide 103
                                                                                                      • Slide 104
                                                                                                      • Slide 105
                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                      • Buergerrsquos Disease
                                                                                                      • Slide 108
                                                                                                      • Manifestations
                                                                                                      • Slide 110
                                                                                                      • Diagnosis amp Treatment
                                                                                                      • Rynaudrsquos Disease
                                                                                                      • Manifestations (2)
                                                                                                      • Slide 114
                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                      • Slide 116
                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                      • Slide 118
                                                                                                      • Slide 119
                                                                                                      • Slide 120
                                                                                                      • Slide 121

                                                                                                        NURSING CARE PLAN

                                                                                                        bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early

                                                                                                        morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)

                                                                                                        bull Refer to available community resources for dietary assistance weight reduction exercise program

                                                                                                        EVALUATION

                                                                                                        bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                        distressbull Reduction in dependent edema

                                                                                                        DAY 3 OF

                                                                                                        CARDIOVASCULARDISEASES

                                                                                                        bull hyperlipidemia means high lipid levels

                                                                                                        bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                        bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                        bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                        bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                        Treatment of Hyperlipidemia

                                                                                                        bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                        bull SYSTOLIC DYSFUNCTION

                                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                                        bull Pathophysiologybull 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

                                                                                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                        CARDIOMYOPATHIES

                                                                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                        CARDIOMYOPATHIES

                                                                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                        CARDIOMYOPATHIES

                                                                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                        relief

                                                                                                        CARDIOMYOPATHIES

                                                                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                        CARDIOMYOPATHIES

                                                                                                        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

                                                                                                        Infective endocarditis

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

                                                                                                        bull Can be acute or chronic

                                                                                                        Infective endocarditis

                                                                                                        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

                                                                                                        Infective endocarditis

                                                                                                        bull Pathophysiologybull 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

                                                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                        Infective endocarditis

                                                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                        retina

                                                                                                        Infective endocarditis

                                                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                        Infective endocarditis

                                                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                        Infective endocarditis

                                                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                        organism

                                                                                                        Infective endocarditis

                                                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                        Infective endocarditis

                                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                        B

                                                                                                        Infective endocarditis

                                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                        CARDIOGENIC SHOCK

                                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                        CARDIOGENIC SHOCK

                                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                        CARDIOGENIC SHOCK

                                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                                        Normal is 4-10 cmH2O

                                                                                                        CARDIOGENIC SHOCK

                                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                                        CARDIOGENIC SHOCK

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

                                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                                        CARDIAC TAMPONADE

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

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                        anterior chest

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                        CARDIAC TAMPONADE

                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                        tamponade

                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                        HYPERTENSION

                                                                                                        bull 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

                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                        bull Most common typebull 2 Secondary

                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                        Buergerrsquos Disease

                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                        reaction of the vessel wall

                                                                                                        Manifestations

                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                        Absentdiminished peripheral pulses

                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                        Diagnosis amp Treatment

                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                        (rare occasions)

                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                        A Assessment

                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                        2 vsB Nursing Dx

                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                        2 Impaired gas exchange

                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                        C Goals

                                                                                                        1 Relief of pain amp symptoms

                                                                                                        2 Prevention of further cardiac damage

                                                                                                        D Nursing Interventions

                                                                                                        1 Pain control

                                                                                                        2 Proper medications

                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                        • Slide 2
                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                        • Pathophysiology
                                                                                                        • Slide 5
                                                                                                        • ASSESSING CHEST PAIN
                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                        • Pathophysiology
                                                                                                        • Types
                                                                                                        • Slide 12
                                                                                                        • Slide 13
                                                                                                        • Slide 14
                                                                                                        • Conthellip
                                                                                                        • Conthellip (2)
                                                                                                        • Drug Therapy
                                                                                                        • Classification
                                                                                                        • Nursing Management
                                                                                                        • Nursing Management (2)
                                                                                                        • Acute Coronary Syndrome
                                                                                                        • Slide 22
                                                                                                        • Conthellip (3)
                                                                                                        • Slide 24
                                                                                                        • Conthellip(MI)
                                                                                                        • Slide 26
                                                                                                        • Pathophysiology (2)
                                                                                                        • Tissue Changes After MI
                                                                                                        • Management of MI
                                                                                                        • Slide 30
                                                                                                        • Slide 31
                                                                                                        • ASSESSMENT
                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                        • NURSING CARE PLAN
                                                                                                        • NURSING CARE PLAN (2)
                                                                                                        • NURSING CARE PLAN (3)
                                                                                                        • NURSING CARE PLAN (4)
                                                                                                        • NURSING CARE PLAN (5)
                                                                                                        • NURSING CARE PLAN (6)
                                                                                                        • NURSING CARE PLAN (7)
                                                                                                        • NURSING CARE PLAN (8)
                                                                                                        • EVALUATION
                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                        • PATHOPHYSIOLOGY
                                                                                                        • ASSESSMENT (2)
                                                                                                        • ASSESSMENT (3)
                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                        • Slide 49
                                                                                                        • NURSING CARE PLAN (9)
                                                                                                        • NURSING CARE PLAN (10)
                                                                                                        • NURSING CARE PLAN (11)
                                                                                                        • NURSING CARE PLAN (12)
                                                                                                        • NURSING CARE PLAN (13)
                                                                                                        • EVALUATION
                                                                                                        • Slide 56
                                                                                                        • Slide 57
                                                                                                        • Slide 58
                                                                                                        • Slide 59
                                                                                                        • Slide 60
                                                                                                        • Treatment of Hyperlipidemia
                                                                                                        • Slide 62
                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                        • CARDIOMYOPATHIES
                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                        • Infective endocarditis
                                                                                                        • Infective endocarditis (2)
                                                                                                        • Infective endocarditis (3)
                                                                                                        • Infective endocarditis (4)
                                                                                                        • Infective endocarditis (5)
                                                                                                        • Infective endocarditis (6)
                                                                                                        • Infective endocarditis (7)
                                                                                                        • Infective endocarditis (8)
                                                                                                        • Infective endocarditis (9)
                                                                                                        • Infective endocarditis (10)
                                                                                                        • Infective endocarditis (11)
                                                                                                        • Infective endocarditis (12)
                                                                                                        • CARDIOGENIC SHOCK
                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                        • CARDIAC TAMPONADE
                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                        • Slide 100
                                                                                                        • HYPERTENSION
                                                                                                        • HYPERTENSION (2)
                                                                                                        • Slide 103
                                                                                                        • Slide 104
                                                                                                        • Slide 105
                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                        • Buergerrsquos Disease
                                                                                                        • Slide 108
                                                                                                        • Manifestations
                                                                                                        • Slide 110
                                                                                                        • Diagnosis amp Treatment
                                                                                                        • Rynaudrsquos Disease
                                                                                                        • Manifestations (2)
                                                                                                        • Slide 114
                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                        • Slide 116
                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                        • Slide 118
                                                                                                        • Slide 119
                                                                                                        • Slide 120
                                                                                                        • Slide 121

                                                                                                          EVALUATION

                                                                                                          bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory

                                                                                                          distressbull Reduction in dependent edema

                                                                                                          DAY 3 OF

                                                                                                          CARDIOVASCULARDISEASES

                                                                                                          bull hyperlipidemia means high lipid levels

                                                                                                          bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                          bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                          bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                          bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                          Treatment of Hyperlipidemia

                                                                                                          bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                          bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                          bull SYSTOLIC DYSFUNCTION

                                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                                          bull Pathophysiologybull 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

                                                                                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                          CARDIOMYOPATHIES

                                                                                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                          CARDIOMYOPATHIES

                                                                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                          CARDIOMYOPATHIES

                                                                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                          relief

                                                                                                          CARDIOMYOPATHIES

                                                                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                          CARDIOMYOPATHIES

                                                                                                          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

                                                                                                          Infective endocarditis

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

                                                                                                          bull Can be acute or chronic

                                                                                                          Infective endocarditis

                                                                                                          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

                                                                                                          Infective endocarditis

                                                                                                          bull Pathophysiologybull 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

                                                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                          Infective endocarditis

                                                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                          retina

                                                                                                          Infective endocarditis

                                                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                          Infective endocarditis

                                                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                          Infective endocarditis

                                                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                          organism

                                                                                                          Infective endocarditis

                                                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                          Infective endocarditis

                                                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                          B

                                                                                                          Infective endocarditis

                                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                          CARDIOGENIC SHOCK

                                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                          CARDIOGENIC SHOCK

                                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                          CARDIOGENIC SHOCK

                                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                                          Normal is 4-10 cmH2O

                                                                                                          CARDIOGENIC SHOCK

                                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                                          CARDIOGENIC SHOCK

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

                                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                                          CARDIAC TAMPONADE

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

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                          anterior chest

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                          CARDIAC TAMPONADE

                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                          tamponade

                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                          HYPERTENSION

                                                                                                          bull 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

                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                          bull Most common typebull 2 Secondary

                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                          Buergerrsquos Disease

                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                          reaction of the vessel wall

                                                                                                          Manifestations

                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                          Absentdiminished peripheral pulses

                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                          Diagnosis amp Treatment

                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                          (rare occasions)

                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                          A Assessment

                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                          2 vsB Nursing Dx

                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                          2 Impaired gas exchange

                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                          C Goals

                                                                                                          1 Relief of pain amp symptoms

                                                                                                          2 Prevention of further cardiac damage

                                                                                                          D Nursing Interventions

                                                                                                          1 Pain control

                                                                                                          2 Proper medications

                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                          • Slide 2
                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                          • Pathophysiology
                                                                                                          • Slide 5
                                                                                                          • ASSESSING CHEST PAIN
                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                          • Pathophysiology
                                                                                                          • Types
                                                                                                          • Slide 12
                                                                                                          • Slide 13
                                                                                                          • Slide 14
                                                                                                          • Conthellip
                                                                                                          • Conthellip (2)
                                                                                                          • Drug Therapy
                                                                                                          • Classification
                                                                                                          • Nursing Management
                                                                                                          • Nursing Management (2)
                                                                                                          • Acute Coronary Syndrome
                                                                                                          • Slide 22
                                                                                                          • Conthellip (3)
                                                                                                          • Slide 24
                                                                                                          • Conthellip(MI)
                                                                                                          • Slide 26
                                                                                                          • Pathophysiology (2)
                                                                                                          • Tissue Changes After MI
                                                                                                          • Management of MI
                                                                                                          • Slide 30
                                                                                                          • Slide 31
                                                                                                          • ASSESSMENT
                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                          • NURSING CARE PLAN
                                                                                                          • NURSING CARE PLAN (2)
                                                                                                          • NURSING CARE PLAN (3)
                                                                                                          • NURSING CARE PLAN (4)
                                                                                                          • NURSING CARE PLAN (5)
                                                                                                          • NURSING CARE PLAN (6)
                                                                                                          • NURSING CARE PLAN (7)
                                                                                                          • NURSING CARE PLAN (8)
                                                                                                          • EVALUATION
                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                          • PATHOPHYSIOLOGY
                                                                                                          • ASSESSMENT (2)
                                                                                                          • ASSESSMENT (3)
                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                          • Slide 49
                                                                                                          • NURSING CARE PLAN (9)
                                                                                                          • NURSING CARE PLAN (10)
                                                                                                          • NURSING CARE PLAN (11)
                                                                                                          • NURSING CARE PLAN (12)
                                                                                                          • NURSING CARE PLAN (13)
                                                                                                          • EVALUATION
                                                                                                          • Slide 56
                                                                                                          • Slide 57
                                                                                                          • Slide 58
                                                                                                          • Slide 59
                                                                                                          • Slide 60
                                                                                                          • Treatment of Hyperlipidemia
                                                                                                          • Slide 62
                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                          • CARDIOMYOPATHIES
                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                          • Infective endocarditis
                                                                                                          • Infective endocarditis (2)
                                                                                                          • Infective endocarditis (3)
                                                                                                          • Infective endocarditis (4)
                                                                                                          • Infective endocarditis (5)
                                                                                                          • Infective endocarditis (6)
                                                                                                          • Infective endocarditis (7)
                                                                                                          • Infective endocarditis (8)
                                                                                                          • Infective endocarditis (9)
                                                                                                          • Infective endocarditis (10)
                                                                                                          • Infective endocarditis (11)
                                                                                                          • Infective endocarditis (12)
                                                                                                          • CARDIOGENIC SHOCK
                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                          • CARDIAC TAMPONADE
                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                          • Slide 100
                                                                                                          • HYPERTENSION
                                                                                                          • HYPERTENSION (2)
                                                                                                          • Slide 103
                                                                                                          • Slide 104
                                                                                                          • Slide 105
                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                          • Buergerrsquos Disease
                                                                                                          • Slide 108
                                                                                                          • Manifestations
                                                                                                          • Slide 110
                                                                                                          • Diagnosis amp Treatment
                                                                                                          • Rynaudrsquos Disease
                                                                                                          • Manifestations (2)
                                                                                                          • Slide 114
                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                          • Slide 116
                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                          • Slide 118
                                                                                                          • Slide 119
                                                                                                          • Slide 120
                                                                                                          • Slide 121

                                                                                                            DAY 3 OF

                                                                                                            CARDIOVASCULARDISEASES

                                                                                                            bull hyperlipidemia means high lipid levels

                                                                                                            bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                            bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                            bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                            bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                            Treatment of Hyperlipidemia

                                                                                                            bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                            bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                            CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                            CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                            bull SYSTOLIC DYSFUNCTION

                                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                                            bull Pathophysiologybull 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

                                                                                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                            CARDIOMYOPATHIES

                                                                                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                            CARDIOMYOPATHIES

                                                                                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                            CARDIOMYOPATHIES

                                                                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                            relief

                                                                                                            CARDIOMYOPATHIES

                                                                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                            CARDIOMYOPATHIES

                                                                                                            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

                                                                                                            Infective endocarditis

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

                                                                                                            bull Can be acute or chronic

                                                                                                            Infective endocarditis

                                                                                                            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

                                                                                                            Infective endocarditis

                                                                                                            bull Pathophysiologybull 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

                                                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                            Infective endocarditis

                                                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                            retina

                                                                                                            Infective endocarditis

                                                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                            Infective endocarditis

                                                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                            Infective endocarditis

                                                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                            organism

                                                                                                            Infective endocarditis

                                                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                            Infective endocarditis

                                                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                            B

                                                                                                            Infective endocarditis

                                                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                            CARDIOGENIC SHOCK

                                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                            CARDIOGENIC SHOCK

                                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                            CARDIOGENIC SHOCK

                                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                                            Normal is 4-10 cmH2O

                                                                                                            CARDIOGENIC SHOCK

                                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                                            CARDIOGENIC SHOCK

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

                                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                                            CARDIAC TAMPONADE

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

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                            anterior chest

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                            CARDIAC TAMPONADE

                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                            tamponade

                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                            HYPERTENSION

                                                                                                            bull 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

                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                            bull Most common typebull 2 Secondary

                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                            Buergerrsquos Disease

                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                            reaction of the vessel wall

                                                                                                            Manifestations

                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                            Absentdiminished peripheral pulses

                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                            Diagnosis amp Treatment

                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                            (rare occasions)

                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                            A Assessment

                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                            2 vsB Nursing Dx

                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                            2 Impaired gas exchange

                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                            C Goals

                                                                                                            1 Relief of pain amp symptoms

                                                                                                            2 Prevention of further cardiac damage

                                                                                                            D Nursing Interventions

                                                                                                            1 Pain control

                                                                                                            2 Proper medications

                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                            • Slide 2
                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                            • Pathophysiology
                                                                                                            • Slide 5
                                                                                                            • ASSESSING CHEST PAIN
                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                            • Pathophysiology
                                                                                                            • Types
                                                                                                            • Slide 12
                                                                                                            • Slide 13
                                                                                                            • Slide 14
                                                                                                            • Conthellip
                                                                                                            • Conthellip (2)
                                                                                                            • Drug Therapy
                                                                                                            • Classification
                                                                                                            • Nursing Management
                                                                                                            • Nursing Management (2)
                                                                                                            • Acute Coronary Syndrome
                                                                                                            • Slide 22
                                                                                                            • Conthellip (3)
                                                                                                            • Slide 24
                                                                                                            • Conthellip(MI)
                                                                                                            • Slide 26
                                                                                                            • Pathophysiology (2)
                                                                                                            • Tissue Changes After MI
                                                                                                            • Management of MI
                                                                                                            • Slide 30
                                                                                                            • Slide 31
                                                                                                            • ASSESSMENT
                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                            • NURSING CARE PLAN
                                                                                                            • NURSING CARE PLAN (2)
                                                                                                            • NURSING CARE PLAN (3)
                                                                                                            • NURSING CARE PLAN (4)
                                                                                                            • NURSING CARE PLAN (5)
                                                                                                            • NURSING CARE PLAN (6)
                                                                                                            • NURSING CARE PLAN (7)
                                                                                                            • NURSING CARE PLAN (8)
                                                                                                            • EVALUATION
                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                            • PATHOPHYSIOLOGY
                                                                                                            • ASSESSMENT (2)
                                                                                                            • ASSESSMENT (3)
                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                            • Slide 49
                                                                                                            • NURSING CARE PLAN (9)
                                                                                                            • NURSING CARE PLAN (10)
                                                                                                            • NURSING CARE PLAN (11)
                                                                                                            • NURSING CARE PLAN (12)
                                                                                                            • NURSING CARE PLAN (13)
                                                                                                            • EVALUATION
                                                                                                            • Slide 56
                                                                                                            • Slide 57
                                                                                                            • Slide 58
                                                                                                            • Slide 59
                                                                                                            • Slide 60
                                                                                                            • Treatment of Hyperlipidemia
                                                                                                            • Slide 62
                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                            • CARDIOMYOPATHIES
                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                            • Infective endocarditis
                                                                                                            • Infective endocarditis (2)
                                                                                                            • Infective endocarditis (3)
                                                                                                            • Infective endocarditis (4)
                                                                                                            • Infective endocarditis (5)
                                                                                                            • Infective endocarditis (6)
                                                                                                            • Infective endocarditis (7)
                                                                                                            • Infective endocarditis (8)
                                                                                                            • Infective endocarditis (9)
                                                                                                            • Infective endocarditis (10)
                                                                                                            • Infective endocarditis (11)
                                                                                                            • Infective endocarditis (12)
                                                                                                            • CARDIOGENIC SHOCK
                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                            • CARDIAC TAMPONADE
                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                            • Slide 100
                                                                                                            • HYPERTENSION
                                                                                                            • HYPERTENSION (2)
                                                                                                            • Slide 103
                                                                                                            • Slide 104
                                                                                                            • Slide 105
                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                            • Buergerrsquos Disease
                                                                                                            • Slide 108
                                                                                                            • Manifestations
                                                                                                            • Slide 110
                                                                                                            • Diagnosis amp Treatment
                                                                                                            • Rynaudrsquos Disease
                                                                                                            • Manifestations (2)
                                                                                                            • Slide 114
                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                            • Slide 116
                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                            • Slide 118
                                                                                                            • Slide 119
                                                                                                            • Slide 120
                                                                                                            • Slide 121

                                                                                                              bull hyperlipidemia means high lipid levels

                                                                                                              bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries

                                                                                                              bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                              bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                              bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                              Treatment of Hyperlipidemia

                                                                                                              bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                              bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                              CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                              CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                              DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                              bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                              bull SYSTOLIC DYSFUNCTION

                                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                                              bull Pathophysiologybull 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

                                                                                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                              CARDIOMYOPATHIES

                                                                                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                              CARDIOMYOPATHIES

                                                                                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                              CARDIOMYOPATHIES

                                                                                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                              relief

                                                                                                              CARDIOMYOPATHIES

                                                                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                              CARDIOMYOPATHIES

                                                                                                              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

                                                                                                              Infective endocarditis

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

                                                                                                              bull Can be acute or chronic

                                                                                                              Infective endocarditis

                                                                                                              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

                                                                                                              Infective endocarditis

                                                                                                              bull Pathophysiologybull 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

                                                                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                              Infective endocarditis

                                                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                              retina

                                                                                                              Infective endocarditis

                                                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                              Infective endocarditis

                                                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                              Infective endocarditis

                                                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                              organism

                                                                                                              Infective endocarditis

                                                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                              Infective endocarditis

                                                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                              B

                                                                                                              Infective endocarditis

                                                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                              CARDIOGENIC SHOCK

                                                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                              CARDIOGENIC SHOCK

                                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                              CARDIOGENIC SHOCK

                                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                                              Normal is 4-10 cmH2O

                                                                                                              CARDIOGENIC SHOCK

                                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                                              CARDIOGENIC SHOCK

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

                                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                                              CARDIAC TAMPONADE

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

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                              distention hypotension and distantmuffled heart sound

                                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                              anterior chest

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                              CARDIAC TAMPONADE

                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                              tamponade

                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                              HYPERTENSION

                                                                                                              bull 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

                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                              bull Most common typebull 2 Secondary

                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                              Buergerrsquos Disease

                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                              reaction of the vessel wall

                                                                                                              Manifestations

                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                              Absentdiminished peripheral pulses

                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                              Diagnosis amp Treatment

                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                              (rare occasions)

                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                              A Assessment

                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                              2 vsB Nursing Dx

                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                              2 Impaired gas exchange

                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                              C Goals

                                                                                                              1 Relief of pain amp symptoms

                                                                                                              2 Prevention of further cardiac damage

                                                                                                              D Nursing Interventions

                                                                                                              1 Pain control

                                                                                                              2 Proper medications

                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                              • Slide 2
                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                              • Pathophysiology
                                                                                                              • Slide 5
                                                                                                              • ASSESSING CHEST PAIN
                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                              • Pathophysiology
                                                                                                              • Types
                                                                                                              • Slide 12
                                                                                                              • Slide 13
                                                                                                              • Slide 14
                                                                                                              • Conthellip
                                                                                                              • Conthellip (2)
                                                                                                              • Drug Therapy
                                                                                                              • Classification
                                                                                                              • Nursing Management
                                                                                                              • Nursing Management (2)
                                                                                                              • Acute Coronary Syndrome
                                                                                                              • Slide 22
                                                                                                              • Conthellip (3)
                                                                                                              • Slide 24
                                                                                                              • Conthellip(MI)
                                                                                                              • Slide 26
                                                                                                              • Pathophysiology (2)
                                                                                                              • Tissue Changes After MI
                                                                                                              • Management of MI
                                                                                                              • Slide 30
                                                                                                              • Slide 31
                                                                                                              • ASSESSMENT
                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                              • NURSING CARE PLAN
                                                                                                              • NURSING CARE PLAN (2)
                                                                                                              • NURSING CARE PLAN (3)
                                                                                                              • NURSING CARE PLAN (4)
                                                                                                              • NURSING CARE PLAN (5)
                                                                                                              • NURSING CARE PLAN (6)
                                                                                                              • NURSING CARE PLAN (7)
                                                                                                              • NURSING CARE PLAN (8)
                                                                                                              • EVALUATION
                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                              • PATHOPHYSIOLOGY
                                                                                                              • ASSESSMENT (2)
                                                                                                              • ASSESSMENT (3)
                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                              • Slide 49
                                                                                                              • NURSING CARE PLAN (9)
                                                                                                              • NURSING CARE PLAN (10)
                                                                                                              • NURSING CARE PLAN (11)
                                                                                                              • NURSING CARE PLAN (12)
                                                                                                              • NURSING CARE PLAN (13)
                                                                                                              • EVALUATION
                                                                                                              • Slide 56
                                                                                                              • Slide 57
                                                                                                              • Slide 58
                                                                                                              • Slide 59
                                                                                                              • Slide 60
                                                                                                              • Treatment of Hyperlipidemia
                                                                                                              • Slide 62
                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                              • CARDIOMYOPATHIES
                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                              • Infective endocarditis
                                                                                                              • Infective endocarditis (2)
                                                                                                              • Infective endocarditis (3)
                                                                                                              • Infective endocarditis (4)
                                                                                                              • Infective endocarditis (5)
                                                                                                              • Infective endocarditis (6)
                                                                                                              • Infective endocarditis (7)
                                                                                                              • Infective endocarditis (8)
                                                                                                              • Infective endocarditis (9)
                                                                                                              • Infective endocarditis (10)
                                                                                                              • Infective endocarditis (11)
                                                                                                              • Infective endocarditis (12)
                                                                                                              • CARDIOGENIC SHOCK
                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                              • CARDIAC TAMPONADE
                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                              • Slide 100
                                                                                                              • HYPERTENSION
                                                                                                              • HYPERTENSION (2)
                                                                                                              • Slide 103
                                                                                                              • Slide 104
                                                                                                              • Slide 105
                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                              • Buergerrsquos Disease
                                                                                                              • Slide 108
                                                                                                              • Manifestations
                                                                                                              • Slide 110
                                                                                                              • Diagnosis amp Treatment
                                                                                                              • Rynaudrsquos Disease
                                                                                                              • Manifestations (2)
                                                                                                              • Slide 114
                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                              • Slide 116
                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                              • Slide 118
                                                                                                              • Slide 119
                                                                                                              • Slide 120
                                                                                                              • Slide 121

                                                                                                                bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland

                                                                                                                bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                                bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                                Treatment of Hyperlipidemia

                                                                                                                bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                                bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                                CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                bull SYSTOLIC DYSFUNCTION

                                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                bull Pathophysiologybull 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

                                                                                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                CARDIOMYOPATHIES

                                                                                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                CARDIOMYOPATHIES

                                                                                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                CARDIOMYOPATHIES

                                                                                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                relief

                                                                                                                CARDIOMYOPATHIES

                                                                                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                CARDIOMYOPATHIES

                                                                                                                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

                                                                                                                Infective endocarditis

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

                                                                                                                bull Can be acute or chronic

                                                                                                                Infective endocarditis

                                                                                                                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

                                                                                                                Infective endocarditis

                                                                                                                bull Pathophysiologybull 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

                                                                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                Infective endocarditis

                                                                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                retina

                                                                                                                Infective endocarditis

                                                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                Infective endocarditis

                                                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                Infective endocarditis

                                                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                organism

                                                                                                                Infective endocarditis

                                                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                Infective endocarditis

                                                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                B

                                                                                                                Infective endocarditis

                                                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                CARDIOGENIC SHOCK

                                                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                CARDIOGENIC SHOCK

                                                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                CARDIOGENIC SHOCK

                                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                                Normal is 4-10 cmH2O

                                                                                                                CARDIOGENIC SHOCK

                                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                                CARDIOGENIC SHOCK

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

                                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                                CARDIAC TAMPONADE

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

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                anterior chest

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                CARDIAC TAMPONADE

                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                tamponade

                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                HYPERTENSION

                                                                                                                bull 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

                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                Buergerrsquos Disease

                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                reaction of the vessel wall

                                                                                                                Manifestations

                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                Absentdiminished peripheral pulses

                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                Diagnosis amp Treatment

                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                (rare occasions)

                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                A Assessment

                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                2 vsB Nursing Dx

                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                2 Impaired gas exchange

                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                C Goals

                                                                                                                1 Relief of pain amp symptoms

                                                                                                                2 Prevention of further cardiac damage

                                                                                                                D Nursing Interventions

                                                                                                                1 Pain control

                                                                                                                2 Proper medications

                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                • Slide 2
                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                • Pathophysiology
                                                                                                                • Slide 5
                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                • Pathophysiology
                                                                                                                • Types
                                                                                                                • Slide 12
                                                                                                                • Slide 13
                                                                                                                • Slide 14
                                                                                                                • Conthellip
                                                                                                                • Conthellip (2)
                                                                                                                • Drug Therapy
                                                                                                                • Classification
                                                                                                                • Nursing Management
                                                                                                                • Nursing Management (2)
                                                                                                                • Acute Coronary Syndrome
                                                                                                                • Slide 22
                                                                                                                • Conthellip (3)
                                                                                                                • Slide 24
                                                                                                                • Conthellip(MI)
                                                                                                                • Slide 26
                                                                                                                • Pathophysiology (2)
                                                                                                                • Tissue Changes After MI
                                                                                                                • Management of MI
                                                                                                                • Slide 30
                                                                                                                • Slide 31
                                                                                                                • ASSESSMENT
                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                • NURSING CARE PLAN
                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                • EVALUATION
                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                • ASSESSMENT (2)
                                                                                                                • ASSESSMENT (3)
                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                • Slide 49
                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                • EVALUATION
                                                                                                                • Slide 56
                                                                                                                • Slide 57
                                                                                                                • Slide 58
                                                                                                                • Slide 59
                                                                                                                • Slide 60
                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                • Slide 62
                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                • CARDIOMYOPATHIES
                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                • Infective endocarditis
                                                                                                                • Infective endocarditis (2)
                                                                                                                • Infective endocarditis (3)
                                                                                                                • Infective endocarditis (4)
                                                                                                                • Infective endocarditis (5)
                                                                                                                • Infective endocarditis (6)
                                                                                                                • Infective endocarditis (7)
                                                                                                                • Infective endocarditis (8)
                                                                                                                • Infective endocarditis (9)
                                                                                                                • Infective endocarditis (10)
                                                                                                                • Infective endocarditis (11)
                                                                                                                • Infective endocarditis (12)
                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                • CARDIAC TAMPONADE
                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                • Slide 100
                                                                                                                • HYPERTENSION
                                                                                                                • HYPERTENSION (2)
                                                                                                                • Slide 103
                                                                                                                • Slide 104
                                                                                                                • Slide 105
                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                • Buergerrsquos Disease
                                                                                                                • Slide 108
                                                                                                                • Manifestations
                                                                                                                • Slide 110
                                                                                                                • Diagnosis amp Treatment
                                                                                                                • Rynaudrsquos Disease
                                                                                                                • Manifestations (2)
                                                                                                                • Slide 114
                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                • Slide 116
                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                • Slide 118
                                                                                                                • Slide 119
                                                                                                                • Slide 120
                                                                                                                • Slide 121

                                                                                                                  bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia

                                                                                                                  bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                                  Treatment of Hyperlipidemia

                                                                                                                  bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                                  bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                                  CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                  CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                  DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                  bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                  DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                  bull SYSTOLIC DYSFUNCTION

                                                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                  bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                  bull Pathophysiologybull 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

                                                                                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                  CARDIOMYOPATHIES

                                                                                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                  CARDIOMYOPATHIES

                                                                                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                  CARDIOMYOPATHIES

                                                                                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                  relief

                                                                                                                  CARDIOMYOPATHIES

                                                                                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                  CARDIOMYOPATHIES

                                                                                                                  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

                                                                                                                  Infective endocarditis

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

                                                                                                                  bull Can be acute or chronic

                                                                                                                  Infective endocarditis

                                                                                                                  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

                                                                                                                  Infective endocarditis

                                                                                                                  bull Pathophysiologybull 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

                                                                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                  Infective endocarditis

                                                                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                  retina

                                                                                                                  Infective endocarditis

                                                                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                  Infective endocarditis

                                                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                  Infective endocarditis

                                                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                  organism

                                                                                                                  Infective endocarditis

                                                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                  Infective endocarditis

                                                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                  B

                                                                                                                  Infective endocarditis

                                                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                                                  Normal is 4-10 cmH2O

                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                                  CARDIAC TAMPONADE

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

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                  anterior chest

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                  CARDIAC TAMPONADE

                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                  tamponade

                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                  HYPERTENSION

                                                                                                                  bull 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

                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                  Buergerrsquos Disease

                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                  reaction of the vessel wall

                                                                                                                  Manifestations

                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                  Diagnosis amp Treatment

                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                  (rare occasions)

                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                  A Assessment

                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                  2 vsB Nursing Dx

                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                  2 Impaired gas exchange

                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                  C Goals

                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                  D Nursing Interventions

                                                                                                                  1 Pain control

                                                                                                                  2 Proper medications

                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                  • Slide 2
                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                  • Pathophysiology
                                                                                                                  • Slide 5
                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                  • Pathophysiology
                                                                                                                  • Types
                                                                                                                  • Slide 12
                                                                                                                  • Slide 13
                                                                                                                  • Slide 14
                                                                                                                  • Conthellip
                                                                                                                  • Conthellip (2)
                                                                                                                  • Drug Therapy
                                                                                                                  • Classification
                                                                                                                  • Nursing Management
                                                                                                                  • Nursing Management (2)
                                                                                                                  • Acute Coronary Syndrome
                                                                                                                  • Slide 22
                                                                                                                  • Conthellip (3)
                                                                                                                  • Slide 24
                                                                                                                  • Conthellip(MI)
                                                                                                                  • Slide 26
                                                                                                                  • Pathophysiology (2)
                                                                                                                  • Tissue Changes After MI
                                                                                                                  • Management of MI
                                                                                                                  • Slide 30
                                                                                                                  • Slide 31
                                                                                                                  • ASSESSMENT
                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                  • NURSING CARE PLAN
                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                  • EVALUATION
                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                  • ASSESSMENT (2)
                                                                                                                  • ASSESSMENT (3)
                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                  • Slide 49
                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                  • EVALUATION
                                                                                                                  • Slide 56
                                                                                                                  • Slide 57
                                                                                                                  • Slide 58
                                                                                                                  • Slide 59
                                                                                                                  • Slide 60
                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                  • Slide 62
                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                  • Infective endocarditis
                                                                                                                  • Infective endocarditis (2)
                                                                                                                  • Infective endocarditis (3)
                                                                                                                  • Infective endocarditis (4)
                                                                                                                  • Infective endocarditis (5)
                                                                                                                  • Infective endocarditis (6)
                                                                                                                  • Infective endocarditis (7)
                                                                                                                  • Infective endocarditis (8)
                                                                                                                  • Infective endocarditis (9)
                                                                                                                  • Infective endocarditis (10)
                                                                                                                  • Infective endocarditis (11)
                                                                                                                  • Infective endocarditis (12)
                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                  • Slide 100
                                                                                                                  • HYPERTENSION
                                                                                                                  • HYPERTENSION (2)
                                                                                                                  • Slide 103
                                                                                                                  • Slide 104
                                                                                                                  • Slide 105
                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                  • Buergerrsquos Disease
                                                                                                                  • Slide 108
                                                                                                                  • Manifestations
                                                                                                                  • Slide 110
                                                                                                                  • Diagnosis amp Treatment
                                                                                                                  • Rynaudrsquos Disease
                                                                                                                  • Manifestations (2)
                                                                                                                  • Slide 114
                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                  • Slide 116
                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                  • Slide 118
                                                                                                                  • Slide 119
                                                                                                                  • Slide 120
                                                                                                                  • Slide 121

                                                                                                                    bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk

                                                                                                                    Treatment of Hyperlipidemia

                                                                                                                    bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                                    bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                                    CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                    CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                    DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                    bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                    DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                    bull SYSTOLIC DYSFUNCTION

                                                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                    bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                    HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                    bull Pathophysiologybull 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

                                                                                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                    CARDIOMYOPATHIES

                                                                                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                    CARDIOMYOPATHIES

                                                                                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                    CARDIOMYOPATHIES

                                                                                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                    relief

                                                                                                                    CARDIOMYOPATHIES

                                                                                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                    CARDIOMYOPATHIES

                                                                                                                    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

                                                                                                                    Infective endocarditis

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

                                                                                                                    bull Can be acute or chronic

                                                                                                                    Infective endocarditis

                                                                                                                    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

                                                                                                                    Infective endocarditis

                                                                                                                    bull Pathophysiologybull 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

                                                                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                    Infective endocarditis

                                                                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                    retina

                                                                                                                    Infective endocarditis

                                                                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                    Infective endocarditis

                                                                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                    Infective endocarditis

                                                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                    organism

                                                                                                                    Infective endocarditis

                                                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                    Infective endocarditis

                                                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                    B

                                                                                                                    Infective endocarditis

                                                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                                                    Normal is 4-10 cmH2O

                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                                    CARDIAC TAMPONADE

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

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                    anterior chest

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                    CARDIAC TAMPONADE

                                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                    tamponade

                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                    HYPERTENSION

                                                                                                                    bull 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

                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                    Buergerrsquos Disease

                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                    reaction of the vessel wall

                                                                                                                    Manifestations

                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                    Diagnosis amp Treatment

                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                    (rare occasions)

                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                    A Assessment

                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                    2 vsB Nursing Dx

                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                    2 Impaired gas exchange

                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                    C Goals

                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                    D Nursing Interventions

                                                                                                                    1 Pain control

                                                                                                                    2 Proper medications

                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                    • Slide 2
                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                    • Pathophysiology
                                                                                                                    • Slide 5
                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                    • Pathophysiology
                                                                                                                    • Types
                                                                                                                    • Slide 12
                                                                                                                    • Slide 13
                                                                                                                    • Slide 14
                                                                                                                    • Conthellip
                                                                                                                    • Conthellip (2)
                                                                                                                    • Drug Therapy
                                                                                                                    • Classification
                                                                                                                    • Nursing Management
                                                                                                                    • Nursing Management (2)
                                                                                                                    • Acute Coronary Syndrome
                                                                                                                    • Slide 22
                                                                                                                    • Conthellip (3)
                                                                                                                    • Slide 24
                                                                                                                    • Conthellip(MI)
                                                                                                                    • Slide 26
                                                                                                                    • Pathophysiology (2)
                                                                                                                    • Tissue Changes After MI
                                                                                                                    • Management of MI
                                                                                                                    • Slide 30
                                                                                                                    • Slide 31
                                                                                                                    • ASSESSMENT
                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                    • NURSING CARE PLAN
                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                    • EVALUATION
                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                    • ASSESSMENT (2)
                                                                                                                    • ASSESSMENT (3)
                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                    • Slide 49
                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                    • EVALUATION
                                                                                                                    • Slide 56
                                                                                                                    • Slide 57
                                                                                                                    • Slide 58
                                                                                                                    • Slide 59
                                                                                                                    • Slide 60
                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                    • Slide 62
                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                    • Infective endocarditis
                                                                                                                    • Infective endocarditis (2)
                                                                                                                    • Infective endocarditis (3)
                                                                                                                    • Infective endocarditis (4)
                                                                                                                    • Infective endocarditis (5)
                                                                                                                    • Infective endocarditis (6)
                                                                                                                    • Infective endocarditis (7)
                                                                                                                    • Infective endocarditis (8)
                                                                                                                    • Infective endocarditis (9)
                                                                                                                    • Infective endocarditis (10)
                                                                                                                    • Infective endocarditis (11)
                                                                                                                    • Infective endocarditis (12)
                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                    • Slide 100
                                                                                                                    • HYPERTENSION
                                                                                                                    • HYPERTENSION (2)
                                                                                                                    • Slide 103
                                                                                                                    • Slide 104
                                                                                                                    • Slide 105
                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                    • Buergerrsquos Disease
                                                                                                                    • Slide 108
                                                                                                                    • Manifestations
                                                                                                                    • Slide 110
                                                                                                                    • Diagnosis amp Treatment
                                                                                                                    • Rynaudrsquos Disease
                                                                                                                    • Manifestations (2)
                                                                                                                    • Slide 114
                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                    • Slide 116
                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                    • Slide 118
                                                                                                                    • Slide 119
                                                                                                                    • Slide 120
                                                                                                                    • Slide 121

                                                                                                                      Treatment of Hyperlipidemia

                                                                                                                      bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary

                                                                                                                      bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                                      CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                      CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                      DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                      bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                      DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                      bull SYSTOLIC DYSFUNCTION

                                                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                      bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                      HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                      bull Pathophysiologybull 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

                                                                                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                      CARDIOMYOPATHIES

                                                                                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                      CARDIOMYOPATHIES

                                                                                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                      CARDIOMYOPATHIES

                                                                                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                      relief

                                                                                                                      CARDIOMYOPATHIES

                                                                                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                      CARDIOMYOPATHIES

                                                                                                                      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

                                                                                                                      Infective endocarditis

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

                                                                                                                      bull Can be acute or chronic

                                                                                                                      Infective endocarditis

                                                                                                                      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

                                                                                                                      Infective endocarditis

                                                                                                                      bull Pathophysiologybull 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

                                                                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                      Infective endocarditis

                                                                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                      retina

                                                                                                                      Infective endocarditis

                                                                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                      Infective endocarditis

                                                                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                      Infective endocarditis

                                                                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                      organism

                                                                                                                      Infective endocarditis

                                                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                      Infective endocarditis

                                                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                      B

                                                                                                                      Infective endocarditis

                                                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                                                      Normal is 4-10 cmH2O

                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                                                      CARDIOGENIC SHOCK

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

                                                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                                                      CARDIAC TAMPONADE

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

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                      anterior chest

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                      CARDIAC TAMPONADE

                                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                      tamponade

                                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                      HYPERTENSION

                                                                                                                      bull 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

                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                      Buergerrsquos Disease

                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                      reaction of the vessel wall

                                                                                                                      Manifestations

                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                      Diagnosis amp Treatment

                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                      (rare occasions)

                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                      A Assessment

                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                      2 vsB Nursing Dx

                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                      2 Impaired gas exchange

                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                      C Goals

                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                      D Nursing Interventions

                                                                                                                      1 Pain control

                                                                                                                      2 Proper medications

                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                      • Slide 2
                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                      • Pathophysiology
                                                                                                                      • Slide 5
                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                      • Pathophysiology
                                                                                                                      • Types
                                                                                                                      • Slide 12
                                                                                                                      • Slide 13
                                                                                                                      • Slide 14
                                                                                                                      • Conthellip
                                                                                                                      • Conthellip (2)
                                                                                                                      • Drug Therapy
                                                                                                                      • Classification
                                                                                                                      • Nursing Management
                                                                                                                      • Nursing Management (2)
                                                                                                                      • Acute Coronary Syndrome
                                                                                                                      • Slide 22
                                                                                                                      • Conthellip (3)
                                                                                                                      • Slide 24
                                                                                                                      • Conthellip(MI)
                                                                                                                      • Slide 26
                                                                                                                      • Pathophysiology (2)
                                                                                                                      • Tissue Changes After MI
                                                                                                                      • Management of MI
                                                                                                                      • Slide 30
                                                                                                                      • Slide 31
                                                                                                                      • ASSESSMENT
                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                      • NURSING CARE PLAN
                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                      • EVALUATION
                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                      • ASSESSMENT (2)
                                                                                                                      • ASSESSMENT (3)
                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                      • Slide 49
                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                      • EVALUATION
                                                                                                                      • Slide 56
                                                                                                                      • Slide 57
                                                                                                                      • Slide 58
                                                                                                                      • Slide 59
                                                                                                                      • Slide 60
                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                      • Slide 62
                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                      • Infective endocarditis
                                                                                                                      • Infective endocarditis (2)
                                                                                                                      • Infective endocarditis (3)
                                                                                                                      • Infective endocarditis (4)
                                                                                                                      • Infective endocarditis (5)
                                                                                                                      • Infective endocarditis (6)
                                                                                                                      • Infective endocarditis (7)
                                                                                                                      • Infective endocarditis (8)
                                                                                                                      • Infective endocarditis (9)
                                                                                                                      • Infective endocarditis (10)
                                                                                                                      • Infective endocarditis (11)
                                                                                                                      • Infective endocarditis (12)
                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                      • Slide 100
                                                                                                                      • HYPERTENSION
                                                                                                                      • HYPERTENSION (2)
                                                                                                                      • Slide 103
                                                                                                                      • Slide 104
                                                                                                                      • Slide 105
                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                      • Buergerrsquos Disease
                                                                                                                      • Slide 108
                                                                                                                      • Manifestations
                                                                                                                      • Slide 110
                                                                                                                      • Diagnosis amp Treatment
                                                                                                                      • Rynaudrsquos Disease
                                                                                                                      • Manifestations (2)
                                                                                                                      • Slide 114
                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                      • Slide 116
                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                      • Slide 118
                                                                                                                      • Slide 119
                                                                                                                      • Slide 120
                                                                                                                      • Slide 121

                                                                                                                        bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body

                                                                                                                        CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                        CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                        DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                        bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                        DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                        bull SYSTOLIC DYSFUNCTION

                                                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                        bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                        HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                        bull Pathophysiologybull 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

                                                                                                                        RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                        bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                        CARDIOMYOPATHIES

                                                                                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                        CARDIOMYOPATHIES

                                                                                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                        CARDIOMYOPATHIES

                                                                                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                        relief

                                                                                                                        CARDIOMYOPATHIES

                                                                                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                        CARDIOMYOPATHIES

                                                                                                                        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

                                                                                                                        Infective endocarditis

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

                                                                                                                        bull Can be acute or chronic

                                                                                                                        Infective endocarditis

                                                                                                                        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

                                                                                                                        Infective endocarditis

                                                                                                                        bull Pathophysiologybull 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

                                                                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                        Infective endocarditis

                                                                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                        retina

                                                                                                                        Infective endocarditis

                                                                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                        Infective endocarditis

                                                                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                        Infective endocarditis

                                                                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                        organism

                                                                                                                        Infective endocarditis

                                                                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                        Infective endocarditis

                                                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                        B

                                                                                                                        Infective endocarditis

                                                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                                                        Normal is 4-10 cmH2O

                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                                                        CARDIOGENIC SHOCK

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

                                                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                                                        CARDIAC TAMPONADE

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

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                        anterior chest

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                        CARDIAC TAMPONADE

                                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                        tamponade

                                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                        HYPERTENSION

                                                                                                                        bull 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

                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                        Buergerrsquos Disease

                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                        reaction of the vessel wall

                                                                                                                        Manifestations

                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                        Diagnosis amp Treatment

                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                        (rare occasions)

                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                        A Assessment

                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                        2 vsB Nursing Dx

                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                        2 Impaired gas exchange

                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                        C Goals

                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                        D Nursing Interventions

                                                                                                                        1 Pain control

                                                                                                                        2 Proper medications

                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                        • Slide 2
                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                        • Pathophysiology
                                                                                                                        • Slide 5
                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                        • Pathophysiology
                                                                                                                        • Types
                                                                                                                        • Slide 12
                                                                                                                        • Slide 13
                                                                                                                        • Slide 14
                                                                                                                        • Conthellip
                                                                                                                        • Conthellip (2)
                                                                                                                        • Drug Therapy
                                                                                                                        • Classification
                                                                                                                        • Nursing Management
                                                                                                                        • Nursing Management (2)
                                                                                                                        • Acute Coronary Syndrome
                                                                                                                        • Slide 22
                                                                                                                        • Conthellip (3)
                                                                                                                        • Slide 24
                                                                                                                        • Conthellip(MI)
                                                                                                                        • Slide 26
                                                                                                                        • Pathophysiology (2)
                                                                                                                        • Tissue Changes After MI
                                                                                                                        • Management of MI
                                                                                                                        • Slide 30
                                                                                                                        • Slide 31
                                                                                                                        • ASSESSMENT
                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                        • NURSING CARE PLAN
                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                        • EVALUATION
                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                        • ASSESSMENT (2)
                                                                                                                        • ASSESSMENT (3)
                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                        • Slide 49
                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                        • EVALUATION
                                                                                                                        • Slide 56
                                                                                                                        • Slide 57
                                                                                                                        • Slide 58
                                                                                                                        • Slide 59
                                                                                                                        • Slide 60
                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                        • Slide 62
                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                        • Infective endocarditis
                                                                                                                        • Infective endocarditis (2)
                                                                                                                        • Infective endocarditis (3)
                                                                                                                        • Infective endocarditis (4)
                                                                                                                        • Infective endocarditis (5)
                                                                                                                        • Infective endocarditis (6)
                                                                                                                        • Infective endocarditis (7)
                                                                                                                        • Infective endocarditis (8)
                                                                                                                        • Infective endocarditis (9)
                                                                                                                        • Infective endocarditis (10)
                                                                                                                        • Infective endocarditis (11)
                                                                                                                        • Infective endocarditis (12)
                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                        • Slide 100
                                                                                                                        • HYPERTENSION
                                                                                                                        • HYPERTENSION (2)
                                                                                                                        • Slide 103
                                                                                                                        • Slide 104
                                                                                                                        • Slide 105
                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                        • Buergerrsquos Disease
                                                                                                                        • Slide 108
                                                                                                                        • Manifestations
                                                                                                                        • Slide 110
                                                                                                                        • Diagnosis amp Treatment
                                                                                                                        • Rynaudrsquos Disease
                                                                                                                        • Manifestations (2)
                                                                                                                        • Slide 114
                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                        • Slide 116
                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                        • Slide 118
                                                                                                                        • Slide 119
                                                                                                                        • Slide 120
                                                                                                                        • Slide 121

                                                                                                                          CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction

                                                                                                                          CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy

                                                                                                                          DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                          bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                          DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                          bull SYSTOLIC DYSFUNCTION

                                                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                          bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                          HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                          bull Pathophysiologybull 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

                                                                                                                          RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                          bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                          CARDIOMYOPATHIES

                                                                                                                          bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                          CARDIOMYOPATHIES

                                                                                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                          CARDIOMYOPATHIES

                                                                                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                          relief

                                                                                                                          CARDIOMYOPATHIES

                                                                                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                          CARDIOMYOPATHIES

                                                                                                                          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

                                                                                                                          Infective endocarditis

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

                                                                                                                          bull Can be acute or chronic

                                                                                                                          Infective endocarditis

                                                                                                                          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

                                                                                                                          Infective endocarditis

                                                                                                                          bull Pathophysiologybull 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

                                                                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                          Infective endocarditis

                                                                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                          retina

                                                                                                                          Infective endocarditis

                                                                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                          Infective endocarditis

                                                                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                          Infective endocarditis

                                                                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                          organism

                                                                                                                          Infective endocarditis

                                                                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                          Infective endocarditis

                                                                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                          B

                                                                                                                          Infective endocarditis

                                                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                                                          Normal is 4-10 cmH2O

                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                                                          CARDIOGENIC SHOCK

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

                                                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                                                          CARDIAC TAMPONADE

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

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                          anterior chest

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                          CARDIAC TAMPONADE

                                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                          tamponade

                                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                          HYPERTENSION

                                                                                                                          bull 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

                                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                          bull Most common typebull 2 Secondary

                                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                          Buergerrsquos Disease

                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                          reaction of the vessel wall

                                                                                                                          Manifestations

                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                          Diagnosis amp Treatment

                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                          (rare occasions)

                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                          A Assessment

                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                          2 vsB Nursing Dx

                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                          2 Impaired gas exchange

                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                          C Goals

                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                          D Nursing Interventions

                                                                                                                          1 Pain control

                                                                                                                          2 Proper medications

                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                          • Slide 2
                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                          • Pathophysiology
                                                                                                                          • Slide 5
                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                          • Pathophysiology
                                                                                                                          • Types
                                                                                                                          • Slide 12
                                                                                                                          • Slide 13
                                                                                                                          • Slide 14
                                                                                                                          • Conthellip
                                                                                                                          • Conthellip (2)
                                                                                                                          • Drug Therapy
                                                                                                                          • Classification
                                                                                                                          • Nursing Management
                                                                                                                          • Nursing Management (2)
                                                                                                                          • Acute Coronary Syndrome
                                                                                                                          • Slide 22
                                                                                                                          • Conthellip (3)
                                                                                                                          • Slide 24
                                                                                                                          • Conthellip(MI)
                                                                                                                          • Slide 26
                                                                                                                          • Pathophysiology (2)
                                                                                                                          • Tissue Changes After MI
                                                                                                                          • Management of MI
                                                                                                                          • Slide 30
                                                                                                                          • Slide 31
                                                                                                                          • ASSESSMENT
                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                          • NURSING CARE PLAN
                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                          • EVALUATION
                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                          • ASSESSMENT (2)
                                                                                                                          • ASSESSMENT (3)
                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                          • Slide 49
                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                          • EVALUATION
                                                                                                                          • Slide 56
                                                                                                                          • Slide 57
                                                                                                                          • Slide 58
                                                                                                                          • Slide 59
                                                                                                                          • Slide 60
                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                          • Slide 62
                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                          • Infective endocarditis
                                                                                                                          • Infective endocarditis (2)
                                                                                                                          • Infective endocarditis (3)
                                                                                                                          • Infective endocarditis (4)
                                                                                                                          • Infective endocarditis (5)
                                                                                                                          • Infective endocarditis (6)
                                                                                                                          • Infective endocarditis (7)
                                                                                                                          • Infective endocarditis (8)
                                                                                                                          • Infective endocarditis (9)
                                                                                                                          • Infective endocarditis (10)
                                                                                                                          • Infective endocarditis (11)
                                                                                                                          • Infective endocarditis (12)
                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                          • Slide 100
                                                                                                                          • HYPERTENSION
                                                                                                                          • HYPERTENSION (2)
                                                                                                                          • Slide 103
                                                                                                                          • Slide 104
                                                                                                                          • Slide 105
                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                          • Buergerrsquos Disease
                                                                                                                          • Slide 108
                                                                                                                          • Manifestations
                                                                                                                          • Slide 110
                                                                                                                          • Diagnosis amp Treatment
                                                                                                                          • Rynaudrsquos Disease
                                                                                                                          • Manifestations (2)
                                                                                                                          • Slide 114
                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                          • Slide 116
                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                          • Slide 118
                                                                                                                          • Slide 119
                                                                                                                          • Slide 120
                                                                                                                          • Slide 121

                                                                                                                            DILATED CARDIOMYOPATHY ASSOCIATED FACTORS

                                                                                                                            bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic

                                                                                                                            DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                            bull SYSTOLIC DYSFUNCTION

                                                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                            bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                            HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                            bull Pathophysiologybull 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

                                                                                                                            RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                            bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                            CARDIOMYOPATHIES

                                                                                                                            bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                            CARDIOMYOPATHIES

                                                                                                                            bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                            CARDIOMYOPATHIES

                                                                                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                            relief

                                                                                                                            CARDIOMYOPATHIES

                                                                                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                            CARDIOMYOPATHIES

                                                                                                                            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

                                                                                                                            Infective endocarditis

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

                                                                                                                            bull Can be acute or chronic

                                                                                                                            Infective endocarditis

                                                                                                                            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

                                                                                                                            Infective endocarditis

                                                                                                                            bull Pathophysiologybull 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

                                                                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                            Infective endocarditis

                                                                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                            retina

                                                                                                                            Infective endocarditis

                                                                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                            Infective endocarditis

                                                                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                            Infective endocarditis

                                                                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                            organism

                                                                                                                            Infective endocarditis

                                                                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                            Infective endocarditis

                                                                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                            B

                                                                                                                            Infective endocarditis

                                                                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                                                            Normal is 4-10 cmH2O

                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                                                            CARDIOGENIC SHOCK

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

                                                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                                                            CARDIAC TAMPONADE

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

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                            anterior chest

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                            CARDIAC TAMPONADE

                                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                            tamponade

                                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                            HYPERTENSION

                                                                                                                            bull 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

                                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                            bull Most common typebull 2 Secondary

                                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                                            Buergerrsquos Disease

                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                            reaction of the vessel wall

                                                                                                                            Manifestations

                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                            Diagnosis amp Treatment

                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                            (rare occasions)

                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                            A Assessment

                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                            2 vsB Nursing Dx

                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                            2 Impaired gas exchange

                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                            C Goals

                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                            D Nursing Interventions

                                                                                                                            1 Pain control

                                                                                                                            2 Proper medications

                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                            • Slide 2
                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                            • Pathophysiology
                                                                                                                            • Slide 5
                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                            • Pathophysiology
                                                                                                                            • Types
                                                                                                                            • Slide 12
                                                                                                                            • Slide 13
                                                                                                                            • Slide 14
                                                                                                                            • Conthellip
                                                                                                                            • Conthellip (2)
                                                                                                                            • Drug Therapy
                                                                                                                            • Classification
                                                                                                                            • Nursing Management
                                                                                                                            • Nursing Management (2)
                                                                                                                            • Acute Coronary Syndrome
                                                                                                                            • Slide 22
                                                                                                                            • Conthellip (3)
                                                                                                                            • Slide 24
                                                                                                                            • Conthellip(MI)
                                                                                                                            • Slide 26
                                                                                                                            • Pathophysiology (2)
                                                                                                                            • Tissue Changes After MI
                                                                                                                            • Management of MI
                                                                                                                            • Slide 30
                                                                                                                            • Slide 31
                                                                                                                            • ASSESSMENT
                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                            • NURSING CARE PLAN
                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                            • EVALUATION
                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                            • ASSESSMENT (2)
                                                                                                                            • ASSESSMENT (3)
                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                            • Slide 49
                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                            • EVALUATION
                                                                                                                            • Slide 56
                                                                                                                            • Slide 57
                                                                                                                            • Slide 58
                                                                                                                            • Slide 59
                                                                                                                            • Slide 60
                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                            • Slide 62
                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                            • Infective endocarditis
                                                                                                                            • Infective endocarditis (2)
                                                                                                                            • Infective endocarditis (3)
                                                                                                                            • Infective endocarditis (4)
                                                                                                                            • Infective endocarditis (5)
                                                                                                                            • Infective endocarditis (6)
                                                                                                                            • Infective endocarditis (7)
                                                                                                                            • Infective endocarditis (8)
                                                                                                                            • Infective endocarditis (9)
                                                                                                                            • Infective endocarditis (10)
                                                                                                                            • Infective endocarditis (11)
                                                                                                                            • Infective endocarditis (12)
                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                            • Slide 100
                                                                                                                            • HYPERTENSION
                                                                                                                            • HYPERTENSION (2)
                                                                                                                            • Slide 103
                                                                                                                            • Slide 104
                                                                                                                            • Slide 105
                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                            • Buergerrsquos Disease
                                                                                                                            • Slide 108
                                                                                                                            • Manifestations
                                                                                                                            • Slide 110
                                                                                                                            • Diagnosis amp Treatment
                                                                                                                            • Rynaudrsquos Disease
                                                                                                                            • Manifestations (2)
                                                                                                                            • Slide 114
                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                            • Slide 116
                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                            • Slide 118
                                                                                                                            • Slide 119
                                                                                                                            • Slide 120
                                                                                                                            • Slide 121

                                                                                                                              DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY

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

                                                                                                                              bull SYSTOLIC DYSFUNCTION

                                                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                              bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                              HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                              bull Pathophysiologybull 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

                                                                                                                              RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                              bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                              CARDIOMYOPATHIES

                                                                                                                              bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                              CARDIOMYOPATHIES

                                                                                                                              bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                              CARDIOMYOPATHIES

                                                                                                                              bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                              relief

                                                                                                                              CARDIOMYOPATHIES

                                                                                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                              CARDIOMYOPATHIES

                                                                                                                              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

                                                                                                                              Infective endocarditis

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

                                                                                                                              bull Can be acute or chronic

                                                                                                                              Infective endocarditis

                                                                                                                              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

                                                                                                                              Infective endocarditis

                                                                                                                              bull Pathophysiologybull 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

                                                                                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                              Infective endocarditis

                                                                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                              retina

                                                                                                                              Infective endocarditis

                                                                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                              Infective endocarditis

                                                                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                              Infective endocarditis

                                                                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                              organism

                                                                                                                              Infective endocarditis

                                                                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                              Infective endocarditis

                                                                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                              B

                                                                                                                              Infective endocarditis

                                                                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                                                              Normal is 4-10 cmH2O

                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                                                              CARDIOGENIC SHOCK

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

                                                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                                                              CARDIAC TAMPONADE

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

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                              distention hypotension and distantmuffled heart sound

                                                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                              anterior chest

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                              CARDIAC TAMPONADE

                                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                              tamponade

                                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                              HYPERTENSION

                                                                                                                              bull 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

                                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                              bull Most common typebull 2 Secondary

                                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                                              Buergerrsquos Disease

                                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                              reaction of the vessel wall

                                                                                                                              Manifestations

                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                              Diagnosis amp Treatment

                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                              (rare occasions)

                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                              A Assessment

                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                              2 vsB Nursing Dx

                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                              2 Impaired gas exchange

                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                              C Goals

                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                              D Nursing Interventions

                                                                                                                              1 Pain control

                                                                                                                              2 Proper medications

                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                              • Slide 2
                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                              • Pathophysiology
                                                                                                                              • Slide 5
                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                              • Pathophysiology
                                                                                                                              • Types
                                                                                                                              • Slide 12
                                                                                                                              • Slide 13
                                                                                                                              • Slide 14
                                                                                                                              • Conthellip
                                                                                                                              • Conthellip (2)
                                                                                                                              • Drug Therapy
                                                                                                                              • Classification
                                                                                                                              • Nursing Management
                                                                                                                              • Nursing Management (2)
                                                                                                                              • Acute Coronary Syndrome
                                                                                                                              • Slide 22
                                                                                                                              • Conthellip (3)
                                                                                                                              • Slide 24
                                                                                                                              • Conthellip(MI)
                                                                                                                              • Slide 26
                                                                                                                              • Pathophysiology (2)
                                                                                                                              • Tissue Changes After MI
                                                                                                                              • Management of MI
                                                                                                                              • Slide 30
                                                                                                                              • Slide 31
                                                                                                                              • ASSESSMENT
                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                              • NURSING CARE PLAN
                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                              • EVALUATION
                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                              • ASSESSMENT (2)
                                                                                                                              • ASSESSMENT (3)
                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                              • Slide 49
                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                              • EVALUATION
                                                                                                                              • Slide 56
                                                                                                                              • Slide 57
                                                                                                                              • Slide 58
                                                                                                                              • Slide 59
                                                                                                                              • Slide 60
                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                              • Slide 62
                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                              • Infective endocarditis
                                                                                                                              • Infective endocarditis (2)
                                                                                                                              • Infective endocarditis (3)
                                                                                                                              • Infective endocarditis (4)
                                                                                                                              • Infective endocarditis (5)
                                                                                                                              • Infective endocarditis (6)
                                                                                                                              • Infective endocarditis (7)
                                                                                                                              • Infective endocarditis (8)
                                                                                                                              • Infective endocarditis (9)
                                                                                                                              • Infective endocarditis (10)
                                                                                                                              • Infective endocarditis (11)
                                                                                                                              • Infective endocarditis (12)
                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                              • Slide 100
                                                                                                                              • HYPERTENSION
                                                                                                                              • HYPERTENSION (2)
                                                                                                                              • Slide 103
                                                                                                                              • Slide 104
                                                                                                                              • Slide 105
                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                              • Buergerrsquos Disease
                                                                                                                              • Slide 108
                                                                                                                              • Manifestations
                                                                                                                              • Slide 110
                                                                                                                              • Diagnosis amp Treatment
                                                                                                                              • Rynaudrsquos Disease
                                                                                                                              • Manifestations (2)
                                                                                                                              • Slide 114
                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                              • Slide 116
                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                              • Slide 118
                                                                                                                              • Slide 119
                                                                                                                              • Slide 120
                                                                                                                              • Slide 121

                                                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                                bull Associated factorsbull 1 Geneticbull 2 Idiopathic

                                                                                                                                HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                                bull Pathophysiologybull 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

                                                                                                                                RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                                bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                relief

                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                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

                                                                                                                                Infective endocarditis

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

                                                                                                                                bull Can be acute or chronic

                                                                                                                                Infective endocarditis

                                                                                                                                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

                                                                                                                                Infective endocarditis

                                                                                                                                bull Pathophysiologybull 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

                                                                                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                Infective endocarditis

                                                                                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                retina

                                                                                                                                Infective endocarditis

                                                                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                Infective endocarditis

                                                                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                Infective endocarditis

                                                                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                organism

                                                                                                                                Infective endocarditis

                                                                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                Infective endocarditis

                                                                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                B

                                                                                                                                Infective endocarditis

                                                                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                Normal is 4-10 cmH2O

                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                                                CARDIOGENIC SHOCK

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

                                                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                                                CARDIAC TAMPONADE

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

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                anterior chest

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                tamponade

                                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                HYPERTENSION

                                                                                                                                bull 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

                                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                Buergerrsquos Disease

                                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                reaction of the vessel wall

                                                                                                                                Manifestations

                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                Diagnosis amp Treatment

                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                (rare occasions)

                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                A Assessment

                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                2 vsB Nursing Dx

                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                2 Impaired gas exchange

                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                C Goals

                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                D Nursing Interventions

                                                                                                                                1 Pain control

                                                                                                                                2 Proper medications

                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                • Slide 2
                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                • Pathophysiology
                                                                                                                                • Slide 5
                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                • Pathophysiology
                                                                                                                                • Types
                                                                                                                                • Slide 12
                                                                                                                                • Slide 13
                                                                                                                                • Slide 14
                                                                                                                                • Conthellip
                                                                                                                                • Conthellip (2)
                                                                                                                                • Drug Therapy
                                                                                                                                • Classification
                                                                                                                                • Nursing Management
                                                                                                                                • Nursing Management (2)
                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                • Slide 22
                                                                                                                                • Conthellip (3)
                                                                                                                                • Slide 24
                                                                                                                                • Conthellip(MI)
                                                                                                                                • Slide 26
                                                                                                                                • Pathophysiology (2)
                                                                                                                                • Tissue Changes After MI
                                                                                                                                • Management of MI
                                                                                                                                • Slide 30
                                                                                                                                • Slide 31
                                                                                                                                • ASSESSMENT
                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                • NURSING CARE PLAN
                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                • EVALUATION
                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                • ASSESSMENT (2)
                                                                                                                                • ASSESSMENT (3)
                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                • Slide 49
                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                • EVALUATION
                                                                                                                                • Slide 56
                                                                                                                                • Slide 57
                                                                                                                                • Slide 58
                                                                                                                                • Slide 59
                                                                                                                                • Slide 60
                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                • Slide 62
                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                • Infective endocarditis
                                                                                                                                • Infective endocarditis (2)
                                                                                                                                • Infective endocarditis (3)
                                                                                                                                • Infective endocarditis (4)
                                                                                                                                • Infective endocarditis (5)
                                                                                                                                • Infective endocarditis (6)
                                                                                                                                • Infective endocarditis (7)
                                                                                                                                • Infective endocarditis (8)
                                                                                                                                • Infective endocarditis (9)
                                                                                                                                • Infective endocarditis (10)
                                                                                                                                • Infective endocarditis (11)
                                                                                                                                • Infective endocarditis (12)
                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                • Slide 100
                                                                                                                                • HYPERTENSION
                                                                                                                                • HYPERTENSION (2)
                                                                                                                                • Slide 103
                                                                                                                                • Slide 104
                                                                                                                                • Slide 105
                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                • Buergerrsquos Disease
                                                                                                                                • Slide 108
                                                                                                                                • Manifestations
                                                                                                                                • Slide 110
                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                • Manifestations (2)
                                                                                                                                • Slide 114
                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                • Slide 116
                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                • Slide 118
                                                                                                                                • Slide 119
                                                                                                                                • Slide 120
                                                                                                                                • Slide 121

                                                                                                                                  HYPERTROPHIC CARDIOMYOPATHY

                                                                                                                                  bull Pathophysiologybull 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

                                                                                                                                  RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                                  bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                  bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                  bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                  bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                  relief

                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                  bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                  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

                                                                                                                                  Infective endocarditis

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

                                                                                                                                  bull Can be acute or chronic

                                                                                                                                  Infective endocarditis

                                                                                                                                  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

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Pathophysiologybull 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

                                                                                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                  retina

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                  organism

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                  B

                                                                                                                                  Infective endocarditis

                                                                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                  Normal is 4-10 cmH2O

                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                                                  CARDIAC TAMPONADE

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

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                  anterior chest

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                  tamponade

                                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                  HYPERTENSION

                                                                                                                                  bull 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

                                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                  Buergerrsquos Disease

                                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                  reaction of the vessel wall

                                                                                                                                  Manifestations

                                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                  (rare occasions)

                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                  A Assessment

                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                  2 Impaired gas exchange

                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                  C Goals

                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                  D Nursing Interventions

                                                                                                                                  1 Pain control

                                                                                                                                  2 Proper medications

                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                  • Slide 2
                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                  • Pathophysiology
                                                                                                                                  • Slide 5
                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                  • Pathophysiology
                                                                                                                                  • Types
                                                                                                                                  • Slide 12
                                                                                                                                  • Slide 13
                                                                                                                                  • Slide 14
                                                                                                                                  • Conthellip
                                                                                                                                  • Conthellip (2)
                                                                                                                                  • Drug Therapy
                                                                                                                                  • Classification
                                                                                                                                  • Nursing Management
                                                                                                                                  • Nursing Management (2)
                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                  • Slide 22
                                                                                                                                  • Conthellip (3)
                                                                                                                                  • Slide 24
                                                                                                                                  • Conthellip(MI)
                                                                                                                                  • Slide 26
                                                                                                                                  • Pathophysiology (2)
                                                                                                                                  • Tissue Changes After MI
                                                                                                                                  • Management of MI
                                                                                                                                  • Slide 30
                                                                                                                                  • Slide 31
                                                                                                                                  • ASSESSMENT
                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                  • EVALUATION
                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                  • Slide 49
                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                  • EVALUATION
                                                                                                                                  • Slide 56
                                                                                                                                  • Slide 57
                                                                                                                                  • Slide 58
                                                                                                                                  • Slide 59
                                                                                                                                  • Slide 60
                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                  • Slide 62
                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                  • Infective endocarditis
                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                  • Slide 100
                                                                                                                                  • HYPERTENSION
                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                  • Slide 103
                                                                                                                                  • Slide 104
                                                                                                                                  • Slide 105
                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                  • Slide 108
                                                                                                                                  • Manifestations
                                                                                                                                  • Slide 110
                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                  • Manifestations (2)
                                                                                                                                  • Slide 114
                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                  • Slide 116
                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                  • Slide 118
                                                                                                                                  • Slide 119
                                                                                                                                  • Slide 120
                                                                                                                                  • Slide 121

                                                                                                                                    RESTRICTIVE CARDIOMYOPATHY

                                                                                                                                    Associated factors

                                                                                                                                    1 Infiltrative diseases like AMYLOIDOSIS

                                                                                                                                    2 Idiopathic

                                                                                                                                    RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                                    bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                                    CARDIOMYOPATHIES

                                                                                                                                    bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                                    CARDIOMYOPATHIES

                                                                                                                                    bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                    CARDIOMYOPATHIES

                                                                                                                                    bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                    relief

                                                                                                                                    CARDIOMYOPATHIES

                                                                                                                                    bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                    CARDIOMYOPATHIES

                                                                                                                                    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

                                                                                                                                    Infective endocarditis

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

                                                                                                                                    bull Can be acute or chronic

                                                                                                                                    Infective endocarditis

                                                                                                                                    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

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Pathophysiologybull 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

                                                                                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                    retina

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                    organism

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                    B

                                                                                                                                    Infective endocarditis

                                                                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                    Normal is 4-10 cmH2O

                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                                                    CARDIAC TAMPONADE

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

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                    anterior chest

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                    tamponade

                                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                    HYPERTENSION

                                                                                                                                    bull 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

                                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                    Buergerrsquos Disease

                                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                    reaction of the vessel wall

                                                                                                                                    Manifestations

                                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                    (rare occasions)

                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                    A Assessment

                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                    2 Impaired gas exchange

                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                    C Goals

                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                    D Nursing Interventions

                                                                                                                                    1 Pain control

                                                                                                                                    2 Proper medications

                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                    • Slide 2
                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                    • Pathophysiology
                                                                                                                                    • Slide 5
                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                    • Pathophysiology
                                                                                                                                    • Types
                                                                                                                                    • Slide 12
                                                                                                                                    • Slide 13
                                                                                                                                    • Slide 14
                                                                                                                                    • Conthellip
                                                                                                                                    • Conthellip (2)
                                                                                                                                    • Drug Therapy
                                                                                                                                    • Classification
                                                                                                                                    • Nursing Management
                                                                                                                                    • Nursing Management (2)
                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                    • Slide 22
                                                                                                                                    • Conthellip (3)
                                                                                                                                    • Slide 24
                                                                                                                                    • Conthellip(MI)
                                                                                                                                    • Slide 26
                                                                                                                                    • Pathophysiology (2)
                                                                                                                                    • Tissue Changes After MI
                                                                                                                                    • Management of MI
                                                                                                                                    • Slide 30
                                                                                                                                    • Slide 31
                                                                                                                                    • ASSESSMENT
                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                    • EVALUATION
                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                    • Slide 49
                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                    • EVALUATION
                                                                                                                                    • Slide 56
                                                                                                                                    • Slide 57
                                                                                                                                    • Slide 58
                                                                                                                                    • Slide 59
                                                                                                                                    • Slide 60
                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                    • Slide 62
                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                    • Infective endocarditis
                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                    • Slide 100
                                                                                                                                    • HYPERTENSION
                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                    • Slide 103
                                                                                                                                    • Slide 104
                                                                                                                                    • Slide 105
                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                    • Slide 108
                                                                                                                                    • Manifestations
                                                                                                                                    • Slide 110
                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                    • Manifestations (2)
                                                                                                                                    • Slide 114
                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                    • Slide 116
                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                    • Slide 118
                                                                                                                                    • Slide 119
                                                                                                                                    • Slide 120
                                                                                                                                    • Slide 121

                                                                                                                                      RESTRICTIVE CARDIOMYOPATHYPathophysiology

                                                                                                                                      bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction

                                                                                                                                      CARDIOMYOPATHIES

                                                                                                                                      bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                                      CARDIOMYOPATHIES

                                                                                                                                      bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                      CARDIOMYOPATHIES

                                                                                                                                      bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                      relief

                                                                                                                                      CARDIOMYOPATHIES

                                                                                                                                      bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                      CARDIOMYOPATHIES

                                                                                                                                      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

                                                                                                                                      Infective endocarditis

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

                                                                                                                                      bull Can be acute or chronic

                                                                                                                                      Infective endocarditis

                                                                                                                                      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

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Pathophysiologybull 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

                                                                                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                      retina

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                      organism

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                      B

                                                                                                                                      Infective endocarditis

                                                                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                      Normal is 4-10 cmH2O

                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                                                                      CARDIOGENIC SHOCK

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

                                                                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                                                                      CARDIAC TAMPONADE

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

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                      anterior chest

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                      tamponade

                                                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                      HYPERTENSION

                                                                                                                                      bull 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

                                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                      Buergerrsquos Disease

                                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                      reaction of the vessel wall

                                                                                                                                      Manifestations

                                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                                      Diagnosis amp Treatment

                                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                      (rare occasions)

                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                      A Assessment

                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                      2 Impaired gas exchange

                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                      C Goals

                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                      D Nursing Interventions

                                                                                                                                      1 Pain control

                                                                                                                                      2 Proper medications

                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                      • Slide 2
                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                      • Pathophysiology
                                                                                                                                      • Slide 5
                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                      • Pathophysiology
                                                                                                                                      • Types
                                                                                                                                      • Slide 12
                                                                                                                                      • Slide 13
                                                                                                                                      • Slide 14
                                                                                                                                      • Conthellip
                                                                                                                                      • Conthellip (2)
                                                                                                                                      • Drug Therapy
                                                                                                                                      • Classification
                                                                                                                                      • Nursing Management
                                                                                                                                      • Nursing Management (2)
                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                      • Slide 22
                                                                                                                                      • Conthellip (3)
                                                                                                                                      • Slide 24
                                                                                                                                      • Conthellip(MI)
                                                                                                                                      • Slide 26
                                                                                                                                      • Pathophysiology (2)
                                                                                                                                      • Tissue Changes After MI
                                                                                                                                      • Management of MI
                                                                                                                                      • Slide 30
                                                                                                                                      • Slide 31
                                                                                                                                      • ASSESSMENT
                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                      • EVALUATION
                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                      • Slide 49
                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                      • EVALUATION
                                                                                                                                      • Slide 56
                                                                                                                                      • Slide 57
                                                                                                                                      • Slide 58
                                                                                                                                      • Slide 59
                                                                                                                                      • Slide 60
                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                      • Slide 62
                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                      • Infective endocarditis
                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                      • Slide 100
                                                                                                                                      • HYPERTENSION
                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                      • Slide 103
                                                                                                                                      • Slide 104
                                                                                                                                      • Slide 105
                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                      • Slide 108
                                                                                                                                      • Manifestations
                                                                                                                                      • Slide 110
                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                      • Manifestations (2)
                                                                                                                                      • Slide 114
                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                      • Slide 116
                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                      • Slide 118
                                                                                                                                      • Slide 119
                                                                                                                                      • Slide 120
                                                                                                                                      • Slide 121

                                                                                                                                        CARDIOMYOPATHIES

                                                                                                                                        bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion

                                                                                                                                        CARDIOMYOPATHIES

                                                                                                                                        bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                        CARDIOMYOPATHIES

                                                                                                                                        bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                        relief

                                                                                                                                        CARDIOMYOPATHIES

                                                                                                                                        bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                        CARDIOMYOPATHIES

                                                                                                                                        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

                                                                                                                                        Infective endocarditis

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

                                                                                                                                        bull Can be acute or chronic

                                                                                                                                        Infective endocarditis

                                                                                                                                        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

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Pathophysiologybull 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

                                                                                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                        retina

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                        organism

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                        B

                                                                                                                                        Infective endocarditis

                                                                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                        Normal is 4-10 cmH2O

                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                                                                        CARDIOGENIC SHOCK

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

                                                                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                                                                        CARDIAC TAMPONADE

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

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                        anterior chest

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                        tamponade

                                                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                        HYPERTENSION

                                                                                                                                        bull 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

                                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                        Buergerrsquos Disease

                                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                        reaction of the vessel wall

                                                                                                                                        Manifestations

                                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                                        Diagnosis amp Treatment

                                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                        (rare occasions)

                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                        A Assessment

                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                        2 Impaired gas exchange

                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                        C Goals

                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                        D Nursing Interventions

                                                                                                                                        1 Pain control

                                                                                                                                        2 Proper medications

                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                        • Slide 2
                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                        • Pathophysiology
                                                                                                                                        • Slide 5
                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                        • Pathophysiology
                                                                                                                                        • Types
                                                                                                                                        • Slide 12
                                                                                                                                        • Slide 13
                                                                                                                                        • Slide 14
                                                                                                                                        • Conthellip
                                                                                                                                        • Conthellip (2)
                                                                                                                                        • Drug Therapy
                                                                                                                                        • Classification
                                                                                                                                        • Nursing Management
                                                                                                                                        • Nursing Management (2)
                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                        • Slide 22
                                                                                                                                        • Conthellip (3)
                                                                                                                                        • Slide 24
                                                                                                                                        • Conthellip(MI)
                                                                                                                                        • Slide 26
                                                                                                                                        • Pathophysiology (2)
                                                                                                                                        • Tissue Changes After MI
                                                                                                                                        • Management of MI
                                                                                                                                        • Slide 30
                                                                                                                                        • Slide 31
                                                                                                                                        • ASSESSMENT
                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                        • EVALUATION
                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                        • Slide 49
                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                        • EVALUATION
                                                                                                                                        • Slide 56
                                                                                                                                        • Slide 57
                                                                                                                                        • Slide 58
                                                                                                                                        • Slide 59
                                                                                                                                        • Slide 60
                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                        • Slide 62
                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                        • Infective endocarditis
                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                        • Slide 100
                                                                                                                                        • HYPERTENSION
                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                        • Slide 103
                                                                                                                                        • Slide 104
                                                                                                                                        • Slide 105
                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                        • Slide 108
                                                                                                                                        • Manifestations
                                                                                                                                        • Slide 110
                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                        • Manifestations (2)
                                                                                                                                        • Slide 114
                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                        • Slide 116
                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                        • Slide 118
                                                                                                                                        • Slide 119
                                                                                                                                        • Slide 120
                                                                                                                                        • Slide 121

                                                                                                                                          CARDIOMYOPATHIES

                                                                                                                                          bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy

                                                                                                                                          CARDIOMYOPATHIES

                                                                                                                                          bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                          relief

                                                                                                                                          CARDIOMYOPATHIES

                                                                                                                                          bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                          CARDIOMYOPATHIES

                                                                                                                                          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

                                                                                                                                          Infective endocarditis

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

                                                                                                                                          bull Can be acute or chronic

                                                                                                                                          Infective endocarditis

                                                                                                                                          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

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Pathophysiologybull 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

                                                                                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                          retina

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                          organism

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                          B

                                                                                                                                          Infective endocarditis

                                                                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                          Normal is 4-10 cmH2O

                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                                                                          CARDIOGENIC SHOCK

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

                                                                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                                                                          CARDIAC TAMPONADE

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

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                          anterior chest

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                          tamponade

                                                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                          HYPERTENSION

                                                                                                                                          bull 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

                                                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                          bull Most common typebull 2 Secondary

                                                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                          Buergerrsquos Disease

                                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                          reaction of the vessel wall

                                                                                                                                          Manifestations

                                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                                          Diagnosis amp Treatment

                                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                          (rare occasions)

                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                          A Assessment

                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                          2 Impaired gas exchange

                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                          C Goals

                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                          D Nursing Interventions

                                                                                                                                          1 Pain control

                                                                                                                                          2 Proper medications

                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                          • Slide 2
                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                          • Pathophysiology
                                                                                                                                          • Slide 5
                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                          • Pathophysiology
                                                                                                                                          • Types
                                                                                                                                          • Slide 12
                                                                                                                                          • Slide 13
                                                                                                                                          • Slide 14
                                                                                                                                          • Conthellip
                                                                                                                                          • Conthellip (2)
                                                                                                                                          • Drug Therapy
                                                                                                                                          • Classification
                                                                                                                                          • Nursing Management
                                                                                                                                          • Nursing Management (2)
                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                          • Slide 22
                                                                                                                                          • Conthellip (3)
                                                                                                                                          • Slide 24
                                                                                                                                          • Conthellip(MI)
                                                                                                                                          • Slide 26
                                                                                                                                          • Pathophysiology (2)
                                                                                                                                          • Tissue Changes After MI
                                                                                                                                          • Management of MI
                                                                                                                                          • Slide 30
                                                                                                                                          • Slide 31
                                                                                                                                          • ASSESSMENT
                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                          • EVALUATION
                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                          • Slide 49
                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                          • EVALUATION
                                                                                                                                          • Slide 56
                                                                                                                                          • Slide 57
                                                                                                                                          • Slide 58
                                                                                                                                          • Slide 59
                                                                                                                                          • Slide 60
                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                          • Slide 62
                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                          • Infective endocarditis
                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                          • Slide 100
                                                                                                                                          • HYPERTENSION
                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                          • Slide 103
                                                                                                                                          • Slide 104
                                                                                                                                          • Slide 105
                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                          • Slide 108
                                                                                                                                          • Manifestations
                                                                                                                                          • Slide 110
                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                          • Manifestations (2)
                                                                                                                                          • Slide 114
                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                          • Slide 116
                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                          • Slide 118
                                                                                                                                          • Slide 119
                                                                                                                                          • Slide 120
                                                                                                                                          • Slide 121

                                                                                                                                            CARDIOMYOPATHIES

                                                                                                                                            bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom

                                                                                                                                            relief

                                                                                                                                            CARDIOMYOPATHIES

                                                                                                                                            bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                            CARDIOMYOPATHIES

                                                                                                                                            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

                                                                                                                                            Infective endocarditis

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

                                                                                                                                            bull Can be acute or chronic

                                                                                                                                            Infective endocarditis

                                                                                                                                            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

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Pathophysiologybull 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

                                                                                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                            retina

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                            organism

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                            B

                                                                                                                                            Infective endocarditis

                                                                                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                            Normal is 4-10 cmH2O

                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                                                                            CARDIOGENIC SHOCK

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

                                                                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                                                                            CARDIAC TAMPONADE

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

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                            anterior chest

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                            tamponade

                                                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                            HYPERTENSION

                                                                                                                                            bull 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

                                                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                            bull Most common typebull 2 Secondary

                                                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                            Buergerrsquos Disease

                                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                            reaction of the vessel wall

                                                                                                                                            Manifestations

                                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                                            Diagnosis amp Treatment

                                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                            (rare occasions)

                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                            A Assessment

                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                            2 Impaired gas exchange

                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                            C Goals

                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                            D Nursing Interventions

                                                                                                                                            1 Pain control

                                                                                                                                            2 Proper medications

                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                            • Slide 2
                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                            • Pathophysiology
                                                                                                                                            • Slide 5
                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                            • Pathophysiology
                                                                                                                                            • Types
                                                                                                                                            • Slide 12
                                                                                                                                            • Slide 13
                                                                                                                                            • Slide 14
                                                                                                                                            • Conthellip
                                                                                                                                            • Conthellip (2)
                                                                                                                                            • Drug Therapy
                                                                                                                                            • Classification
                                                                                                                                            • Nursing Management
                                                                                                                                            • Nursing Management (2)
                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                            • Slide 22
                                                                                                                                            • Conthellip (3)
                                                                                                                                            • Slide 24
                                                                                                                                            • Conthellip(MI)
                                                                                                                                            • Slide 26
                                                                                                                                            • Pathophysiology (2)
                                                                                                                                            • Tissue Changes After MI
                                                                                                                                            • Management of MI
                                                                                                                                            • Slide 30
                                                                                                                                            • Slide 31
                                                                                                                                            • ASSESSMENT
                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                            • EVALUATION
                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                            • Slide 49
                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                            • EVALUATION
                                                                                                                                            • Slide 56
                                                                                                                                            • Slide 57
                                                                                                                                            • Slide 58
                                                                                                                                            • Slide 59
                                                                                                                                            • Slide 60
                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                            • Slide 62
                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                            • Infective endocarditis
                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                            • Slide 100
                                                                                                                                            • HYPERTENSION
                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                            • Slide 103
                                                                                                                                            • Slide 104
                                                                                                                                            • Slide 105
                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                            • Slide 108
                                                                                                                                            • Manifestations
                                                                                                                                            • Slide 110
                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                            • Manifestations (2)
                                                                                                                                            • Slide 114
                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                            • Slide 116
                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                            • Slide 118
                                                                                                                                            • Slide 119
                                                                                                                                            • Slide 120
                                                                                                                                            • Slide 121

                                                                                                                                              CARDIOMYOPATHIES

                                                                                                                                              bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet

                                                                                                                                              CARDIOMYOPATHIES

                                                                                                                                              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

                                                                                                                                              Infective endocarditis

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

                                                                                                                                              bull Can be acute or chronic

                                                                                                                                              Infective endocarditis

                                                                                                                                              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

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Pathophysiologybull 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

                                                                                                                                              bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                              retina

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                              organism

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                              B

                                                                                                                                              Infective endocarditis

                                                                                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                              Normal is 4-10 cmH2O

                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                                                                              CARDIOGENIC SHOCK

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

                                                                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                                                                              CARDIAC TAMPONADE

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

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                              distention hypotension and distantmuffled heart sound

                                                                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                              anterior chest

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                              tamponade

                                                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                              HYPERTENSION

                                                                                                                                              bull 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

                                                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                              bull Most common typebull 2 Secondary

                                                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                              Buergerrsquos Disease

                                                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                              reaction of the vessel wall

                                                                                                                                              Manifestations

                                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                                              Diagnosis amp Treatment

                                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                              (rare occasions)

                                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                              A Assessment

                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                              2 Impaired gas exchange

                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                              C Goals

                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                              D Nursing Interventions

                                                                                                                                              1 Pain control

                                                                                                                                              2 Proper medications

                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                              • Slide 2
                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                              • Pathophysiology
                                                                                                                                              • Slide 5
                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                              • Pathophysiology
                                                                                                                                              • Types
                                                                                                                                              • Slide 12
                                                                                                                                              • Slide 13
                                                                                                                                              • Slide 14
                                                                                                                                              • Conthellip
                                                                                                                                              • Conthellip (2)
                                                                                                                                              • Drug Therapy
                                                                                                                                              • Classification
                                                                                                                                              • Nursing Management
                                                                                                                                              • Nursing Management (2)
                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                              • Slide 22
                                                                                                                                              • Conthellip (3)
                                                                                                                                              • Slide 24
                                                                                                                                              • Conthellip(MI)
                                                                                                                                              • Slide 26
                                                                                                                                              • Pathophysiology (2)
                                                                                                                                              • Tissue Changes After MI
                                                                                                                                              • Management of MI
                                                                                                                                              • Slide 30
                                                                                                                                              • Slide 31
                                                                                                                                              • ASSESSMENT
                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                              • EVALUATION
                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                              • Slide 49
                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                              • EVALUATION
                                                                                                                                              • Slide 56
                                                                                                                                              • Slide 57
                                                                                                                                              • Slide 58
                                                                                                                                              • Slide 59
                                                                                                                                              • Slide 60
                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                              • Slide 62
                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                              • Infective endocarditis
                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                              • Slide 100
                                                                                                                                              • HYPERTENSION
                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                              • Slide 103
                                                                                                                                              • Slide 104
                                                                                                                                              • Slide 105
                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                              • Slide 108
                                                                                                                                              • Manifestations
                                                                                                                                              • Slide 110
                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                              • Manifestations (2)
                                                                                                                                              • Slide 114
                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                              • Slide 116
                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                              • Slide 118
                                                                                                                                              • Slide 119
                                                                                                                                              • Slide 120
                                                                                                                                              • Slide 121

                                                                                                                                                CARDIOMYOPATHIES

                                                                                                                                                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

                                                                                                                                                Infective endocarditis

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

                                                                                                                                                bull Can be acute or chronic

                                                                                                                                                Infective endocarditis

                                                                                                                                                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

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Pathophysiologybull 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

                                                                                                                                                bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                retina

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                organism

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                B

                                                                                                                                                Infective endocarditis

                                                                                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                Normal is 4-10 cmH2O

                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                                                                CARDIOGENIC SHOCK

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

                                                                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                CARDIAC TAMPONADE

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

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                anterior chest

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                tamponade

                                                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                HYPERTENSION

                                                                                                                                                bull 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

                                                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                Buergerrsquos Disease

                                                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                reaction of the vessel wall

                                                                                                                                                Manifestations

                                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                                Diagnosis amp Treatment

                                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                (rare occasions)

                                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                A Assessment

                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                C Goals

                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                D Nursing Interventions

                                                                                                                                                1 Pain control

                                                                                                                                                2 Proper medications

                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                • Slide 2
                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                • Pathophysiology
                                                                                                                                                • Slide 5
                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                • Pathophysiology
                                                                                                                                                • Types
                                                                                                                                                • Slide 12
                                                                                                                                                • Slide 13
                                                                                                                                                • Slide 14
                                                                                                                                                • Conthellip
                                                                                                                                                • Conthellip (2)
                                                                                                                                                • Drug Therapy
                                                                                                                                                • Classification
                                                                                                                                                • Nursing Management
                                                                                                                                                • Nursing Management (2)
                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                • Slide 22
                                                                                                                                                • Conthellip (3)
                                                                                                                                                • Slide 24
                                                                                                                                                • Conthellip(MI)
                                                                                                                                                • Slide 26
                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                • Management of MI
                                                                                                                                                • Slide 30
                                                                                                                                                • Slide 31
                                                                                                                                                • ASSESSMENT
                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                • EVALUATION
                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                • Slide 49
                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                • EVALUATION
                                                                                                                                                • Slide 56
                                                                                                                                                • Slide 57
                                                                                                                                                • Slide 58
                                                                                                                                                • Slide 59
                                                                                                                                                • Slide 60
                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                • Slide 62
                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                • Infective endocarditis
                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                • Slide 100
                                                                                                                                                • HYPERTENSION
                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                • Slide 103
                                                                                                                                                • Slide 104
                                                                                                                                                • Slide 105
                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                • Slide 108
                                                                                                                                                • Manifestations
                                                                                                                                                • Slide 110
                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                • Manifestations (2)
                                                                                                                                                • Slide 114
                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                • Slide 116
                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                • Slide 118
                                                                                                                                                • Slide 119
                                                                                                                                                • Slide 120
                                                                                                                                                • Slide 121

                                                                                                                                                  CARDIOMYOPATHIES

                                                                                                                                                  Nursing Management

                                                                                                                                                  3 Reduce patient anxiety

                                                                                                                                                  Support

                                                                                                                                                  Offer information about transplantations

                                                                                                                                                  Support family in anticipatory grieving

                                                                                                                                                  Infective endocarditis

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

                                                                                                                                                  bull Can be acute or chronic

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  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

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Pathophysiologybull 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

                                                                                                                                                  bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                  fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                  retina

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                  organism

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                  B

                                                                                                                                                  Infective endocarditis

                                                                                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                  Normal is 4-10 cmH2O

                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                  CARDIAC TAMPONADE

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

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                  anterior chest

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                  tamponade

                                                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                  HYPERTENSION

                                                                                                                                                  bull 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

                                                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                  Buergerrsquos Disease

                                                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                  reaction of the vessel wall

                                                                                                                                                  Manifestations

                                                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                  (rare occasions)

                                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                  A Assessment

                                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                  2 Impaired gas exchange

                                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                  C Goals

                                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                                  D Nursing Interventions

                                                                                                                                                  1 Pain control

                                                                                                                                                  2 Proper medications

                                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                  • Slide 2
                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                  • Pathophysiology
                                                                                                                                                  • Slide 5
                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                  • Pathophysiology
                                                                                                                                                  • Types
                                                                                                                                                  • Slide 12
                                                                                                                                                  • Slide 13
                                                                                                                                                  • Slide 14
                                                                                                                                                  • Conthellip
                                                                                                                                                  • Conthellip (2)
                                                                                                                                                  • Drug Therapy
                                                                                                                                                  • Classification
                                                                                                                                                  • Nursing Management
                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                  • Slide 22
                                                                                                                                                  • Conthellip (3)
                                                                                                                                                  • Slide 24
                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                  • Slide 26
                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                  • Management of MI
                                                                                                                                                  • Slide 30
                                                                                                                                                  • Slide 31
                                                                                                                                                  • ASSESSMENT
                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                  • EVALUATION
                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                  • Slide 49
                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                  • EVALUATION
                                                                                                                                                  • Slide 56
                                                                                                                                                  • Slide 57
                                                                                                                                                  • Slide 58
                                                                                                                                                  • Slide 59
                                                                                                                                                  • Slide 60
                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                  • Slide 62
                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                  • Infective endocarditis
                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                  • Slide 100
                                                                                                                                                  • HYPERTENSION
                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                  • Slide 103
                                                                                                                                                  • Slide 104
                                                                                                                                                  • Slide 105
                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                  • Slide 108
                                                                                                                                                  • Manifestations
                                                                                                                                                  • Slide 110
                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                  • Manifestations (2)
                                                                                                                                                  • Slide 114
                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                  • Slide 116
                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                  • Slide 118
                                                                                                                                                  • Slide 119
                                                                                                                                                  • Slide 120
                                                                                                                                                  • Slide 121

                                                                                                                                                    Infective endocarditis

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

                                                                                                                                                    bull Can be acute or chronic

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    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

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Pathophysiologybull 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

                                                                                                                                                    bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                    fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                    retina

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                    undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                    organism

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                    B

                                                                                                                                                    Infective endocarditis

                                                                                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                    Normal is 4-10 cmH2O

                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                    CARDIAC TAMPONADE

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

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                    anterior chest

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                    tamponade

                                                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                    HYPERTENSION

                                                                                                                                                    bull 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

                                                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                    Buergerrsquos Disease

                                                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                    reaction of the vessel wall

                                                                                                                                                    Manifestations

                                                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                    (rare occasions)

                                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                    A Assessment

                                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                    2 Impaired gas exchange

                                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                    C Goals

                                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                                    D Nursing Interventions

                                                                                                                                                    1 Pain control

                                                                                                                                                    2 Proper medications

                                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                                    • Slide 2
                                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                    • Pathophysiology
                                                                                                                                                    • Slide 5
                                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                                    • Pathophysiology
                                                                                                                                                    • Types
                                                                                                                                                    • Slide 12
                                                                                                                                                    • Slide 13
                                                                                                                                                    • Slide 14
                                                                                                                                                    • Conthellip
                                                                                                                                                    • Conthellip (2)
                                                                                                                                                    • Drug Therapy
                                                                                                                                                    • Classification
                                                                                                                                                    • Nursing Management
                                                                                                                                                    • Nursing Management (2)
                                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                                    • Slide 22
                                                                                                                                                    • Conthellip (3)
                                                                                                                                                    • Slide 24
                                                                                                                                                    • Conthellip(MI)
                                                                                                                                                    • Slide 26
                                                                                                                                                    • Pathophysiology (2)
                                                                                                                                                    • Tissue Changes After MI
                                                                                                                                                    • Management of MI
                                                                                                                                                    • Slide 30
                                                                                                                                                    • Slide 31
                                                                                                                                                    • ASSESSMENT
                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                                    • EVALUATION
                                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                    • Slide 49
                                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                                    • EVALUATION
                                                                                                                                                    • Slide 56
                                                                                                                                                    • Slide 57
                                                                                                                                                    • Slide 58
                                                                                                                                                    • Slide 59
                                                                                                                                                    • Slide 60
                                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                                    • Slide 62
                                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                                    • Infective endocarditis
                                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                                    • Slide 100
                                                                                                                                                    • HYPERTENSION
                                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                                    • Slide 103
                                                                                                                                                    • Slide 104
                                                                                                                                                    • Slide 105
                                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                                    • Slide 108
                                                                                                                                                    • Manifestations
                                                                                                                                                    • Slide 110
                                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                                    • Manifestations (2)
                                                                                                                                                    • Slide 114
                                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                                    • Slide 116
                                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                    • Slide 118
                                                                                                                                                    • Slide 119
                                                                                                                                                    • Slide 120
                                                                                                                                                    • Slide 121

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      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

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Pathophysiologybull 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

                                                                                                                                                      bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                      fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                      retina

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                      undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                      organism

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                      B

                                                                                                                                                      Infective endocarditis

                                                                                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                      Normal is 4-10 cmH2O

                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                                                                                      CARDIOGENIC SHOCK

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

                                                                                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                      CARDIAC TAMPONADE

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

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                      anterior chest

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                      tamponade

                                                                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                      HYPERTENSION

                                                                                                                                                      bull 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

                                                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                      Buergerrsquos Disease

                                                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                      reaction of the vessel wall

                                                                                                                                                      Manifestations

                                                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                                                      Diagnosis amp Treatment

                                                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                      (rare occasions)

                                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                      A Assessment

                                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                      2 Impaired gas exchange

                                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                      C Goals

                                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                                      D Nursing Interventions

                                                                                                                                                      1 Pain control

                                                                                                                                                      2 Proper medications

                                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                                      • Slide 2
                                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                      • Pathophysiology
                                                                                                                                                      • Slide 5
                                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                                      • Pathophysiology
                                                                                                                                                      • Types
                                                                                                                                                      • Slide 12
                                                                                                                                                      • Slide 13
                                                                                                                                                      • Slide 14
                                                                                                                                                      • Conthellip
                                                                                                                                                      • Conthellip (2)
                                                                                                                                                      • Drug Therapy
                                                                                                                                                      • Classification
                                                                                                                                                      • Nursing Management
                                                                                                                                                      • Nursing Management (2)
                                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                                      • Slide 22
                                                                                                                                                      • Conthellip (3)
                                                                                                                                                      • Slide 24
                                                                                                                                                      • Conthellip(MI)
                                                                                                                                                      • Slide 26
                                                                                                                                                      • Pathophysiology (2)
                                                                                                                                                      • Tissue Changes After MI
                                                                                                                                                      • Management of MI
                                                                                                                                                      • Slide 30
                                                                                                                                                      • Slide 31
                                                                                                                                                      • ASSESSMENT
                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                                      • EVALUATION
                                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                      • Slide 49
                                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                                      • EVALUATION
                                                                                                                                                      • Slide 56
                                                                                                                                                      • Slide 57
                                                                                                                                                      • Slide 58
                                                                                                                                                      • Slide 59
                                                                                                                                                      • Slide 60
                                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                                      • Slide 62
                                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                                      • Infective endocarditis
                                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                                      • Slide 100
                                                                                                                                                      • HYPERTENSION
                                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                                      • Slide 103
                                                                                                                                                      • Slide 104
                                                                                                                                                      • Slide 105
                                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                                      • Slide 108
                                                                                                                                                      • Manifestations
                                                                                                                                                      • Slide 110
                                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                                      • Manifestations (2)
                                                                                                                                                      • Slide 114
                                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                                      • Slide 116
                                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                      • Slide 118
                                                                                                                                                      • Slide 119
                                                                                                                                                      • Slide 120
                                                                                                                                                      • Slide 121

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        Risk factors

                                                                                                                                                        1 Prosthetic valves

                                                                                                                                                        2 Congenital malformation

                                                                                                                                                        3 Cardiomyopathy

                                                                                                                                                        4 IV drug users

                                                                                                                                                        5 Valvular dysfunctions

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Pathophysiologybull 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

                                                                                                                                                        bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                        fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                        retina

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                        undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                        organism

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                        soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                        B

                                                                                                                                                        Infective endocarditis

                                                                                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                        Normal is 4-10 cmH2O

                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                                                                                        CARDIOGENIC SHOCK

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

                                                                                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                        CARDIAC TAMPONADE

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

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                        anterior chest

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                        tamponade

                                                                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                        HYPERTENSION

                                                                                                                                                        bull 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

                                                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                        Buergerrsquos Disease

                                                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                        reaction of the vessel wall

                                                                                                                                                        Manifestations

                                                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                                                        Diagnosis amp Treatment

                                                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                        (rare occasions)

                                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                        A Assessment

                                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                        2 Impaired gas exchange

                                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                        C Goals

                                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                                        D Nursing Interventions

                                                                                                                                                        1 Pain control

                                                                                                                                                        2 Proper medications

                                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                                        • Slide 2
                                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                        • Pathophysiology
                                                                                                                                                        • Slide 5
                                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                                        • Pathophysiology
                                                                                                                                                        • Types
                                                                                                                                                        • Slide 12
                                                                                                                                                        • Slide 13
                                                                                                                                                        • Slide 14
                                                                                                                                                        • Conthellip
                                                                                                                                                        • Conthellip (2)
                                                                                                                                                        • Drug Therapy
                                                                                                                                                        • Classification
                                                                                                                                                        • Nursing Management
                                                                                                                                                        • Nursing Management (2)
                                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                                        • Slide 22
                                                                                                                                                        • Conthellip (3)
                                                                                                                                                        • Slide 24
                                                                                                                                                        • Conthellip(MI)
                                                                                                                                                        • Slide 26
                                                                                                                                                        • Pathophysiology (2)
                                                                                                                                                        • Tissue Changes After MI
                                                                                                                                                        • Management of MI
                                                                                                                                                        • Slide 30
                                                                                                                                                        • Slide 31
                                                                                                                                                        • ASSESSMENT
                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                                        • EVALUATION
                                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                        • Slide 49
                                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                                        • EVALUATION
                                                                                                                                                        • Slide 56
                                                                                                                                                        • Slide 57
                                                                                                                                                        • Slide 58
                                                                                                                                                        • Slide 59
                                                                                                                                                        • Slide 60
                                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                                        • Slide 62
                                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                                        • Infective endocarditis
                                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                                        • Slide 100
                                                                                                                                                        • HYPERTENSION
                                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                                        • Slide 103
                                                                                                                                                        • Slide 104
                                                                                                                                                        • Slide 105
                                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                                        • Slide 108
                                                                                                                                                        • Manifestations
                                                                                                                                                        • Slide 110
                                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                                        • Manifestations (2)
                                                                                                                                                        • Slide 114
                                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                                        • Slide 116
                                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                        • Slide 118
                                                                                                                                                        • Slide 119
                                                                                                                                                        • Slide 120
                                                                                                                                                        • Slide 121

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Pathophysiologybull 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

                                                                                                                                                          bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                          fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                          retina

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                          undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                          organism

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                          soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                          B

                                                                                                                                                          Infective endocarditis

                                                                                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                          Normal is 4-10 cmH2O

                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                                                                                          CARDIOGENIC SHOCK

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

                                                                                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                          CARDIAC TAMPONADE

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

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                          anterior chest

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                          tamponade

                                                                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                          HYPERTENSION

                                                                                                                                                          bull 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

                                                                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                          bull Most common typebull 2 Secondary

                                                                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                          Buergerrsquos Disease

                                                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                          reaction of the vessel wall

                                                                                                                                                          Manifestations

                                                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                                                          Diagnosis amp Treatment

                                                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                          (rare occasions)

                                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                          A Assessment

                                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                          2 Impaired gas exchange

                                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                          C Goals

                                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                                          D Nursing Interventions

                                                                                                                                                          1 Pain control

                                                                                                                                                          2 Proper medications

                                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                                          • Slide 2
                                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                          • Pathophysiology
                                                                                                                                                          • Slide 5
                                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                                          • Pathophysiology
                                                                                                                                                          • Types
                                                                                                                                                          • Slide 12
                                                                                                                                                          • Slide 13
                                                                                                                                                          • Slide 14
                                                                                                                                                          • Conthellip
                                                                                                                                                          • Conthellip (2)
                                                                                                                                                          • Drug Therapy
                                                                                                                                                          • Classification
                                                                                                                                                          • Nursing Management
                                                                                                                                                          • Nursing Management (2)
                                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                                          • Slide 22
                                                                                                                                                          • Conthellip (3)
                                                                                                                                                          • Slide 24
                                                                                                                                                          • Conthellip(MI)
                                                                                                                                                          • Slide 26
                                                                                                                                                          • Pathophysiology (2)
                                                                                                                                                          • Tissue Changes After MI
                                                                                                                                                          • Management of MI
                                                                                                                                                          • Slide 30
                                                                                                                                                          • Slide 31
                                                                                                                                                          • ASSESSMENT
                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                                          • EVALUATION
                                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                          • Slide 49
                                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                                          • EVALUATION
                                                                                                                                                          • Slide 56
                                                                                                                                                          • Slide 57
                                                                                                                                                          • Slide 58
                                                                                                                                                          • Slide 59
                                                                                                                                                          • Slide 60
                                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                                          • Slide 62
                                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                                          • Infective endocarditis
                                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                                          • Slide 100
                                                                                                                                                          • HYPERTENSION
                                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                                          • Slide 103
                                                                                                                                                          • Slide 104
                                                                                                                                                          • Slide 105
                                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                                          • Slide 108
                                                                                                                                                          • Manifestations
                                                                                                                                                          • Slide 110
                                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                                          • Manifestations (2)
                                                                                                                                                          • Slide 114
                                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                                          • Slide 116
                                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                          • Slide 118
                                                                                                                                                          • Slide 119
                                                                                                                                                          • Slide 120
                                                                                                                                                          • Slide 121

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                            fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                            retina

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                            undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                            organism

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                            soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                            B

                                                                                                                                                            Infective endocarditis

                                                                                                                                                            bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                            Normal is 4-10 cmH2O

                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                                                                                            CARDIOGENIC SHOCK

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

                                                                                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                            CARDIAC TAMPONADE

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

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                            anterior chest

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                            tamponade

                                                                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                            HYPERTENSION

                                                                                                                                                            bull 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

                                                                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                            bull Most common typebull 2 Secondary

                                                                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                            Buergerrsquos Disease

                                                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                            reaction of the vessel wall

                                                                                                                                                            Manifestations

                                                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                                                            Diagnosis amp Treatment

                                                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                            (rare occasions)

                                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                            A Assessment

                                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                            2 Impaired gas exchange

                                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                            C Goals

                                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                                            D Nursing Interventions

                                                                                                                                                            1 Pain control

                                                                                                                                                            2 Proper medications

                                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                                            • Slide 2
                                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                            • Pathophysiology
                                                                                                                                                            • Slide 5
                                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                                            • Pathophysiology
                                                                                                                                                            • Types
                                                                                                                                                            • Slide 12
                                                                                                                                                            • Slide 13
                                                                                                                                                            • Slide 14
                                                                                                                                                            • Conthellip
                                                                                                                                                            • Conthellip (2)
                                                                                                                                                            • Drug Therapy
                                                                                                                                                            • Classification
                                                                                                                                                            • Nursing Management
                                                                                                                                                            • Nursing Management (2)
                                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                                            • Slide 22
                                                                                                                                                            • Conthellip (3)
                                                                                                                                                            • Slide 24
                                                                                                                                                            • Conthellip(MI)
                                                                                                                                                            • Slide 26
                                                                                                                                                            • Pathophysiology (2)
                                                                                                                                                            • Tissue Changes After MI
                                                                                                                                                            • Management of MI
                                                                                                                                                            • Slide 30
                                                                                                                                                            • Slide 31
                                                                                                                                                            • ASSESSMENT
                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                                            • EVALUATION
                                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                            • Slide 49
                                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                                            • EVALUATION
                                                                                                                                                            • Slide 56
                                                                                                                                                            • Slide 57
                                                                                                                                                            • Slide 58
                                                                                                                                                            • Slide 59
                                                                                                                                                            • Slide 60
                                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                                            • Slide 62
                                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                                            • Infective endocarditis
                                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                                            • Slide 100
                                                                                                                                                            • HYPERTENSION
                                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                                            • Slide 103
                                                                                                                                                            • Slide 104
                                                                                                                                                            • Slide 105
                                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                                            • Slide 108
                                                                                                                                                            • Manifestations
                                                                                                                                                            • Slide 110
                                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                                            • Manifestations (2)
                                                                                                                                                            • Slide 114
                                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                                            • Slide 116
                                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                            • Slide 118
                                                                                                                                                            • Slide 119
                                                                                                                                                            • Slide 120
                                                                                                                                                            • Slide 121

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on

                                                                                                                                                              fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the

                                                                                                                                                              retina

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                              undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                              organism

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                              soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                              B

                                                                                                                                                              Infective endocarditis

                                                                                                                                                              bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                              bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                              bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                              Normal is 4-10 cmH2O

                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                                                                                              CARDIOGENIC SHOCK

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

                                                                                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                              CARDIAC TAMPONADE

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

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                              distention hypotension and distantmuffled heart sound

                                                                                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                              anterior chest

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                              tamponade

                                                                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                              HYPERTENSION

                                                                                                                                                              bull 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

                                                                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                              bull Most common typebull 2 Secondary

                                                                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                              Buergerrsquos Disease

                                                                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                              reaction of the vessel wall

                                                                                                                                                              Manifestations

                                                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                                                              Diagnosis amp Treatment

                                                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                              (rare occasions)

                                                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                              A Assessment

                                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                              2 Impaired gas exchange

                                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                              C Goals

                                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                                              D Nursing Interventions

                                                                                                                                                              1 Pain control

                                                                                                                                                              2 Proper medications

                                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                                              • Slide 2
                                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                              • Pathophysiology
                                                                                                                                                              • Slide 5
                                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                                              • Pathophysiology
                                                                                                                                                              • Types
                                                                                                                                                              • Slide 12
                                                                                                                                                              • Slide 13
                                                                                                                                                              • Slide 14
                                                                                                                                                              • Conthellip
                                                                                                                                                              • Conthellip (2)
                                                                                                                                                              • Drug Therapy
                                                                                                                                                              • Classification
                                                                                                                                                              • Nursing Management
                                                                                                                                                              • Nursing Management (2)
                                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                                              • Slide 22
                                                                                                                                                              • Conthellip (3)
                                                                                                                                                              • Slide 24
                                                                                                                                                              • Conthellip(MI)
                                                                                                                                                              • Slide 26
                                                                                                                                                              • Pathophysiology (2)
                                                                                                                                                              • Tissue Changes After MI
                                                                                                                                                              • Management of MI
                                                                                                                                                              • Slide 30
                                                                                                                                                              • Slide 31
                                                                                                                                                              • ASSESSMENT
                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                                              • EVALUATION
                                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                              • Slide 49
                                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                                              • EVALUATION
                                                                                                                                                              • Slide 56
                                                                                                                                                              • Slide 57
                                                                                                                                                              • Slide 58
                                                                                                                                                              • Slide 59
                                                                                                                                                              • Slide 60
                                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                                              • Slide 62
                                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                                              • Infective endocarditis
                                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                                              • Slide 100
                                                                                                                                                              • HYPERTENSION
                                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                                              • Slide 103
                                                                                                                                                              • Slide 104
                                                                                                                                                              • Slide 105
                                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                                              • Slide 108
                                                                                                                                                              • Manifestations
                                                                                                                                                              • Slide 110
                                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                                              • Manifestations (2)
                                                                                                                                                              • Slide 114
                                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                                              • Slide 116
                                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                              • Slide 118
                                                                                                                                                              • Slide 119
                                                                                                                                                              • Slide 120
                                                                                                                                                              • Slide 121

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                                undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                                organism

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                                soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                                B

                                                                                                                                                                Infective endocarditis

                                                                                                                                                                bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                Normal is 4-10 cmH2O

                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                                                                                CARDIOGENIC SHOCK

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

                                                                                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                CARDIAC TAMPONADE

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

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                anterior chest

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                tamponade

                                                                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                HYPERTENSION

                                                                                                                                                                bull 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

                                                                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                Buergerrsquos Disease

                                                                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                reaction of the vessel wall

                                                                                                                                                                Manifestations

                                                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                                                Diagnosis amp Treatment

                                                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                (rare occasions)

                                                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                A Assessment

                                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                C Goals

                                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                                D Nursing Interventions

                                                                                                                                                                1 Pain control

                                                                                                                                                                2 Proper medications

                                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                                • Slide 2
                                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                • Pathophysiology
                                                                                                                                                                • Slide 5
                                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                • Pathophysiology
                                                                                                                                                                • Types
                                                                                                                                                                • Slide 12
                                                                                                                                                                • Slide 13
                                                                                                                                                                • Slide 14
                                                                                                                                                                • Conthellip
                                                                                                                                                                • Conthellip (2)
                                                                                                                                                                • Drug Therapy
                                                                                                                                                                • Classification
                                                                                                                                                                • Nursing Management
                                                                                                                                                                • Nursing Management (2)
                                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                                • Slide 22
                                                                                                                                                                • Conthellip (3)
                                                                                                                                                                • Slide 24
                                                                                                                                                                • Conthellip(MI)
                                                                                                                                                                • Slide 26
                                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                                • Management of MI
                                                                                                                                                                • Slide 30
                                                                                                                                                                • Slide 31
                                                                                                                                                                • ASSESSMENT
                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                                • EVALUATION
                                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                • Slide 49
                                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                                • EVALUATION
                                                                                                                                                                • Slide 56
                                                                                                                                                                • Slide 57
                                                                                                                                                                • Slide 58
                                                                                                                                                                • Slide 59
                                                                                                                                                                • Slide 60
                                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                                • Slide 62
                                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                                • Infective endocarditis
                                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                                • Slide 100
                                                                                                                                                                • HYPERTENSION
                                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                                • Slide 103
                                                                                                                                                                • Slide 104
                                                                                                                                                                • Slide 105
                                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                                • Slide 108
                                                                                                                                                                • Manifestations
                                                                                                                                                                • Slide 110
                                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                                • Manifestations (2)
                                                                                                                                                                • Slide 114
                                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                                • Slide 116
                                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                • Slide 118
                                                                                                                                                                • Slide 119
                                                                                                                                                                • Slide 120
                                                                                                                                                                • Slide 121

                                                                                                                                                                  Infective endocarditis

                                                                                                                                                                  bull Preventionbull Antibiotic prophylaxis if patient is

                                                                                                                                                                  undergoing procedures like dental extractions bronchoscopy surgery etc

                                                                                                                                                                  Infective endocarditis

                                                                                                                                                                  bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                                  organism

                                                                                                                                                                  Infective endocarditis

                                                                                                                                                                  bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                                  soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                                  Infective endocarditis

                                                                                                                                                                  bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                                  B

                                                                                                                                                                  Infective endocarditis

                                                                                                                                                                  bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                                  bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                  bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                                  bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                  Normal is 4-10 cmH2O

                                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                  CARDIAC TAMPONADE

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

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                  anterior chest

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                  tamponade

                                                                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                  HYPERTENSION

                                                                                                                                                                  bull 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

                                                                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                  Buergerrsquos Disease

                                                                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                  reaction of the vessel wall

                                                                                                                                                                  Manifestations

                                                                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                  (rare occasions)

                                                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                  A Assessment

                                                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                  2 Impaired gas exchange

                                                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                  C Goals

                                                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                                                  D Nursing Interventions

                                                                                                                                                                  1 Pain control

                                                                                                                                                                  2 Proper medications

                                                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                                  • Slide 2
                                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                  • Slide 5
                                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                  • Types
                                                                                                                                                                  • Slide 12
                                                                                                                                                                  • Slide 13
                                                                                                                                                                  • Slide 14
                                                                                                                                                                  • Conthellip
                                                                                                                                                                  • Conthellip (2)
                                                                                                                                                                  • Drug Therapy
                                                                                                                                                                  • Classification
                                                                                                                                                                  • Nursing Management
                                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                                  • Slide 22
                                                                                                                                                                  • Conthellip (3)
                                                                                                                                                                  • Slide 24
                                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                                  • Slide 26
                                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                                  • Management of MI
                                                                                                                                                                  • Slide 30
                                                                                                                                                                  • Slide 31
                                                                                                                                                                  • ASSESSMENT
                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                                  • EVALUATION
                                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                  • Slide 49
                                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                                  • EVALUATION
                                                                                                                                                                  • Slide 56
                                                                                                                                                                  • Slide 57
                                                                                                                                                                  • Slide 58
                                                                                                                                                                  • Slide 59
                                                                                                                                                                  • Slide 60
                                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                                  • Slide 62
                                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                                  • Infective endocarditis
                                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                                  • Slide 100
                                                                                                                                                                  • HYPERTENSION
                                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                                  • Slide 103
                                                                                                                                                                  • Slide 104
                                                                                                                                                                  • Slide 105
                                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                                  • Slide 108
                                                                                                                                                                  • Manifestations
                                                                                                                                                                  • Slide 110
                                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                                  • Manifestations (2)
                                                                                                                                                                  • Slide 114
                                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                                  • Slide 116
                                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                  • Slide 118
                                                                                                                                                                  • Slide 119
                                                                                                                                                                  • Slide 120
                                                                                                                                                                  • Slide 121

                                                                                                                                                                    Infective endocarditis

                                                                                                                                                                    bull LABORATORY EXAMbull Blood Cultures to determine the exact

                                                                                                                                                                    organism

                                                                                                                                                                    Infective endocarditis

                                                                                                                                                                    bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                                    soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                                    Infective endocarditis

                                                                                                                                                                    bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                                    B

                                                                                                                                                                    Infective endocarditis

                                                                                                                                                                    bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                                    bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                    bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                                    bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                    Normal is 4-10 cmH2O

                                                                                                                                                                    CARDIOGENIC SHOCK

                                                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                    Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                    inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                    bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                    decreased pulmonary congestion and to relieve pain

                                                                                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                    CARDIAC TAMPONADE

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

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                    anterior chest

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                    tamponade

                                                                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                    HYPERTENSION

                                                                                                                                                                    bull 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

                                                                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                    Buergerrsquos Disease

                                                                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                    reaction of the vessel wall

                                                                                                                                                                    Manifestations

                                                                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                    (rare occasions)

                                                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                    A Assessment

                                                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                    2 Impaired gas exchange

                                                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                    C Goals

                                                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                                                    D Nursing Interventions

                                                                                                                                                                    1 Pain control

                                                                                                                                                                    2 Proper medications

                                                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                                                    • Slide 2
                                                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                    • Slide 5
                                                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                    • Types
                                                                                                                                                                    • Slide 12
                                                                                                                                                                    • Slide 13
                                                                                                                                                                    • Slide 14
                                                                                                                                                                    • Conthellip
                                                                                                                                                                    • Conthellip (2)
                                                                                                                                                                    • Drug Therapy
                                                                                                                                                                    • Classification
                                                                                                                                                                    • Nursing Management
                                                                                                                                                                    • Nursing Management (2)
                                                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                                                    • Slide 22
                                                                                                                                                                    • Conthellip (3)
                                                                                                                                                                    • Slide 24
                                                                                                                                                                    • Conthellip(MI)
                                                                                                                                                                    • Slide 26
                                                                                                                                                                    • Pathophysiology (2)
                                                                                                                                                                    • Tissue Changes After MI
                                                                                                                                                                    • Management of MI
                                                                                                                                                                    • Slide 30
                                                                                                                                                                    • Slide 31
                                                                                                                                                                    • ASSESSMENT
                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                                                    • EVALUATION
                                                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                    • Slide 49
                                                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                                                    • EVALUATION
                                                                                                                                                                    • Slide 56
                                                                                                                                                                    • Slide 57
                                                                                                                                                                    • Slide 58
                                                                                                                                                                    • Slide 59
                                                                                                                                                                    • Slide 60
                                                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                                                    • Slide 62
                                                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                                                    • Infective endocarditis
                                                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                                                    • Slide 100
                                                                                                                                                                    • HYPERTENSION
                                                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                                                    • Slide 103
                                                                                                                                                                    • Slide 104
                                                                                                                                                                    • Slide 105
                                                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                                                    • Slide 108
                                                                                                                                                                    • Manifestations
                                                                                                                                                                    • Slide 110
                                                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                                                    • Manifestations (2)
                                                                                                                                                                    • Slide 114
                                                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                                                    • Slide 116
                                                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                    • Slide 118
                                                                                                                                                                    • Slide 119
                                                                                                                                                                    • Slide 120
                                                                                                                                                                    • Slide 121

                                                                                                                                                                      Infective endocarditis

                                                                                                                                                                      bull Nursing managementbull 1 regular monitoring of temperature heart

                                                                                                                                                                      soundsbull 2 manage infectionbull 3 long-term antibiotic therapy

                                                                                                                                                                      Infective endocarditis

                                                                                                                                                                      bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                                      B

                                                                                                                                                                      Infective endocarditis

                                                                                                                                                                      bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                                      bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                      bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                                      bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                      Normal is 4-10 cmH2O

                                                                                                                                                                      CARDIOGENIC SHOCK

                                                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                      Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                      inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                      bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                      decreased pulmonary congestion and to relieve pain

                                                                                                                                                                      CARDIOGENIC SHOCK

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

                                                                                                                                                                      bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                      bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                      CARDIAC TAMPONADE

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

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                      anterior chest

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                      tamponade

                                                                                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                      HYPERTENSION

                                                                                                                                                                      bull 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

                                                                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                      Buergerrsquos Disease

                                                                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                      reaction of the vessel wall

                                                                                                                                                                      Manifestations

                                                                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                                                                      Diagnosis amp Treatment

                                                                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                      (rare occasions)

                                                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                      A Assessment

                                                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                      2 Impaired gas exchange

                                                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                      C Goals

                                                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                                                      D Nursing Interventions

                                                                                                                                                                      1 Pain control

                                                                                                                                                                      2 Proper medications

                                                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                                                      • Slide 2
                                                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                      • Slide 5
                                                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                      • Types
                                                                                                                                                                      • Slide 12
                                                                                                                                                                      • Slide 13
                                                                                                                                                                      • Slide 14
                                                                                                                                                                      • Conthellip
                                                                                                                                                                      • Conthellip (2)
                                                                                                                                                                      • Drug Therapy
                                                                                                                                                                      • Classification
                                                                                                                                                                      • Nursing Management
                                                                                                                                                                      • Nursing Management (2)
                                                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                                                      • Slide 22
                                                                                                                                                                      • Conthellip (3)
                                                                                                                                                                      • Slide 24
                                                                                                                                                                      • Conthellip(MI)
                                                                                                                                                                      • Slide 26
                                                                                                                                                                      • Pathophysiology (2)
                                                                                                                                                                      • Tissue Changes After MI
                                                                                                                                                                      • Management of MI
                                                                                                                                                                      • Slide 30
                                                                                                                                                                      • Slide 31
                                                                                                                                                                      • ASSESSMENT
                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                                                      • EVALUATION
                                                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                      • Slide 49
                                                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                                                      • EVALUATION
                                                                                                                                                                      • Slide 56
                                                                                                                                                                      • Slide 57
                                                                                                                                                                      • Slide 58
                                                                                                                                                                      • Slide 59
                                                                                                                                                                      • Slide 60
                                                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                                                      • Slide 62
                                                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                                                      • Infective endocarditis
                                                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                                                      • Slide 100
                                                                                                                                                                      • HYPERTENSION
                                                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                                                      • Slide 103
                                                                                                                                                                      • Slide 104
                                                                                                                                                                      • Slide 105
                                                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                                                      • Slide 108
                                                                                                                                                                      • Manifestations
                                                                                                                                                                      • Slide 110
                                                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                                                      • Manifestations (2)
                                                                                                                                                                      • Slide 114
                                                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                                                      • Slide 116
                                                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                      • Slide 118
                                                                                                                                                                      • Slide 119
                                                                                                                                                                      • Slide 120
                                                                                                                                                                      • Slide 121

                                                                                                                                                                        Infective endocarditis

                                                                                                                                                                        bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin

                                                                                                                                                                        B

                                                                                                                                                                        Infective endocarditis

                                                                                                                                                                        bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                                        bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                        bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                                        bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                        Normal is 4-10 cmH2O

                                                                                                                                                                        CARDIOGENIC SHOCK

                                                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                        Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                        inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                        bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                        decreased pulmonary congestion and to relieve pain

                                                                                                                                                                        CARDIOGENIC SHOCK

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

                                                                                                                                                                        bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                        bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                        CARDIAC TAMPONADE

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

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                        anterior chest

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                        tamponade

                                                                                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                        HYPERTENSION

                                                                                                                                                                        bull 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

                                                                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                        Buergerrsquos Disease

                                                                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                        reaction of the vessel wall

                                                                                                                                                                        Manifestations

                                                                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                                                                        Diagnosis amp Treatment

                                                                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                        (rare occasions)

                                                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                        A Assessment

                                                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                        2 Impaired gas exchange

                                                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                        C Goals

                                                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                                                        D Nursing Interventions

                                                                                                                                                                        1 Pain control

                                                                                                                                                                        2 Proper medications

                                                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                                                        • Slide 2
                                                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                        • Slide 5
                                                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                        • Types
                                                                                                                                                                        • Slide 12
                                                                                                                                                                        • Slide 13
                                                                                                                                                                        • Slide 14
                                                                                                                                                                        • Conthellip
                                                                                                                                                                        • Conthellip (2)
                                                                                                                                                                        • Drug Therapy
                                                                                                                                                                        • Classification
                                                                                                                                                                        • Nursing Management
                                                                                                                                                                        • Nursing Management (2)
                                                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                                                        • Slide 22
                                                                                                                                                                        • Conthellip (3)
                                                                                                                                                                        • Slide 24
                                                                                                                                                                        • Conthellip(MI)
                                                                                                                                                                        • Slide 26
                                                                                                                                                                        • Pathophysiology (2)
                                                                                                                                                                        • Tissue Changes After MI
                                                                                                                                                                        • Management of MI
                                                                                                                                                                        • Slide 30
                                                                                                                                                                        • Slide 31
                                                                                                                                                                        • ASSESSMENT
                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                                                        • EVALUATION
                                                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                        • Slide 49
                                                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                                                        • EVALUATION
                                                                                                                                                                        • Slide 56
                                                                                                                                                                        • Slide 57
                                                                                                                                                                        • Slide 58
                                                                                                                                                                        • Slide 59
                                                                                                                                                                        • Slide 60
                                                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                                                        • Slide 62
                                                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                                                        • Infective endocarditis
                                                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                                                        • Slide 100
                                                                                                                                                                        • HYPERTENSION
                                                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                                                        • Slide 103
                                                                                                                                                                        • Slide 104
                                                                                                                                                                        • Slide 105
                                                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                                                        • Slide 108
                                                                                                                                                                        • Manifestations
                                                                                                                                                                        • Slide 110
                                                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                                                        • Manifestations (2)
                                                                                                                                                                        • Slide 114
                                                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                                                        • Slide 116
                                                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                        • Slide 118
                                                                                                                                                                        • Slide 119
                                                                                                                                                                        • Slide 120
                                                                                                                                                                        • Slide 121

                                                                                                                                                                          Infective endocarditis

                                                                                                                                                                          bull Medical managementbull 2 Surgerybull Valvular replacement

                                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                                          bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                          bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                                          bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                          Normal is 4-10 cmH2O

                                                                                                                                                                          CARDIOGENIC SHOCK

                                                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                          Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                          inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                          bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                          decreased pulmonary congestion and to relieve pain

                                                                                                                                                                          CARDIOGENIC SHOCK

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

                                                                                                                                                                          bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                          bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                          CARDIAC TAMPONADE

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

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                          anterior chest

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                          tamponade

                                                                                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                          HYPERTENSION

                                                                                                                                                                          bull 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

                                                                                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                          bull Most common typebull 2 Secondary

                                                                                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                          Buergerrsquos Disease

                                                                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                          reaction of the vessel wall

                                                                                                                                                                          Manifestations

                                                                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                                                                          Diagnosis amp Treatment

                                                                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                          (rare occasions)

                                                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                          A Assessment

                                                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                          2 Impaired gas exchange

                                                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                          C Goals

                                                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                                                          D Nursing Interventions

                                                                                                                                                                          1 Pain control

                                                                                                                                                                          2 Proper medications

                                                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                                                          • Slide 2
                                                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                          • Slide 5
                                                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                          • Types
                                                                                                                                                                          • Slide 12
                                                                                                                                                                          • Slide 13
                                                                                                                                                                          • Slide 14
                                                                                                                                                                          • Conthellip
                                                                                                                                                                          • Conthellip (2)
                                                                                                                                                                          • Drug Therapy
                                                                                                                                                                          • Classification
                                                                                                                                                                          • Nursing Management
                                                                                                                                                                          • Nursing Management (2)
                                                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                                                          • Slide 22
                                                                                                                                                                          • Conthellip (3)
                                                                                                                                                                          • Slide 24
                                                                                                                                                                          • Conthellip(MI)
                                                                                                                                                                          • Slide 26
                                                                                                                                                                          • Pathophysiology (2)
                                                                                                                                                                          • Tissue Changes After MI
                                                                                                                                                                          • Management of MI
                                                                                                                                                                          • Slide 30
                                                                                                                                                                          • Slide 31
                                                                                                                                                                          • ASSESSMENT
                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                                                          • EVALUATION
                                                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                          • Slide 49
                                                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                                                          • EVALUATION
                                                                                                                                                                          • Slide 56
                                                                                                                                                                          • Slide 57
                                                                                                                                                                          • Slide 58
                                                                                                                                                                          • Slide 59
                                                                                                                                                                          • Slide 60
                                                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                                                          • Slide 62
                                                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                                                          • Infective endocarditis
                                                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                                                          • Slide 100
                                                                                                                                                                          • HYPERTENSION
                                                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                                                          • Slide 103
                                                                                                                                                                          • Slide 104
                                                                                                                                                                          • Slide 105
                                                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                                                          • Slide 108
                                                                                                                                                                          • Manifestations
                                                                                                                                                                          • Slide 110
                                                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                                                          • Manifestations (2)
                                                                                                                                                                          • Slide 114
                                                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                                                          • Slide 116
                                                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                          • Slide 118
                                                                                                                                                                          • Slide 119
                                                                                                                                                                          • Slide 120
                                                                                                                                                                          • Slide 121

                                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                                            bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

                                                                                                                                                                            bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade

                                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                                            bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                            Normal is 4-10 cmH2O

                                                                                                                                                                            CARDIOGENIC SHOCK

                                                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                            Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                            inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                            bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                            decreased pulmonary congestion and to relieve pain

                                                                                                                                                                            CARDIOGENIC SHOCK

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

                                                                                                                                                                            bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                            bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                            CARDIAC TAMPONADE

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

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                            infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                            anterior chest

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                            tamponade

                                                                                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                            HYPERTENSION

                                                                                                                                                                            bull 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

                                                                                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                            bull Most common typebull 2 Secondary

                                                                                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                            Buergerrsquos Disease

                                                                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                            reaction of the vessel wall

                                                                                                                                                                            Manifestations

                                                                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                                                                            Diagnosis amp Treatment

                                                                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                            (rare occasions)

                                                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                            A Assessment

                                                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                            2 Impaired gas exchange

                                                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                            C Goals

                                                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                                                            D Nursing Interventions

                                                                                                                                                                            1 Pain control

                                                                                                                                                                            2 Proper medications

                                                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                                                            • Slide 2
                                                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                            • Slide 5
                                                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                            • Types
                                                                                                                                                                            • Slide 12
                                                                                                                                                                            • Slide 13
                                                                                                                                                                            • Slide 14
                                                                                                                                                                            • Conthellip
                                                                                                                                                                            • Conthellip (2)
                                                                                                                                                                            • Drug Therapy
                                                                                                                                                                            • Classification
                                                                                                                                                                            • Nursing Management
                                                                                                                                                                            • Nursing Management (2)
                                                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                                                            • Slide 22
                                                                                                                                                                            • Conthellip (3)
                                                                                                                                                                            • Slide 24
                                                                                                                                                                            • Conthellip(MI)
                                                                                                                                                                            • Slide 26
                                                                                                                                                                            • Pathophysiology (2)
                                                                                                                                                                            • Tissue Changes After MI
                                                                                                                                                                            • Management of MI
                                                                                                                                                                            • Slide 30
                                                                                                                                                                            • Slide 31
                                                                                                                                                                            • ASSESSMENT
                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                                                            • EVALUATION
                                                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                            • Slide 49
                                                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                                                            • EVALUATION
                                                                                                                                                                            • Slide 56
                                                                                                                                                                            • Slide 57
                                                                                                                                                                            • Slide 58
                                                                                                                                                                            • Slide 59
                                                                                                                                                                            • Slide 60
                                                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                                                            • Slide 62
                                                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                                                            • Infective endocarditis
                                                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                                                            • Slide 100
                                                                                                                                                                            • HYPERTENSION
                                                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                                                            • Slide 103
                                                                                                                                                                            • Slide 104
                                                                                                                                                                            • Slide 105
                                                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                                                            • Slide 108
                                                                                                                                                                            • Manifestations
                                                                                                                                                                            • Slide 110
                                                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                                                            • Manifestations (2)
                                                                                                                                                                            • Slide 114
                                                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                                                            • Slide 116
                                                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                            • Slide 118
                                                                                                                                                                            • Slide 119
                                                                                                                                                                            • Slide 120
                                                                                                                                                                            • Slide 121

                                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion

                                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                                              bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                              Normal is 4-10 cmH2O

                                                                                                                                                                              CARDIOGENIC SHOCK

                                                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                              Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                              inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                              bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                              decreased pulmonary congestion and to relieve pain

                                                                                                                                                                              CARDIOGENIC SHOCK

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

                                                                                                                                                                              bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                              bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                              CARDIAC TAMPONADE

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

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                              infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                              distention hypotension and distantmuffled heart sound

                                                                                                                                                                              bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                              anterior chest

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                              tamponade

                                                                                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                              HYPERTENSION

                                                                                                                                                                              bull 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

                                                                                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                              bull Most common typebull 2 Secondary

                                                                                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                              Buergerrsquos Disease

                                                                                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                              reaction of the vessel wall

                                                                                                                                                                              Manifestations

                                                                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                                                                              Diagnosis amp Treatment

                                                                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                              (rare occasions)

                                                                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                              A Assessment

                                                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                              2 Impaired gas exchange

                                                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                              C Goals

                                                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                                                              D Nursing Interventions

                                                                                                                                                                              1 Pain control

                                                                                                                                                                              2 Proper medications

                                                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                                                              • Slide 2
                                                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                              • Slide 5
                                                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                              • Types
                                                                                                                                                                              • Slide 12
                                                                                                                                                                              • Slide 13
                                                                                                                                                                              • Slide 14
                                                                                                                                                                              • Conthellip
                                                                                                                                                                              • Conthellip (2)
                                                                                                                                                                              • Drug Therapy
                                                                                                                                                                              • Classification
                                                                                                                                                                              • Nursing Management
                                                                                                                                                                              • Nursing Management (2)
                                                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                                                              • Slide 22
                                                                                                                                                                              • Conthellip (3)
                                                                                                                                                                              • Slide 24
                                                                                                                                                                              • Conthellip(MI)
                                                                                                                                                                              • Slide 26
                                                                                                                                                                              • Pathophysiology (2)
                                                                                                                                                                              • Tissue Changes After MI
                                                                                                                                                                              • Management of MI
                                                                                                                                                                              • Slide 30
                                                                                                                                                                              • Slide 31
                                                                                                                                                                              • ASSESSMENT
                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                                                              • EVALUATION
                                                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                              • Slide 49
                                                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                                                              • EVALUATION
                                                                                                                                                                              • Slide 56
                                                                                                                                                                              • Slide 57
                                                                                                                                                                              • Slide 58
                                                                                                                                                                              • Slide 59
                                                                                                                                                                              • Slide 60
                                                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                                                              • Slide 62
                                                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                                                              • Infective endocarditis
                                                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                                                              • Slide 100
                                                                                                                                                                              • HYPERTENSION
                                                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                                                              • Slide 103
                                                                                                                                                                              • Slide 104
                                                                                                                                                                              • Slide 105
                                                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                                                              • Slide 108
                                                                                                                                                                              • Manifestations
                                                                                                                                                                              • Slide 110
                                                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                                                              • Manifestations (2)
                                                                                                                                                                              • Slide 114
                                                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                                                              • Slide 116
                                                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                              • Slide 118
                                                                                                                                                                              • Slide 119
                                                                                                                                                                              • Slide 120
                                                                                                                                                                              • Slide 121

                                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                                bull LABORATORY FINDINGSIncreased CVP

                                                                                                                                                                                Normal is 4-10 cmH2O

                                                                                                                                                                                CARDIOGENIC SHOCK

                                                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                                Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                                inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                                bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                                decreased pulmonary congestion and to relieve pain

                                                                                                                                                                                CARDIOGENIC SHOCK

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

                                                                                                                                                                                bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                                bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                                CARDIAC TAMPONADE

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

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                distention hypotension and distantmuffled heart sound

                                                                                                                                                                                bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                anterior chest

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                tamponade

                                                                                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                HYPERTENSION

                                                                                                                                                                                bull 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

                                                                                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                Buergerrsquos Disease

                                                                                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                reaction of the vessel wall

                                                                                                                                                                                Manifestations

                                                                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                Diagnosis amp Treatment

                                                                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                (rare occasions)

                                                                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                A Assessment

                                                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                C Goals

                                                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                                                D Nursing Interventions

                                                                                                                                                                                1 Pain control

                                                                                                                                                                                2 Proper medications

                                                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                                                • Slide 2
                                                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                • Slide 5
                                                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                • Types
                                                                                                                                                                                • Slide 12
                                                                                                                                                                                • Slide 13
                                                                                                                                                                                • Slide 14
                                                                                                                                                                                • Conthellip
                                                                                                                                                                                • Conthellip (2)
                                                                                                                                                                                • Drug Therapy
                                                                                                                                                                                • Classification
                                                                                                                                                                                • Nursing Management
                                                                                                                                                                                • Nursing Management (2)
                                                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                                                • Slide 22
                                                                                                                                                                                • Conthellip (3)
                                                                                                                                                                                • Slide 24
                                                                                                                                                                                • Conthellip(MI)
                                                                                                                                                                                • Slide 26
                                                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                                                • Management of MI
                                                                                                                                                                                • Slide 30
                                                                                                                                                                                • Slide 31
                                                                                                                                                                                • ASSESSMENT
                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                • Slide 49
                                                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                • Slide 56
                                                                                                                                                                                • Slide 57
                                                                                                                                                                                • Slide 58
                                                                                                                                                                                • Slide 59
                                                                                                                                                                                • Slide 60
                                                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                                                • Slide 62
                                                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                                                • Infective endocarditis
                                                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                                                • Slide 100
                                                                                                                                                                                • HYPERTENSION
                                                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                                                • Slide 103
                                                                                                                                                                                • Slide 104
                                                                                                                                                                                • Slide 105
                                                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                                                • Slide 108
                                                                                                                                                                                • Manifestations
                                                                                                                                                                                • Slide 110
                                                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                                                • Manifestations (2)
                                                                                                                                                                                • Slide 114
                                                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                                                • Slide 116
                                                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                • Slide 118
                                                                                                                                                                                • Slide 119
                                                                                                                                                                                • Slide 120
                                                                                                                                                                                • Slide 121

                                                                                                                                                                                  CARDIOGENIC SHOCK

                                                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Place patient in a modified

                                                                                                                                                                                  Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and

                                                                                                                                                                                  inotropics such as DOPAMINE and DOBUTAMINE

                                                                                                                                                                                  bull 3 Administer O2bull 4 Morphine is administered to

                                                                                                                                                                                  decreased pulmonary congestion and to relieve pain

                                                                                                                                                                                  CARDIOGENIC SHOCK

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

                                                                                                                                                                                  bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                                  bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                                  CARDIAC TAMPONADE

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

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                  infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                  distention hypotension and distantmuffled heart sound

                                                                                                                                                                                  bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                  anterior chest

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                  tamponade

                                                                                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                  HYPERTENSION

                                                                                                                                                                                  bull 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

                                                                                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                  Buergerrsquos Disease

                                                                                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                  reaction of the vessel wall

                                                                                                                                                                                  Manifestations

                                                                                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                  (rare occasions)

                                                                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                  A Assessment

                                                                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                  2 Impaired gas exchange

                                                                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                  C Goals

                                                                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                                                                  D Nursing Interventions

                                                                                                                                                                                  1 Pain control

                                                                                                                                                                                  2 Proper medications

                                                                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                                                  • Slide 2
                                                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                  • Slide 5
                                                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                  • Types
                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                  • Slide 14
                                                                                                                                                                                  • Conthellip
                                                                                                                                                                                  • Conthellip (2)
                                                                                                                                                                                  • Drug Therapy
                                                                                                                                                                                  • Classification
                                                                                                                                                                                  • Nursing Management
                                                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                  • Conthellip (3)
                                                                                                                                                                                  • Slide 24
                                                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                                                  • Slide 26
                                                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                                                  • Management of MI
                                                                                                                                                                                  • Slide 30
                                                                                                                                                                                  • Slide 31
                                                                                                                                                                                  • ASSESSMENT
                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                  • Slide 56
                                                                                                                                                                                  • Slide 57
                                                                                                                                                                                  • Slide 58
                                                                                                                                                                                  • Slide 59
                                                                                                                                                                                  • Slide 60
                                                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                                                  • Slide 62
                                                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                                                  • Infective endocarditis
                                                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                  • HYPERTENSION
                                                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                  • Manifestations
                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                                                  • Manifestations (2)
                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                                                  • Slide 116
                                                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                  • Slide 120
                                                                                                                                                                                  • Slide 121

                                                                                                                                                                                    CARDIOGENIC SHOCK

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

                                                                                                                                                                                    bull 6 Monitor urinary output BP and pulses

                                                                                                                                                                                    bull 7 cautiously administer diuretics and nitrates

                                                                                                                                                                                    CARDIAC TAMPONADE

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

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                    infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                    distention hypotension and distantmuffled heart sound

                                                                                                                                                                                    bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                    anterior chest

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                    CARDIAC TAMPONADE

                                                                                                                                                                                    bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                    tamponade

                                                                                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                    HYPERTENSION

                                                                                                                                                                                    bull 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

                                                                                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                    Buergerrsquos Disease

                                                                                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                    reaction of the vessel wall

                                                                                                                                                                                    Manifestations

                                                                                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                    (rare occasions)

                                                                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                    A Assessment

                                                                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                    2 Impaired gas exchange

                                                                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                    C Goals

                                                                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                                                                    D Nursing Interventions

                                                                                                                                                                                    1 Pain control

                                                                                                                                                                                    2 Proper medications

                                                                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                                                                    • Slide 2
                                                                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                    • Slide 5
                                                                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                    • Types
                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                    • Slide 14
                                                                                                                                                                                    • Conthellip
                                                                                                                                                                                    • Conthellip (2)
                                                                                                                                                                                    • Drug Therapy
                                                                                                                                                                                    • Classification
                                                                                                                                                                                    • Nursing Management
                                                                                                                                                                                    • Nursing Management (2)
                                                                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                    • Conthellip (3)
                                                                                                                                                                                    • Slide 24
                                                                                                                                                                                    • Conthellip(MI)
                                                                                                                                                                                    • Slide 26
                                                                                                                                                                                    • Pathophysiology (2)
                                                                                                                                                                                    • Tissue Changes After MI
                                                                                                                                                                                    • Management of MI
                                                                                                                                                                                    • Slide 30
                                                                                                                                                                                    • Slide 31
                                                                                                                                                                                    • ASSESSMENT
                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                    • Slide 56
                                                                                                                                                                                    • Slide 57
                                                                                                                                                                                    • Slide 58
                                                                                                                                                                                    • Slide 59
                                                                                                                                                                                    • Slide 60
                                                                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                                                                    • Slide 62
                                                                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                                                                    • Infective endocarditis
                                                                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                    • HYPERTENSION
                                                                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                    • Manifestations
                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                                                                    • Manifestations (2)
                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                                                                    • Slide 116
                                                                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                    • Slide 120
                                                                                                                                                                                    • Slide 121

                                                                                                                                                                                      CARDIAC TAMPONADE

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

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                      infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                      distention hypotension and distantmuffled heart sound

                                                                                                                                                                                      bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                      anterior chest

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                      CARDIAC TAMPONADE

                                                                                                                                                                                      bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                      tamponade

                                                                                                                                                                                      bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                      artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                      HYPERTENSION

                                                                                                                                                                                      bull 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

                                                                                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                      Buergerrsquos Disease

                                                                                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                      reaction of the vessel wall

                                                                                                                                                                                      Manifestations

                                                                                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                      Diagnosis amp Treatment

                                                                                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                      (rare occasions)

                                                                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                      A Assessment

                                                                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                      2 Impaired gas exchange

                                                                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                      C Goals

                                                                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                                                                      D Nursing Interventions

                                                                                                                                                                                      1 Pain control

                                                                                                                                                                                      2 Proper medications

                                                                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                                                                      • Slide 2
                                                                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                      • Slide 5
                                                                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                      • Types
                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                      • Slide 14
                                                                                                                                                                                      • Conthellip
                                                                                                                                                                                      • Conthellip (2)
                                                                                                                                                                                      • Drug Therapy
                                                                                                                                                                                      • Classification
                                                                                                                                                                                      • Nursing Management
                                                                                                                                                                                      • Nursing Management (2)
                                                                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                      • Conthellip (3)
                                                                                                                                                                                      • Slide 24
                                                                                                                                                                                      • Conthellip(MI)
                                                                                                                                                                                      • Slide 26
                                                                                                                                                                                      • Pathophysiology (2)
                                                                                                                                                                                      • Tissue Changes After MI
                                                                                                                                                                                      • Management of MI
                                                                                                                                                                                      • Slide 30
                                                                                                                                                                                      • Slide 31
                                                                                                                                                                                      • ASSESSMENT
                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                      • Slide 56
                                                                                                                                                                                      • Slide 57
                                                                                                                                                                                      • Slide 58
                                                                                                                                                                                      • Slide 59
                                                                                                                                                                                      • Slide 60
                                                                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                                                                      • Slide 62
                                                                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                                                                      • Infective endocarditis
                                                                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                      • HYPERTENSION
                                                                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                      • Manifestations
                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                                                                      • Manifestations (2)
                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                                                                      • Slide 116
                                                                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                      • Slide 120
                                                                                                                                                                                      • Slide 121

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull This condition restricts ventricular filling resulting to decreased cardiac output

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

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                        infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                        distention hypotension and distantmuffled heart sound

                                                                                                                                                                                        bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                        anterior chest

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                        CARDIAC TAMPONADE

                                                                                                                                                                                        bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                        tamponade

                                                                                                                                                                                        bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                        artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                        HYPERTENSION

                                                                                                                                                                                        bull 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

                                                                                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                        Buergerrsquos Disease

                                                                                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                        reaction of the vessel wall

                                                                                                                                                                                        Manifestations

                                                                                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                        Diagnosis amp Treatment

                                                                                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                        (rare occasions)

                                                                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                        A Assessment

                                                                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                        2 Impaired gas exchange

                                                                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                        C Goals

                                                                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                                                                        D Nursing Interventions

                                                                                                                                                                                        1 Pain control

                                                                                                                                                                                        2 Proper medications

                                                                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                                                                        • Slide 2
                                                                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                        • Slide 5
                                                                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                        • Types
                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                        • Slide 14
                                                                                                                                                                                        • Conthellip
                                                                                                                                                                                        • Conthellip (2)
                                                                                                                                                                                        • Drug Therapy
                                                                                                                                                                                        • Classification
                                                                                                                                                                                        • Nursing Management
                                                                                                                                                                                        • Nursing Management (2)
                                                                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                        • Conthellip (3)
                                                                                                                                                                                        • Slide 24
                                                                                                                                                                                        • Conthellip(MI)
                                                                                                                                                                                        • Slide 26
                                                                                                                                                                                        • Pathophysiology (2)
                                                                                                                                                                                        • Tissue Changes After MI
                                                                                                                                                                                        • Management of MI
                                                                                                                                                                                        • Slide 30
                                                                                                                                                                                        • Slide 31
                                                                                                                                                                                        • ASSESSMENT
                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                        • Slide 56
                                                                                                                                                                                        • Slide 57
                                                                                                                                                                                        • Slide 58
                                                                                                                                                                                        • Slide 59
                                                                                                                                                                                        • Slide 60
                                                                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                                                                        • Slide 62
                                                                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                                                                        • Infective endocarditis
                                                                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                        • HYPERTENSION
                                                                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                        • Manifestations
                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                                                                        • Manifestations (2)
                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                                                                        • Slide 116
                                                                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                        • Slide 120
                                                                                                                                                                                        • Slide 121

                                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                                          bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial

                                                                                                                                                                                          infarctionbull 3 Pericarditisbull 4 Cancer metastasis

                                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                                          bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                          distention hypotension and distantmuffled heart sound

                                                                                                                                                                                          bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                                          bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                          anterior chest

                                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                                          bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                          CARDIAC TAMPONADE

                                                                                                                                                                                          bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                          tamponade

                                                                                                                                                                                          bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                          artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                          HYPERTENSION

                                                                                                                                                                                          bull 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

                                                                                                                                                                                          bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                          bull Most common typebull 2 Secondary

                                                                                                                                                                                          bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                          Buergerrsquos Disease

                                                                                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                          reaction of the vessel wall

                                                                                                                                                                                          Manifestations

                                                                                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                          Diagnosis amp Treatment

                                                                                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                          (rare occasions)

                                                                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                          A Assessment

                                                                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                          2 Impaired gas exchange

                                                                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                          C Goals

                                                                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                                                                          D Nursing Interventions

                                                                                                                                                                                          1 Pain control

                                                                                                                                                                                          2 Proper medications

                                                                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                                                                          • Slide 2
                                                                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                          • Slide 5
                                                                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                          • Types
                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                          • Slide 14
                                                                                                                                                                                          • Conthellip
                                                                                                                                                                                          • Conthellip (2)
                                                                                                                                                                                          • Drug Therapy
                                                                                                                                                                                          • Classification
                                                                                                                                                                                          • Nursing Management
                                                                                                                                                                                          • Nursing Management (2)
                                                                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                          • Conthellip (3)
                                                                                                                                                                                          • Slide 24
                                                                                                                                                                                          • Conthellip(MI)
                                                                                                                                                                                          • Slide 26
                                                                                                                                                                                          • Pathophysiology (2)
                                                                                                                                                                                          • Tissue Changes After MI
                                                                                                                                                                                          • Management of MI
                                                                                                                                                                                          • Slide 30
                                                                                                                                                                                          • Slide 31
                                                                                                                                                                                          • ASSESSMENT
                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                          • Slide 56
                                                                                                                                                                                          • Slide 57
                                                                                                                                                                                          • Slide 58
                                                                                                                                                                                          • Slide 59
                                                                                                                                                                                          • Slide 60
                                                                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                                                                          • Slide 62
                                                                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                                                                          • Infective endocarditis
                                                                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                          • HYPERTENSION
                                                                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                          • Manifestations
                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                                                                          • Manifestations (2)
                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                                                                          • Slide 116
                                                                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                          • Slide 120
                                                                                                                                                                                          • Slide 121

                                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                                            bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein

                                                                                                                                                                                            distention hypotension and distantmuffled heart sound

                                                                                                                                                                                            bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output

                                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                                            bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                            anterior chest

                                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                                            bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                            CARDIAC TAMPONADE

                                                                                                                                                                                            bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                            tamponade

                                                                                                                                                                                            bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                            artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                            HYPERTENSION

                                                                                                                                                                                            bull 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

                                                                                                                                                                                            bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                            bull Most common typebull 2 Secondary

                                                                                                                                                                                            bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                            Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                            Buergerrsquos Disease

                                                                                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                            reaction of the vessel wall

                                                                                                                                                                                            Manifestations

                                                                                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                            Diagnosis amp Treatment

                                                                                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                            (rare occasions)

                                                                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                            A Assessment

                                                                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                            2 Impaired gas exchange

                                                                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                            C Goals

                                                                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                                                                            D Nursing Interventions

                                                                                                                                                                                            1 Pain control

                                                                                                                                                                                            2 Proper medications

                                                                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                                                                            • Slide 2
                                                                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                            • Slide 5
                                                                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                            • Types
                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                            • Slide 14
                                                                                                                                                                                            • Conthellip
                                                                                                                                                                                            • Conthellip (2)
                                                                                                                                                                                            • Drug Therapy
                                                                                                                                                                                            • Classification
                                                                                                                                                                                            • Nursing Management
                                                                                                                                                                                            • Nursing Management (2)
                                                                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                            • Conthellip (3)
                                                                                                                                                                                            • Slide 24
                                                                                                                                                                                            • Conthellip(MI)
                                                                                                                                                                                            • Slide 26
                                                                                                                                                                                            • Pathophysiology (2)
                                                                                                                                                                                            • Tissue Changes After MI
                                                                                                                                                                                            • Management of MI
                                                                                                                                                                                            • Slide 30
                                                                                                                                                                                            • Slide 31
                                                                                                                                                                                            • ASSESSMENT
                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                            • Slide 56
                                                                                                                                                                                            • Slide 57
                                                                                                                                                                                            • Slide 58
                                                                                                                                                                                            • Slide 59
                                                                                                                                                                                            • Slide 60
                                                                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                                                                            • Slide 62
                                                                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                                                                            • Infective endocarditis
                                                                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                            • HYPERTENSION
                                                                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                            • Manifestations
                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                                                                            • Manifestations (2)
                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                                                                            • Slide 116
                                                                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                            • Slide 120
                                                                                                                                                                                            • Slide 121

                                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                                              bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the

                                                                                                                                                                                              anterior chest

                                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                                              bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                              CARDIAC TAMPONADE

                                                                                                                                                                                              bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                              tamponade

                                                                                                                                                                                              bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                              artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                              HYPERTENSION

                                                                                                                                                                                              bull 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

                                                                                                                                                                                              bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                              bull Most common typebull 2 Secondary

                                                                                                                                                                                              bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                              Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                              Buergerrsquos Disease

                                                                                                                                                                                              bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                              bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                              bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                              reaction of the vessel wall

                                                                                                                                                                                              Manifestations

                                                                                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                              Diagnosis amp Treatment

                                                                                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                              (rare occasions)

                                                                                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                              A Assessment

                                                                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                              2 Impaired gas exchange

                                                                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                              C Goals

                                                                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                                                                              D Nursing Interventions

                                                                                                                                                                                              1 Pain control

                                                                                                                                                                                              2 Proper medications

                                                                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                                                                              • Slide 2
                                                                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                              • Slide 5
                                                                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                              • Types
                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                              • Slide 14
                                                                                                                                                                                              • Conthellip
                                                                                                                                                                                              • Conthellip (2)
                                                                                                                                                                                              • Drug Therapy
                                                                                                                                                                                              • Classification
                                                                                                                                                                                              • Nursing Management
                                                                                                                                                                                              • Nursing Management (2)
                                                                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                              • Conthellip (3)
                                                                                                                                                                                              • Slide 24
                                                                                                                                                                                              • Conthellip(MI)
                                                                                                                                                                                              • Slide 26
                                                                                                                                                                                              • Pathophysiology (2)
                                                                                                                                                                                              • Tissue Changes After MI
                                                                                                                                                                                              • Management of MI
                                                                                                                                                                                              • Slide 30
                                                                                                                                                                                              • Slide 31
                                                                                                                                                                                              • ASSESSMENT
                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                              • Slide 56
                                                                                                                                                                                              • Slide 57
                                                                                                                                                                                              • Slide 58
                                                                                                                                                                                              • Slide 59
                                                                                                                                                                                              • Slide 60
                                                                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                                                                              • Slide 62
                                                                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                                                                              • Infective endocarditis
                                                                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                              • HYPERTENSION
                                                                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                              • Manifestations
                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                                                                              • Manifestations (2)
                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                                                                              • Slide 116
                                                                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                              • Slide 120
                                                                                                                                                                                              • Slide 121

                                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                                bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray

                                                                                                                                                                                                CARDIAC TAMPONADE

                                                                                                                                                                                                bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                                tamponade

                                                                                                                                                                                                bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                                artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                                HYPERTENSION

                                                                                                                                                                                                bull 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

                                                                                                                                                                                                bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                                bull Most common typebull 2 Secondary

                                                                                                                                                                                                bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                                Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                Buergerrsquos Disease

                                                                                                                                                                                                bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                reaction of the vessel wall

                                                                                                                                                                                                Manifestations

                                                                                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                Diagnosis amp Treatment

                                                                                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                (rare occasions)

                                                                                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                A Assessment

                                                                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                C Goals

                                                                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                                                                D Nursing Interventions

                                                                                                                                                                                                1 Pain control

                                                                                                                                                                                                2 Proper medications

                                                                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                • Slide 2
                                                                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                • Slide 5
                                                                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                • Types
                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                • Slide 14
                                                                                                                                                                                                • Conthellip
                                                                                                                                                                                                • Conthellip (2)
                                                                                                                                                                                                • Drug Therapy
                                                                                                                                                                                                • Classification
                                                                                                                                                                                                • Nursing Management
                                                                                                                                                                                                • Nursing Management (2)
                                                                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                • Conthellip (3)
                                                                                                                                                                                                • Slide 24
                                                                                                                                                                                                • Conthellip(MI)
                                                                                                                                                                                                • Slide 26
                                                                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                                                                • Management of MI
                                                                                                                                                                                                • Slide 30
                                                                                                                                                                                                • Slide 31
                                                                                                                                                                                                • ASSESSMENT
                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                • Slide 56
                                                                                                                                                                                                • Slide 57
                                                                                                                                                                                                • Slide 58
                                                                                                                                                                                                • Slide 59
                                                                                                                                                                                                • Slide 60
                                                                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                                                                • Slide 62
                                                                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                • Infective endocarditis
                                                                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                • HYPERTENSION
                                                                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                • Manifestations
                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                                                                • Manifestations (2)
                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                                                                • Slide 116
                                                                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                • Slide 120
                                                                                                                                                                                                • Slide 121

                                                                                                                                                                                                  CARDIAC TAMPONADE

                                                                                                                                                                                                  bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of

                                                                                                                                                                                                  tamponade

                                                                                                                                                                                                  bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                                  artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                                  HYPERTENSION

                                                                                                                                                                                                  bull 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

                                                                                                                                                                                                  bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                                  bull Most common typebull 2 Secondary

                                                                                                                                                                                                  bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                                  Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                  Buergerrsquos Disease

                                                                                                                                                                                                  bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                  bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                  bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                  bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                  bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                  response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                  reaction of the vessel wall

                                                                                                                                                                                                  Manifestations

                                                                                                                                                                                                  Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                  Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                  Absentdiminished peripheral pulses

                                                                                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                  (rare occasions)

                                                                                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                  A Assessment

                                                                                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                  2 Impaired gas exchange

                                                                                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                  C Goals

                                                                                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                                                                                  D Nursing Interventions

                                                                                                                                                                                                  1 Pain control

                                                                                                                                                                                                  2 Proper medications

                                                                                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                  • Slide 2
                                                                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                  • Slide 5
                                                                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                  • Types
                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                  • Slide 14
                                                                                                                                                                                                  • Conthellip
                                                                                                                                                                                                  • Conthellip (2)
                                                                                                                                                                                                  • Drug Therapy
                                                                                                                                                                                                  • Classification
                                                                                                                                                                                                  • Nursing Management
                                                                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                  • Conthellip (3)
                                                                                                                                                                                                  • Slide 24
                                                                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                                                                  • Slide 26
                                                                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                                                                  • Management of MI
                                                                                                                                                                                                  • Slide 30
                                                                                                                                                                                                  • Slide 31
                                                                                                                                                                                                  • ASSESSMENT
                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                  • Slide 56
                                                                                                                                                                                                  • Slide 57
                                                                                                                                                                                                  • Slide 58
                                                                                                                                                                                                  • Slide 59
                                                                                                                                                                                                  • Slide 60
                                                                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                                                                  • Slide 62
                                                                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                  • Infective endocarditis
                                                                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                  • HYPERTENSION
                                                                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                  • Manifestations
                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                                                                  • Manifestations (2)
                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                                                                  • Slide 116
                                                                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                  • Slide 120
                                                                                                                                                                                                  • Slide 121

                                                                                                                                                                                                    bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary

                                                                                                                                                                                                    artery rupture dysrhythmias pleural laceration and myocardial trauma

                                                                                                                                                                                                    HYPERTENSION

                                                                                                                                                                                                    bull 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

                                                                                                                                                                                                    bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                                    bull Most common typebull 2 Secondary

                                                                                                                                                                                                    bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                                    Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                    Buergerrsquos Disease

                                                                                                                                                                                                    bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                    bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                    bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                    bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                    bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                    response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                    reaction of the vessel wall

                                                                                                                                                                                                    Manifestations

                                                                                                                                                                                                    Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                    Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                    Absentdiminished peripheral pulses

                                                                                                                                                                                                    Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                    Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                    gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                    (rare occasions)

                                                                                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                    A Assessment

                                                                                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                    2 Impaired gas exchange

                                                                                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                    C Goals

                                                                                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                                                                                    D Nursing Interventions

                                                                                                                                                                                                    1 Pain control

                                                                                                                                                                                                    2 Proper medications

                                                                                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                    • Slide 2
                                                                                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                                    • Slide 5
                                                                                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                                    • Types
                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                    • Slide 14
                                                                                                                                                                                                    • Conthellip
                                                                                                                                                                                                    • Conthellip (2)
                                                                                                                                                                                                    • Drug Therapy
                                                                                                                                                                                                    • Classification
                                                                                                                                                                                                    • Nursing Management
                                                                                                                                                                                                    • Nursing Management (2)
                                                                                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                    • Conthellip (3)
                                                                                                                                                                                                    • Slide 24
                                                                                                                                                                                                    • Conthellip(MI)
                                                                                                                                                                                                    • Slide 26
                                                                                                                                                                                                    • Pathophysiology (2)
                                                                                                                                                                                                    • Tissue Changes After MI
                                                                                                                                                                                                    • Management of MI
                                                                                                                                                                                                    • Slide 30
                                                                                                                                                                                                    • Slide 31
                                                                                                                                                                                                    • ASSESSMENT
                                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                                    • Slide 56
                                                                                                                                                                                                    • Slide 57
                                                                                                                                                                                                    • Slide 58
                                                                                                                                                                                                    • Slide 59
                                                                                                                                                                                                    • Slide 60
                                                                                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                                                                                    • Slide 62
                                                                                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                    • Infective endocarditis
                                                                                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                    • HYPERTENSION
                                                                                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                    • Manifestations
                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                                                                                    • Manifestations (2)
                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                                                                                    • Slide 116
                                                                                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                    • Slide 120
                                                                                                                                                                                                    • Slide 121

                                                                                                                                                                                                      HYPERTENSION

                                                                                                                                                                                                      bull 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

                                                                                                                                                                                                      bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                                      bull Most common typebull 2 Secondary

                                                                                                                                                                                                      bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                                      Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                      Buergerrsquos Disease

                                                                                                                                                                                                      bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                      bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                      bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                      bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                      bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                      response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                      reaction of the vessel wall

                                                                                                                                                                                                      Manifestations

                                                                                                                                                                                                      Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                      Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                      Absentdiminished peripheral pulses

                                                                                                                                                                                                      Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                      Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                      gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                      Diagnosis amp Treatment

                                                                                                                                                                                                      bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                      bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                      (rare occasions)

                                                                                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                      A Assessment

                                                                                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                      2 Impaired gas exchange

                                                                                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                      C Goals

                                                                                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                                                                                      D Nursing Interventions

                                                                                                                                                                                                      1 Pain control

                                                                                                                                                                                                      2 Proper medications

                                                                                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                      • Slide 2
                                                                                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                                      • Slide 5
                                                                                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                                      • Types
                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                      • Slide 14
                                                                                                                                                                                                      • Conthellip
                                                                                                                                                                                                      • Conthellip (2)
                                                                                                                                                                                                      • Drug Therapy
                                                                                                                                                                                                      • Classification
                                                                                                                                                                                                      • Nursing Management
                                                                                                                                                                                                      • Nursing Management (2)
                                                                                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                      • Conthellip (3)
                                                                                                                                                                                                      • Slide 24
                                                                                                                                                                                                      • Conthellip(MI)
                                                                                                                                                                                                      • Slide 26
                                                                                                                                                                                                      • Pathophysiology (2)
                                                                                                                                                                                                      • Tissue Changes After MI
                                                                                                                                                                                                      • Management of MI
                                                                                                                                                                                                      • Slide 30
                                                                                                                                                                                                      • Slide 31
                                                                                                                                                                                                      • ASSESSMENT
                                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                                      • Slide 56
                                                                                                                                                                                                      • Slide 57
                                                                                                                                                                                                      • Slide 58
                                                                                                                                                                                                      • Slide 59
                                                                                                                                                                                                      • Slide 60
                                                                                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                                                                                      • Slide 62
                                                                                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                      • Infective endocarditis
                                                                                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                      • HYPERTENSION
                                                                                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                      • Manifestations
                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                                                                                      • Manifestations (2)
                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                                                                                      • Slide 116
                                                                                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                      • Slide 120
                                                                                                                                                                                                      • Slide 121

                                                                                                                                                                                                        HYPERTENSION

                                                                                                                                                                                                        bull Types of Hypertensionbull 1 Primary or ESSENTIAL

                                                                                                                                                                                                        bull Most common typebull 2 Secondary

                                                                                                                                                                                                        bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH

                                                                                                                                                                                                        Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                        Buergerrsquos Disease

                                                                                                                                                                                                        bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                        bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                        bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                        bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                        bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                        response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                        reaction of the vessel wall

                                                                                                                                                                                                        Manifestations

                                                                                                                                                                                                        Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                        Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                        Absentdiminished peripheral pulses

                                                                                                                                                                                                        Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                        Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                        gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                        Diagnosis amp Treatment

                                                                                                                                                                                                        bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                        bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                        Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                        arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                        emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                        previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                        (rare occasions)

                                                                                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                        A Assessment

                                                                                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                        2 Impaired gas exchange

                                                                                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                        C Goals

                                                                                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                                                                                        D Nursing Interventions

                                                                                                                                                                                                        1 Pain control

                                                                                                                                                                                                        2 Proper medications

                                                                                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                        • Slide 2
                                                                                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                                        • Slide 5
                                                                                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                                        • Types
                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                        • Slide 14
                                                                                                                                                                                                        • Conthellip
                                                                                                                                                                                                        • Conthellip (2)
                                                                                                                                                                                                        • Drug Therapy
                                                                                                                                                                                                        • Classification
                                                                                                                                                                                                        • Nursing Management
                                                                                                                                                                                                        • Nursing Management (2)
                                                                                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                        • Conthellip (3)
                                                                                                                                                                                                        • Slide 24
                                                                                                                                                                                                        • Conthellip(MI)
                                                                                                                                                                                                        • Slide 26
                                                                                                                                                                                                        • Pathophysiology (2)
                                                                                                                                                                                                        • Tissue Changes After MI
                                                                                                                                                                                                        • Management of MI
                                                                                                                                                                                                        • Slide 30
                                                                                                                                                                                                        • Slide 31
                                                                                                                                                                                                        • ASSESSMENT
                                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                                        • Slide 56
                                                                                                                                                                                                        • Slide 57
                                                                                                                                                                                                        • Slide 58
                                                                                                                                                                                                        • Slide 59
                                                                                                                                                                                                        • Slide 60
                                                                                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                                                                                        • Slide 62
                                                                                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                        • Infective endocarditis
                                                                                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                        • HYPERTENSION
                                                                                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                        • Manifestations
                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                                                                                        • Manifestations (2)
                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                                                                                        • Slide 116
                                                                                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                        • Slide 120
                                                                                                                                                                                                        • Slide 121

                                                                                                                                                                                                          Alterations in Blood Flow in the Systemic Circulation

                                                                                                                                                                                                          Buergerrsquos Disease

                                                                                                                                                                                                          bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                          bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                          bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                          bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                          bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                          response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                          reaction of the vessel wall

                                                                                                                                                                                                          Manifestations

                                                                                                                                                                                                          Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                          Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                          Absentdiminished peripheral pulses

                                                                                                                                                                                                          Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                          Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                          gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                          Diagnosis amp Treatment

                                                                                                                                                                                                          bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                          bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                          Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                          arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                          emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                          previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                          Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                          bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                          bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                          (rare occasions)

                                                                                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                          A Assessment

                                                                                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                          2 Impaired gas exchange

                                                                                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                          C Goals

                                                                                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                                                                                          D Nursing Interventions

                                                                                                                                                                                                          1 Pain control

                                                                                                                                                                                                          2 Proper medications

                                                                                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                          • Slide 2
                                                                                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                                          • Slide 5
                                                                                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                                          • Types
                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                          • Slide 14
                                                                                                                                                                                                          • Conthellip
                                                                                                                                                                                                          • Conthellip (2)
                                                                                                                                                                                                          • Drug Therapy
                                                                                                                                                                                                          • Classification
                                                                                                                                                                                                          • Nursing Management
                                                                                                                                                                                                          • Nursing Management (2)
                                                                                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                          • Conthellip (3)
                                                                                                                                                                                                          • Slide 24
                                                                                                                                                                                                          • Conthellip(MI)
                                                                                                                                                                                                          • Slide 26
                                                                                                                                                                                                          • Pathophysiology (2)
                                                                                                                                                                                                          • Tissue Changes After MI
                                                                                                                                                                                                          • Management of MI
                                                                                                                                                                                                          • Slide 30
                                                                                                                                                                                                          • Slide 31
                                                                                                                                                                                                          • ASSESSMENT
                                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                                          • Slide 56
                                                                                                                                                                                                          • Slide 57
                                                                                                                                                                                                          • Slide 58
                                                                                                                                                                                                          • Slide 59
                                                                                                                                                                                                          • Slide 60
                                                                                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                                                                                          • Slide 62
                                                                                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                          • Infective endocarditis
                                                                                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                          • HYPERTENSION
                                                                                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                          • Manifestations
                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                                                                                          • Manifestations (2)
                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                                                                                          • Slide 116
                                                                                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                          • Slide 120
                                                                                                                                                                                                          • Slide 121

                                                                                                                                                                                                            Buergerrsquos Disease

                                                                                                                                                                                                            bull Also known as Thromboangiitis obliterans

                                                                                                                                                                                                            bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo

                                                                                                                                                                                                            bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves

                                                                                                                                                                                                            bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                            bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                            response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                            reaction of the vessel wall

                                                                                                                                                                                                            Manifestations

                                                                                                                                                                                                            Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                            Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                            Absentdiminished peripheral pulses

                                                                                                                                                                                                            Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                            Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                            gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                            Diagnosis amp Treatment

                                                                                                                                                                                                            bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                            bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                            Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                            arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                            emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                            previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                            Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                            bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                            bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                            bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                            affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                            bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                            (rare occasions)

                                                                                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                            A Assessment

                                                                                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                            2 Impaired gas exchange

                                                                                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                            C Goals

                                                                                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                                                                                            D Nursing Interventions

                                                                                                                                                                                                            1 Pain control

                                                                                                                                                                                                            2 Proper medications

                                                                                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                            • Slide 2
                                                                                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                                            • Slide 5
                                                                                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                                            • Types
                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                            • Slide 14
                                                                                                                                                                                                            • Conthellip
                                                                                                                                                                                                            • Conthellip (2)
                                                                                                                                                                                                            • Drug Therapy
                                                                                                                                                                                                            • Classification
                                                                                                                                                                                                            • Nursing Management
                                                                                                                                                                                                            • Nursing Management (2)
                                                                                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                            • Conthellip (3)
                                                                                                                                                                                                            • Slide 24
                                                                                                                                                                                                            • Conthellip(MI)
                                                                                                                                                                                                            • Slide 26
                                                                                                                                                                                                            • Pathophysiology (2)
                                                                                                                                                                                                            • Tissue Changes After MI
                                                                                                                                                                                                            • Management of MI
                                                                                                                                                                                                            • Slide 30
                                                                                                                                                                                                            • Slide 31
                                                                                                                                                                                                            • ASSESSMENT
                                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                                            • Slide 56
                                                                                                                                                                                                            • Slide 57
                                                                                                                                                                                                            • Slide 58
                                                                                                                                                                                                            • Slide 59
                                                                                                                                                                                                            • Slide 60
                                                                                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                                                                                            • Slide 62
                                                                                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                            • Infective endocarditis
                                                                                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                            • HYPERTENSION
                                                                                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                            • Manifestations
                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                                                                                            • Manifestations (2)
                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                                                                                            • Slide 116
                                                                                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                            • Slide 120
                                                                                                                                                                                                            • Slide 121

                                                                                                                                                                                                              bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)

                                                                                                                                                                                                              bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune

                                                                                                                                                                                                              response or bull unmask a clotting defect rarr these 2 can incite an inflammatory

                                                                                                                                                                                                              reaction of the vessel wall

                                                                                                                                                                                                              Manifestations

                                                                                                                                                                                                              Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                              Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                              Absentdiminished peripheral pulses

                                                                                                                                                                                                              Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                              Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                              gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                              Diagnosis amp Treatment

                                                                                                                                                                                                              bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                              bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                              Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                              arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                              emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                              previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                              Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                              bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                              bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                              bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                              affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                              bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                              (rare occasions)

                                                                                                                                                                                                              Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                              Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                              Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                              Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                              A Assessment

                                                                                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                              2 Impaired gas exchange

                                                                                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                              C Goals

                                                                                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                                                                                              D Nursing Interventions

                                                                                                                                                                                                              1 Pain control

                                                                                                                                                                                                              2 Proper medications

                                                                                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                              • Slide 2
                                                                                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                                              • Slide 5
                                                                                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                                              • Types
                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                              • Slide 14
                                                                                                                                                                                                              • Conthellip
                                                                                                                                                                                                              • Conthellip (2)
                                                                                                                                                                                                              • Drug Therapy
                                                                                                                                                                                                              • Classification
                                                                                                                                                                                                              • Nursing Management
                                                                                                                                                                                                              • Nursing Management (2)
                                                                                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                              • Conthellip (3)
                                                                                                                                                                                                              • Slide 24
                                                                                                                                                                                                              • Conthellip(MI)
                                                                                                                                                                                                              • Slide 26
                                                                                                                                                                                                              • Pathophysiology (2)
                                                                                                                                                                                                              • Tissue Changes After MI
                                                                                                                                                                                                              • Management of MI
                                                                                                                                                                                                              • Slide 30
                                                                                                                                                                                                              • Slide 31
                                                                                                                                                                                                              • ASSESSMENT
                                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                                              • Slide 56
                                                                                                                                                                                                              • Slide 57
                                                                                                                                                                                                              • Slide 58
                                                                                                                                                                                                              • Slide 59
                                                                                                                                                                                                              • Slide 60
                                                                                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                                                                                              • Slide 62
                                                                                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                              • Infective endocarditis
                                                                                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                              • HYPERTENSION
                                                                                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                              • Manifestations
                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                                                                                              • Manifestations (2)
                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                                                                                              • Slide 116
                                                                                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                              • Slide 120
                                                                                                                                                                                                              • Slide 121

                                                                                                                                                                                                                Manifestations

                                                                                                                                                                                                                Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits

                                                                                                                                                                                                                Increased sensitivity to cold (due to impaired circulation

                                                                                                                                                                                                                Absentdiminished peripheral pulses

                                                                                                                                                                                                                Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                                Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                                gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                                Diagnosis amp Treatment

                                                                                                                                                                                                                bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                                bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                                Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                                arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                                emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                                previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                                Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                                bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                                bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                                bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                (rare occasions)

                                                                                                                                                                                                                Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                A Assessment

                                                                                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                C Goals

                                                                                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                                                                                D Nursing Interventions

                                                                                                                                                                                                                1 Pain control

                                                                                                                                                                                                                2 Proper medications

                                                                                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                • Slide 2
                                                                                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                                • Slide 5
                                                                                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                                • Types
                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                • Slide 14
                                                                                                                                                                                                                • Conthellip
                                                                                                                                                                                                                • Conthellip (2)
                                                                                                                                                                                                                • Drug Therapy
                                                                                                                                                                                                                • Classification
                                                                                                                                                                                                                • Nursing Management
                                                                                                                                                                                                                • Nursing Management (2)
                                                                                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                • Conthellip (3)
                                                                                                                                                                                                                • Slide 24
                                                                                                                                                                                                                • Conthellip(MI)
                                                                                                                                                                                                                • Slide 26
                                                                                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                                                                                • Management of MI
                                                                                                                                                                                                                • Slide 30
                                                                                                                                                                                                                • Slide 31
                                                                                                                                                                                                                • ASSESSMENT
                                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                                • Slide 56
                                                                                                                                                                                                                • Slide 57
                                                                                                                                                                                                                • Slide 58
                                                                                                                                                                                                                • Slide 59
                                                                                                                                                                                                                • Slide 60
                                                                                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                                                                                • Slide 62
                                                                                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                • Infective endocarditis
                                                                                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                • HYPERTENSION
                                                                                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                • Manifestations
                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                                                                                • Manifestations (2)
                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                • Slide 116
                                                                                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                • Slide 120
                                                                                                                                                                                                                • Slide 121

                                                                                                                                                                                                                  Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)

                                                                                                                                                                                                                  Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp

                                                                                                                                                                                                                  gangrenous changes may arise may necessitate amputation

                                                                                                                                                                                                                  Diagnosis amp Treatment

                                                                                                                                                                                                                  bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                                  bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                                  Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                                  arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                                  emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                                  previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                                  Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                                  bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                                  bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                                  bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                  affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                  bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                  (rare occasions)

                                                                                                                                                                                                                  Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                  Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                  Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                  Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                  Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                  protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                  stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                  Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                  Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                  A Assessment

                                                                                                                                                                                                                  1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                  2 vsB Nursing Dx

                                                                                                                                                                                                                  1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                  2 Impaired gas exchange

                                                                                                                                                                                                                  3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                  C Goals

                                                                                                                                                                                                                  1 Relief of pain amp symptoms

                                                                                                                                                                                                                  2 Prevention of further cardiac damage

                                                                                                                                                                                                                  D Nursing Interventions

                                                                                                                                                                                                                  1 Pain control

                                                                                                                                                                                                                  2 Proper medications

                                                                                                                                                                                                                  3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                  4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                  • Slide 2
                                                                                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                                  • Slide 5
                                                                                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                                  • Types
                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                  • Slide 14
                                                                                                                                                                                                                  • Conthellip
                                                                                                                                                                                                                  • Conthellip (2)
                                                                                                                                                                                                                  • Drug Therapy
                                                                                                                                                                                                                  • Classification
                                                                                                                                                                                                                  • Nursing Management
                                                                                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                  • Conthellip (3)
                                                                                                                                                                                                                  • Slide 24
                                                                                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                                                                                  • Slide 26
                                                                                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                                                                                  • Management of MI
                                                                                                                                                                                                                  • Slide 30
                                                                                                                                                                                                                  • Slide 31
                                                                                                                                                                                                                  • ASSESSMENT
                                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                                  • Slide 56
                                                                                                                                                                                                                  • Slide 57
                                                                                                                                                                                                                  • Slide 58
                                                                                                                                                                                                                  • Slide 59
                                                                                                                                                                                                                  • Slide 60
                                                                                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                                                                                  • Slide 62
                                                                                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                  • Infective endocarditis
                                                                                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                  • HYPERTENSION
                                                                                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                  • Manifestations
                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                                                                                  • Manifestations (2)
                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                  • Slide 116
                                                                                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                  • Slide 120
                                                                                                                                                                                                                  • Slide 121

                                                                                                                                                                                                                    Diagnosis amp Treatment

                                                                                                                                                                                                                    bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)

                                                                                                                                                                                                                    bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation

                                                                                                                                                                                                                    Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                                    arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                                    emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                                    previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                                    Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                                    bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                                    bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                                    bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                    affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                    bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                    (rare occasions)

                                                                                                                                                                                                                    Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                    Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                    Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                    Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                    Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                    protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                    stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                    Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                    Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                    A Assessment

                                                                                                                                                                                                                    1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                    2 vsB Nursing Dx

                                                                                                                                                                                                                    1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                    2 Impaired gas exchange

                                                                                                                                                                                                                    3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                    C Goals

                                                                                                                                                                                                                    1 Relief of pain amp symptoms

                                                                                                                                                                                                                    2 Prevention of further cardiac damage

                                                                                                                                                                                                                    D Nursing Interventions

                                                                                                                                                                                                                    1 Pain control

                                                                                                                                                                                                                    2 Proper medications

                                                                                                                                                                                                                    3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                    4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                    • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                    • Slide 2
                                                                                                                                                                                                                    • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                                                    • Slide 5
                                                                                                                                                                                                                    • ASSESSING CHEST PAIN
                                                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                    • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                    • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                    • Pathophysiology
                                                                                                                                                                                                                    • Types
                                                                                                                                                                                                                    • Slide 12
                                                                                                                                                                                                                    • Slide 13
                                                                                                                                                                                                                    • Slide 14
                                                                                                                                                                                                                    • Conthellip
                                                                                                                                                                                                                    • Conthellip (2)
                                                                                                                                                                                                                    • Drug Therapy
                                                                                                                                                                                                                    • Classification
                                                                                                                                                                                                                    • Nursing Management
                                                                                                                                                                                                                    • Nursing Management (2)
                                                                                                                                                                                                                    • Acute Coronary Syndrome
                                                                                                                                                                                                                    • Slide 22
                                                                                                                                                                                                                    • Conthellip (3)
                                                                                                                                                                                                                    • Slide 24
                                                                                                                                                                                                                    • Conthellip(MI)
                                                                                                                                                                                                                    • Slide 26
                                                                                                                                                                                                                    • Pathophysiology (2)
                                                                                                                                                                                                                    • Tissue Changes After MI
                                                                                                                                                                                                                    • Management of MI
                                                                                                                                                                                                                    • Slide 30
                                                                                                                                                                                                                    • Slide 31
                                                                                                                                                                                                                    • ASSESSMENT
                                                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                    • NURSING CARE PLAN
                                                                                                                                                                                                                    • NURSING CARE PLAN (2)
                                                                                                                                                                                                                    • NURSING CARE PLAN (3)
                                                                                                                                                                                                                    • NURSING CARE PLAN (4)
                                                                                                                                                                                                                    • NURSING CARE PLAN (5)
                                                                                                                                                                                                                    • NURSING CARE PLAN (6)
                                                                                                                                                                                                                    • NURSING CARE PLAN (7)
                                                                                                                                                                                                                    • NURSING CARE PLAN (8)
                                                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                                                    • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                    • PATHOPHYSIOLOGY
                                                                                                                                                                                                                    • ASSESSMENT (2)
                                                                                                                                                                                                                    • ASSESSMENT (3)
                                                                                                                                                                                                                    • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                    • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                    • Slide 49
                                                                                                                                                                                                                    • NURSING CARE PLAN (9)
                                                                                                                                                                                                                    • NURSING CARE PLAN (10)
                                                                                                                                                                                                                    • NURSING CARE PLAN (11)
                                                                                                                                                                                                                    • NURSING CARE PLAN (12)
                                                                                                                                                                                                                    • NURSING CARE PLAN (13)
                                                                                                                                                                                                                    • EVALUATION
                                                                                                                                                                                                                    • Slide 56
                                                                                                                                                                                                                    • Slide 57
                                                                                                                                                                                                                    • Slide 58
                                                                                                                                                                                                                    • Slide 59
                                                                                                                                                                                                                    • Slide 60
                                                                                                                                                                                                                    • Treatment of Hyperlipidemia
                                                                                                                                                                                                                    • Slide 62
                                                                                                                                                                                                                    • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                    • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                    • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                    • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                    • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                    • CARDIOMYOPATHIES
                                                                                                                                                                                                                    • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                    • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                    • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                    • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                    • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                    • Infective endocarditis
                                                                                                                                                                                                                    • Infective endocarditis (2)
                                                                                                                                                                                                                    • Infective endocarditis (3)
                                                                                                                                                                                                                    • Infective endocarditis (4)
                                                                                                                                                                                                                    • Infective endocarditis (5)
                                                                                                                                                                                                                    • Infective endocarditis (6)
                                                                                                                                                                                                                    • Infective endocarditis (7)
                                                                                                                                                                                                                    • Infective endocarditis (8)
                                                                                                                                                                                                                    • Infective endocarditis (9)
                                                                                                                                                                                                                    • Infective endocarditis (10)
                                                                                                                                                                                                                    • Infective endocarditis (11)
                                                                                                                                                                                                                    • Infective endocarditis (12)
                                                                                                                                                                                                                    • CARDIOGENIC SHOCK
                                                                                                                                                                                                                    • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                    • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                    • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                    • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                    • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                    • Slide 100
                                                                                                                                                                                                                    • HYPERTENSION
                                                                                                                                                                                                                    • HYPERTENSION (2)
                                                                                                                                                                                                                    • Slide 103
                                                                                                                                                                                                                    • Slide 104
                                                                                                                                                                                                                    • Slide 105
                                                                                                                                                                                                                    • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                    • Buergerrsquos Disease
                                                                                                                                                                                                                    • Slide 108
                                                                                                                                                                                                                    • Manifestations
                                                                                                                                                                                                                    • Slide 110
                                                                                                                                                                                                                    • Diagnosis amp Treatment
                                                                                                                                                                                                                    • Rynaudrsquos Disease
                                                                                                                                                                                                                    • Manifestations (2)
                                                                                                                                                                                                                    • Slide 114
                                                                                                                                                                                                                    • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                    • Slide 116
                                                                                                                                                                                                                    • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                    • Slide 118
                                                                                                                                                                                                                    • Slide 119
                                                                                                                                                                                                                    • Slide 120
                                                                                                                                                                                                                    • Slide 121

                                                                                                                                                                                                                      Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp

                                                                                                                                                                                                                      arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong

                                                                                                                                                                                                                      emotionsRaynaudrsquos phenomenon ndash associated with

                                                                                                                                                                                                                      previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)

                                                                                                                                                                                                                      Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                                      bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                                      bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                                      bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                      affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                      bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                      (rare occasions)

                                                                                                                                                                                                                      Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                      Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                      Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                      Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                      Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                      protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                      stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                      Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                      Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                      A Assessment

                                                                                                                                                                                                                      1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                      2 vsB Nursing Dx

                                                                                                                                                                                                                      1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                      2 Impaired gas exchange

                                                                                                                                                                                                                      3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                      C Goals

                                                                                                                                                                                                                      1 Relief of pain amp symptoms

                                                                                                                                                                                                                      2 Prevention of further cardiac damage

                                                                                                                                                                                                                      D Nursing Interventions

                                                                                                                                                                                                                      1 Pain control

                                                                                                                                                                                                                      2 Proper medications

                                                                                                                                                                                                                      3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                      4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                      • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                      • Slide 2
                                                                                                                                                                                                                      • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                                                      • Slide 5
                                                                                                                                                                                                                      • ASSESSING CHEST PAIN
                                                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                      • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                      • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                      • Pathophysiology
                                                                                                                                                                                                                      • Types
                                                                                                                                                                                                                      • Slide 12
                                                                                                                                                                                                                      • Slide 13
                                                                                                                                                                                                                      • Slide 14
                                                                                                                                                                                                                      • Conthellip
                                                                                                                                                                                                                      • Conthellip (2)
                                                                                                                                                                                                                      • Drug Therapy
                                                                                                                                                                                                                      • Classification
                                                                                                                                                                                                                      • Nursing Management
                                                                                                                                                                                                                      • Nursing Management (2)
                                                                                                                                                                                                                      • Acute Coronary Syndrome
                                                                                                                                                                                                                      • Slide 22
                                                                                                                                                                                                                      • Conthellip (3)
                                                                                                                                                                                                                      • Slide 24
                                                                                                                                                                                                                      • Conthellip(MI)
                                                                                                                                                                                                                      • Slide 26
                                                                                                                                                                                                                      • Pathophysiology (2)
                                                                                                                                                                                                                      • Tissue Changes After MI
                                                                                                                                                                                                                      • Management of MI
                                                                                                                                                                                                                      • Slide 30
                                                                                                                                                                                                                      • Slide 31
                                                                                                                                                                                                                      • ASSESSMENT
                                                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                      • NURSING CARE PLAN
                                                                                                                                                                                                                      • NURSING CARE PLAN (2)
                                                                                                                                                                                                                      • NURSING CARE PLAN (3)
                                                                                                                                                                                                                      • NURSING CARE PLAN (4)
                                                                                                                                                                                                                      • NURSING CARE PLAN (5)
                                                                                                                                                                                                                      • NURSING CARE PLAN (6)
                                                                                                                                                                                                                      • NURSING CARE PLAN (7)
                                                                                                                                                                                                                      • NURSING CARE PLAN (8)
                                                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                                                      • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                      • PATHOPHYSIOLOGY
                                                                                                                                                                                                                      • ASSESSMENT (2)
                                                                                                                                                                                                                      • ASSESSMENT (3)
                                                                                                                                                                                                                      • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                      • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                      • Slide 49
                                                                                                                                                                                                                      • NURSING CARE PLAN (9)
                                                                                                                                                                                                                      • NURSING CARE PLAN (10)
                                                                                                                                                                                                                      • NURSING CARE PLAN (11)
                                                                                                                                                                                                                      • NURSING CARE PLAN (12)
                                                                                                                                                                                                                      • NURSING CARE PLAN (13)
                                                                                                                                                                                                                      • EVALUATION
                                                                                                                                                                                                                      • Slide 56
                                                                                                                                                                                                                      • Slide 57
                                                                                                                                                                                                                      • Slide 58
                                                                                                                                                                                                                      • Slide 59
                                                                                                                                                                                                                      • Slide 60
                                                                                                                                                                                                                      • Treatment of Hyperlipidemia
                                                                                                                                                                                                                      • Slide 62
                                                                                                                                                                                                                      • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                      • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                      • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                      • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                      • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                      • CARDIOMYOPATHIES
                                                                                                                                                                                                                      • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                      • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                      • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                      • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                      • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                      • Infective endocarditis
                                                                                                                                                                                                                      • Infective endocarditis (2)
                                                                                                                                                                                                                      • Infective endocarditis (3)
                                                                                                                                                                                                                      • Infective endocarditis (4)
                                                                                                                                                                                                                      • Infective endocarditis (5)
                                                                                                                                                                                                                      • Infective endocarditis (6)
                                                                                                                                                                                                                      • Infective endocarditis (7)
                                                                                                                                                                                                                      • Infective endocarditis (8)
                                                                                                                                                                                                                      • Infective endocarditis (9)
                                                                                                                                                                                                                      • Infective endocarditis (10)
                                                                                                                                                                                                                      • Infective endocarditis (11)
                                                                                                                                                                                                                      • Infective endocarditis (12)
                                                                                                                                                                                                                      • CARDIOGENIC SHOCK
                                                                                                                                                                                                                      • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                      • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                      • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                      • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                      • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                      • Slide 100
                                                                                                                                                                                                                      • HYPERTENSION
                                                                                                                                                                                                                      • HYPERTENSION (2)
                                                                                                                                                                                                                      • Slide 103
                                                                                                                                                                                                                      • Slide 104
                                                                                                                                                                                                                      • Slide 105
                                                                                                                                                                                                                      • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                      • Buergerrsquos Disease
                                                                                                                                                                                                                      • Slide 108
                                                                                                                                                                                                                      • Manifestations
                                                                                                                                                                                                                      • Slide 110
                                                                                                                                                                                                                      • Diagnosis amp Treatment
                                                                                                                                                                                                                      • Rynaudrsquos Disease
                                                                                                                                                                                                                      • Manifestations (2)
                                                                                                                                                                                                                      • Slide 114
                                                                                                                                                                                                                      • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                      • Slide 116
                                                                                                                                                                                                                      • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                      • Slide 118
                                                                                                                                                                                                                      • Slide 119
                                                                                                                                                                                                                      • Slide 120
                                                                                                                                                                                                                      • Slide 121

                                                                                                                                                                                                                        Manifestations bull Period of ischemia (ischemia due to vasospasm)

                                                                                                                                                                                                                        bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)

                                                                                                                                                                                                                        bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia

                                                                                                                                                                                                                        bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                        affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                        bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                        (rare occasions)

                                                                                                                                                                                                                        Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                        Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                        Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                        Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                        Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                        protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                        stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                        Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                        Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                        A Assessment

                                                                                                                                                                                                                        1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                        2 vsB Nursing Dx

                                                                                                                                                                                                                        1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                        2 Impaired gas exchange

                                                                                                                                                                                                                        3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                        C Goals

                                                                                                                                                                                                                        1 Relief of pain amp symptoms

                                                                                                                                                                                                                        2 Prevention of further cardiac damage

                                                                                                                                                                                                                        D Nursing Interventions

                                                                                                                                                                                                                        1 Pain control

                                                                                                                                                                                                                        2 Proper medications

                                                                                                                                                                                                                        3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                        4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                        • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                        • Slide 2
                                                                                                                                                                                                                        • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                                                        • Slide 5
                                                                                                                                                                                                                        • ASSESSING CHEST PAIN
                                                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                        • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                        • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                        • Pathophysiology
                                                                                                                                                                                                                        • Types
                                                                                                                                                                                                                        • Slide 12
                                                                                                                                                                                                                        • Slide 13
                                                                                                                                                                                                                        • Slide 14
                                                                                                                                                                                                                        • Conthellip
                                                                                                                                                                                                                        • Conthellip (2)
                                                                                                                                                                                                                        • Drug Therapy
                                                                                                                                                                                                                        • Classification
                                                                                                                                                                                                                        • Nursing Management
                                                                                                                                                                                                                        • Nursing Management (2)
                                                                                                                                                                                                                        • Acute Coronary Syndrome
                                                                                                                                                                                                                        • Slide 22
                                                                                                                                                                                                                        • Conthellip (3)
                                                                                                                                                                                                                        • Slide 24
                                                                                                                                                                                                                        • Conthellip(MI)
                                                                                                                                                                                                                        • Slide 26
                                                                                                                                                                                                                        • Pathophysiology (2)
                                                                                                                                                                                                                        • Tissue Changes After MI
                                                                                                                                                                                                                        • Management of MI
                                                                                                                                                                                                                        • Slide 30
                                                                                                                                                                                                                        • Slide 31
                                                                                                                                                                                                                        • ASSESSMENT
                                                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                        • NURSING CARE PLAN
                                                                                                                                                                                                                        • NURSING CARE PLAN (2)
                                                                                                                                                                                                                        • NURSING CARE PLAN (3)
                                                                                                                                                                                                                        • NURSING CARE PLAN (4)
                                                                                                                                                                                                                        • NURSING CARE PLAN (5)
                                                                                                                                                                                                                        • NURSING CARE PLAN (6)
                                                                                                                                                                                                                        • NURSING CARE PLAN (7)
                                                                                                                                                                                                                        • NURSING CARE PLAN (8)
                                                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                                                        • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                        • PATHOPHYSIOLOGY
                                                                                                                                                                                                                        • ASSESSMENT (2)
                                                                                                                                                                                                                        • ASSESSMENT (3)
                                                                                                                                                                                                                        • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                        • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                        • Slide 49
                                                                                                                                                                                                                        • NURSING CARE PLAN (9)
                                                                                                                                                                                                                        • NURSING CARE PLAN (10)
                                                                                                                                                                                                                        • NURSING CARE PLAN (11)
                                                                                                                                                                                                                        • NURSING CARE PLAN (12)
                                                                                                                                                                                                                        • NURSING CARE PLAN (13)
                                                                                                                                                                                                                        • EVALUATION
                                                                                                                                                                                                                        • Slide 56
                                                                                                                                                                                                                        • Slide 57
                                                                                                                                                                                                                        • Slide 58
                                                                                                                                                                                                                        • Slide 59
                                                                                                                                                                                                                        • Slide 60
                                                                                                                                                                                                                        • Treatment of Hyperlipidemia
                                                                                                                                                                                                                        • Slide 62
                                                                                                                                                                                                                        • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                        • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                        • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                        • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                        • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                        • CARDIOMYOPATHIES
                                                                                                                                                                                                                        • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                        • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                        • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                        • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                        • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                        • Infective endocarditis
                                                                                                                                                                                                                        • Infective endocarditis (2)
                                                                                                                                                                                                                        • Infective endocarditis (3)
                                                                                                                                                                                                                        • Infective endocarditis (4)
                                                                                                                                                                                                                        • Infective endocarditis (5)
                                                                                                                                                                                                                        • Infective endocarditis (6)
                                                                                                                                                                                                                        • Infective endocarditis (7)
                                                                                                                                                                                                                        • Infective endocarditis (8)
                                                                                                                                                                                                                        • Infective endocarditis (9)
                                                                                                                                                                                                                        • Infective endocarditis (10)
                                                                                                                                                                                                                        • Infective endocarditis (11)
                                                                                                                                                                                                                        • Infective endocarditis (12)
                                                                                                                                                                                                                        • CARDIOGENIC SHOCK
                                                                                                                                                                                                                        • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                        • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                        • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                        • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                        • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                        • Slide 100
                                                                                                                                                                                                                        • HYPERTENSION
                                                                                                                                                                                                                        • HYPERTENSION (2)
                                                                                                                                                                                                                        • Slide 103
                                                                                                                                                                                                                        • Slide 104
                                                                                                                                                                                                                        • Slide 105
                                                                                                                                                                                                                        • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                        • Buergerrsquos Disease
                                                                                                                                                                                                                        • Slide 108
                                                                                                                                                                                                                        • Manifestations
                                                                                                                                                                                                                        • Slide 110
                                                                                                                                                                                                                        • Diagnosis amp Treatment
                                                                                                                                                                                                                        • Rynaudrsquos Disease
                                                                                                                                                                                                                        • Manifestations (2)
                                                                                                                                                                                                                        • Slide 114
                                                                                                                                                                                                                        • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                        • Slide 116
                                                                                                                                                                                                                        • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                        • Slide 118
                                                                                                                                                                                                                        • Slide 119
                                                                                                                                                                                                                        • Slide 120
                                                                                                                                                                                                                        • Slide 121

                                                                                                                                                                                                                          bull Return to normal colorbull Note although all of the fingers are

                                                                                                                                                                                                                          affected symmetrically only 1-2digits may be involved

                                                                                                                                                                                                                          bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers

                                                                                                                                                                                                                          (rare occasions)

                                                                                                                                                                                                                          Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                          Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                          Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                          Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                          Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                          protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                          stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                          Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                          Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                          A Assessment

                                                                                                                                                                                                                          1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                          2 vsB Nursing Dx

                                                                                                                                                                                                                          1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                          2 Impaired gas exchange

                                                                                                                                                                                                                          3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                          C Goals

                                                                                                                                                                                                                          1 Relief of pain amp symptoms

                                                                                                                                                                                                                          2 Prevention of further cardiac damage

                                                                                                                                                                                                                          D Nursing Interventions

                                                                                                                                                                                                                          1 Pain control

                                                                                                                                                                                                                          2 Proper medications

                                                                                                                                                                                                                          3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                          4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                          • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                          • Slide 2
                                                                                                                                                                                                                          • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                                                          • Slide 5
                                                                                                                                                                                                                          • ASSESSING CHEST PAIN
                                                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                          • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                          • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                          • Pathophysiology
                                                                                                                                                                                                                          • Types
                                                                                                                                                                                                                          • Slide 12
                                                                                                                                                                                                                          • Slide 13
                                                                                                                                                                                                                          • Slide 14
                                                                                                                                                                                                                          • Conthellip
                                                                                                                                                                                                                          • Conthellip (2)
                                                                                                                                                                                                                          • Drug Therapy
                                                                                                                                                                                                                          • Classification
                                                                                                                                                                                                                          • Nursing Management
                                                                                                                                                                                                                          • Nursing Management (2)
                                                                                                                                                                                                                          • Acute Coronary Syndrome
                                                                                                                                                                                                                          • Slide 22
                                                                                                                                                                                                                          • Conthellip (3)
                                                                                                                                                                                                                          • Slide 24
                                                                                                                                                                                                                          • Conthellip(MI)
                                                                                                                                                                                                                          • Slide 26
                                                                                                                                                                                                                          • Pathophysiology (2)
                                                                                                                                                                                                                          • Tissue Changes After MI
                                                                                                                                                                                                                          • Management of MI
                                                                                                                                                                                                                          • Slide 30
                                                                                                                                                                                                                          • Slide 31
                                                                                                                                                                                                                          • ASSESSMENT
                                                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                          • NURSING CARE PLAN
                                                                                                                                                                                                                          • NURSING CARE PLAN (2)
                                                                                                                                                                                                                          • NURSING CARE PLAN (3)
                                                                                                                                                                                                                          • NURSING CARE PLAN (4)
                                                                                                                                                                                                                          • NURSING CARE PLAN (5)
                                                                                                                                                                                                                          • NURSING CARE PLAN (6)
                                                                                                                                                                                                                          • NURSING CARE PLAN (7)
                                                                                                                                                                                                                          • NURSING CARE PLAN (8)
                                                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                                                          • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                          • PATHOPHYSIOLOGY
                                                                                                                                                                                                                          • ASSESSMENT (2)
                                                                                                                                                                                                                          • ASSESSMENT (3)
                                                                                                                                                                                                                          • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                          • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                          • Slide 49
                                                                                                                                                                                                                          • NURSING CARE PLAN (9)
                                                                                                                                                                                                                          • NURSING CARE PLAN (10)
                                                                                                                                                                                                                          • NURSING CARE PLAN (11)
                                                                                                                                                                                                                          • NURSING CARE PLAN (12)
                                                                                                                                                                                                                          • NURSING CARE PLAN (13)
                                                                                                                                                                                                                          • EVALUATION
                                                                                                                                                                                                                          • Slide 56
                                                                                                                                                                                                                          • Slide 57
                                                                                                                                                                                                                          • Slide 58
                                                                                                                                                                                                                          • Slide 59
                                                                                                                                                                                                                          • Slide 60
                                                                                                                                                                                                                          • Treatment of Hyperlipidemia
                                                                                                                                                                                                                          • Slide 62
                                                                                                                                                                                                                          • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                          • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                          • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                          • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                          • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                          • CARDIOMYOPATHIES
                                                                                                                                                                                                                          • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                          • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                          • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                          • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                          • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                          • Infective endocarditis
                                                                                                                                                                                                                          • Infective endocarditis (2)
                                                                                                                                                                                                                          • Infective endocarditis (3)
                                                                                                                                                                                                                          • Infective endocarditis (4)
                                                                                                                                                                                                                          • Infective endocarditis (5)
                                                                                                                                                                                                                          • Infective endocarditis (6)
                                                                                                                                                                                                                          • Infective endocarditis (7)
                                                                                                                                                                                                                          • Infective endocarditis (8)
                                                                                                                                                                                                                          • Infective endocarditis (9)
                                                                                                                                                                                                                          • Infective endocarditis (10)
                                                                                                                                                                                                                          • Infective endocarditis (11)
                                                                                                                                                                                                                          • Infective endocarditis (12)
                                                                                                                                                                                                                          • CARDIOGENIC SHOCK
                                                                                                                                                                                                                          • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                          • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                          • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                          • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                          • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                          • Slide 100
                                                                                                                                                                                                                          • HYPERTENSION
                                                                                                                                                                                                                          • HYPERTENSION (2)
                                                                                                                                                                                                                          • Slide 103
                                                                                                                                                                                                                          • Slide 104
                                                                                                                                                                                                                          • Slide 105
                                                                                                                                                                                                                          • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                          • Buergerrsquos Disease
                                                                                                                                                                                                                          • Slide 108
                                                                                                                                                                                                                          • Manifestations
                                                                                                                                                                                                                          • Slide 110
                                                                                                                                                                                                                          • Diagnosis amp Treatment
                                                                                                                                                                                                                          • Rynaudrsquos Disease
                                                                                                                                                                                                                          • Manifestations (2)
                                                                                                                                                                                                                          • Slide 114
                                                                                                                                                                                                                          • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                          • Slide 116
                                                                                                                                                                                                                          • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                          • Slide 118
                                                                                                                                                                                                                          • Slide 119
                                                                                                                                                                                                                          • Slide 120
                                                                                                                                                                                                                          • Slide 121

                                                                                                                                                                                                                            Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks

                                                                                                                                                                                                                            Immersion of hand in cold water to initiate attack aids in the Dx

                                                                                                                                                                                                                            Doppler flow velocimetry ndash used to quantify blood flow during temperature changes

                                                                                                                                                                                                                            Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease

                                                                                                                                                                                                                            Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                            protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                            stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                            Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                            Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                            A Assessment

                                                                                                                                                                                                                            1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                            2 vsB Nursing Dx

                                                                                                                                                                                                                            1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                            2 Impaired gas exchange

                                                                                                                                                                                                                            3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                            C Goals

                                                                                                                                                                                                                            1 Relief of pain amp symptoms

                                                                                                                                                                                                                            2 Prevention of further cardiac damage

                                                                                                                                                                                                                            D Nursing Interventions

                                                                                                                                                                                                                            1 Pain control

                                                                                                                                                                                                                            2 Proper medications

                                                                                                                                                                                                                            3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                            4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                            • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                            • Slide 2
                                                                                                                                                                                                                            • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                                                            • Slide 5
                                                                                                                                                                                                                            • ASSESSING CHEST PAIN
                                                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                            • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                            • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                            • Pathophysiology
                                                                                                                                                                                                                            • Types
                                                                                                                                                                                                                            • Slide 12
                                                                                                                                                                                                                            • Slide 13
                                                                                                                                                                                                                            • Slide 14
                                                                                                                                                                                                                            • Conthellip
                                                                                                                                                                                                                            • Conthellip (2)
                                                                                                                                                                                                                            • Drug Therapy
                                                                                                                                                                                                                            • Classification
                                                                                                                                                                                                                            • Nursing Management
                                                                                                                                                                                                                            • Nursing Management (2)
                                                                                                                                                                                                                            • Acute Coronary Syndrome
                                                                                                                                                                                                                            • Slide 22
                                                                                                                                                                                                                            • Conthellip (3)
                                                                                                                                                                                                                            • Slide 24
                                                                                                                                                                                                                            • Conthellip(MI)
                                                                                                                                                                                                                            • Slide 26
                                                                                                                                                                                                                            • Pathophysiology (2)
                                                                                                                                                                                                                            • Tissue Changes After MI
                                                                                                                                                                                                                            • Management of MI
                                                                                                                                                                                                                            • Slide 30
                                                                                                                                                                                                                            • Slide 31
                                                                                                                                                                                                                            • ASSESSMENT
                                                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                            • NURSING CARE PLAN
                                                                                                                                                                                                                            • NURSING CARE PLAN (2)
                                                                                                                                                                                                                            • NURSING CARE PLAN (3)
                                                                                                                                                                                                                            • NURSING CARE PLAN (4)
                                                                                                                                                                                                                            • NURSING CARE PLAN (5)
                                                                                                                                                                                                                            • NURSING CARE PLAN (6)
                                                                                                                                                                                                                            • NURSING CARE PLAN (7)
                                                                                                                                                                                                                            • NURSING CARE PLAN (8)
                                                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                                                            • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                            • PATHOPHYSIOLOGY
                                                                                                                                                                                                                            • ASSESSMENT (2)
                                                                                                                                                                                                                            • ASSESSMENT (3)
                                                                                                                                                                                                                            • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                            • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                            • Slide 49
                                                                                                                                                                                                                            • NURSING CARE PLAN (9)
                                                                                                                                                                                                                            • NURSING CARE PLAN (10)
                                                                                                                                                                                                                            • NURSING CARE PLAN (11)
                                                                                                                                                                                                                            • NURSING CARE PLAN (12)
                                                                                                                                                                                                                            • NURSING CARE PLAN (13)
                                                                                                                                                                                                                            • EVALUATION
                                                                                                                                                                                                                            • Slide 56
                                                                                                                                                                                                                            • Slide 57
                                                                                                                                                                                                                            • Slide 58
                                                                                                                                                                                                                            • Slide 59
                                                                                                                                                                                                                            • Slide 60
                                                                                                                                                                                                                            • Treatment of Hyperlipidemia
                                                                                                                                                                                                                            • Slide 62
                                                                                                                                                                                                                            • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                            • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                            • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                            • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                            • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                            • CARDIOMYOPATHIES
                                                                                                                                                                                                                            • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                            • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                            • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                            • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                            • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                            • Infective endocarditis
                                                                                                                                                                                                                            • Infective endocarditis (2)
                                                                                                                                                                                                                            • Infective endocarditis (3)
                                                                                                                                                                                                                            • Infective endocarditis (4)
                                                                                                                                                                                                                            • Infective endocarditis (5)
                                                                                                                                                                                                                            • Infective endocarditis (6)
                                                                                                                                                                                                                            • Infective endocarditis (7)
                                                                                                                                                                                                                            • Infective endocarditis (8)
                                                                                                                                                                                                                            • Infective endocarditis (9)
                                                                                                                                                                                                                            • Infective endocarditis (10)
                                                                                                                                                                                                                            • Infective endocarditis (11)
                                                                                                                                                                                                                            • Infective endocarditis (12)
                                                                                                                                                                                                                            • CARDIOGENIC SHOCK
                                                                                                                                                                                                                            • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                            • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                            • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                            • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                            • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                            • Slide 100
                                                                                                                                                                                                                            • HYPERTENSION
                                                                                                                                                                                                                            • HYPERTENSION (2)
                                                                                                                                                                                                                            • Slide 103
                                                                                                                                                                                                                            • Slide 104
                                                                                                                                                                                                                            • Slide 105
                                                                                                                                                                                                                            • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                            • Buergerrsquos Disease
                                                                                                                                                                                                                            • Slide 108
                                                                                                                                                                                                                            • Manifestations
                                                                                                                                                                                                                            • Slide 110
                                                                                                                                                                                                                            • Diagnosis amp Treatment
                                                                                                                                                                                                                            • Rynaudrsquos Disease
                                                                                                                                                                                                                            • Manifestations (2)
                                                                                                                                                                                                                            • Slide 114
                                                                                                                                                                                                                            • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                            • Slide 116
                                                                                                                                                                                                                            • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                            • Slide 118
                                                                                                                                                                                                                            • Slide 119
                                                                                                                                                                                                                            • Slide 120
                                                                                                                                                                                                                            • Slide 121

                                                                                                                                                                                                                              Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp

                                                                                                                                                                                                                              protection from cold Avoidance of emotional stress (anxiety amp

                                                                                                                                                                                                                              stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie

                                                                                                                                                                                                                              Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks

                                                                                                                                                                                                                              Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                              A Assessment

                                                                                                                                                                                                                              1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                              2 vsB Nursing Dx

                                                                                                                                                                                                                              1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                              2 Impaired gas exchange

                                                                                                                                                                                                                              3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                              C Goals

                                                                                                                                                                                                                              1 Relief of pain amp symptoms

                                                                                                                                                                                                                              2 Prevention of further cardiac damage

                                                                                                                                                                                                                              D Nursing Interventions

                                                                                                                                                                                                                              1 Pain control

                                                                                                                                                                                                                              2 Proper medications

                                                                                                                                                                                                                              3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                              4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                              • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                              • Slide 2
                                                                                                                                                                                                                              • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                                                              • Slide 5
                                                                                                                                                                                                                              • ASSESSING CHEST PAIN
                                                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                              • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                              • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                              • Pathophysiology
                                                                                                                                                                                                                              • Types
                                                                                                                                                                                                                              • Slide 12
                                                                                                                                                                                                                              • Slide 13
                                                                                                                                                                                                                              • Slide 14
                                                                                                                                                                                                                              • Conthellip
                                                                                                                                                                                                                              • Conthellip (2)
                                                                                                                                                                                                                              • Drug Therapy
                                                                                                                                                                                                                              • Classification
                                                                                                                                                                                                                              • Nursing Management
                                                                                                                                                                                                                              • Nursing Management (2)
                                                                                                                                                                                                                              • Acute Coronary Syndrome
                                                                                                                                                                                                                              • Slide 22
                                                                                                                                                                                                                              • Conthellip (3)
                                                                                                                                                                                                                              • Slide 24
                                                                                                                                                                                                                              • Conthellip(MI)
                                                                                                                                                                                                                              • Slide 26
                                                                                                                                                                                                                              • Pathophysiology (2)
                                                                                                                                                                                                                              • Tissue Changes After MI
                                                                                                                                                                                                                              • Management of MI
                                                                                                                                                                                                                              • Slide 30
                                                                                                                                                                                                                              • Slide 31
                                                                                                                                                                                                                              • ASSESSMENT
                                                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                              • NURSING CARE PLAN
                                                                                                                                                                                                                              • NURSING CARE PLAN (2)
                                                                                                                                                                                                                              • NURSING CARE PLAN (3)
                                                                                                                                                                                                                              • NURSING CARE PLAN (4)
                                                                                                                                                                                                                              • NURSING CARE PLAN (5)
                                                                                                                                                                                                                              • NURSING CARE PLAN (6)
                                                                                                                                                                                                                              • NURSING CARE PLAN (7)
                                                                                                                                                                                                                              • NURSING CARE PLAN (8)
                                                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                                                              • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                              • PATHOPHYSIOLOGY
                                                                                                                                                                                                                              • ASSESSMENT (2)
                                                                                                                                                                                                                              • ASSESSMENT (3)
                                                                                                                                                                                                                              • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                              • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                              • Slide 49
                                                                                                                                                                                                                              • NURSING CARE PLAN (9)
                                                                                                                                                                                                                              • NURSING CARE PLAN (10)
                                                                                                                                                                                                                              • NURSING CARE PLAN (11)
                                                                                                                                                                                                                              • NURSING CARE PLAN (12)
                                                                                                                                                                                                                              • NURSING CARE PLAN (13)
                                                                                                                                                                                                                              • EVALUATION
                                                                                                                                                                                                                              • Slide 56
                                                                                                                                                                                                                              • Slide 57
                                                                                                                                                                                                                              • Slide 58
                                                                                                                                                                                                                              • Slide 59
                                                                                                                                                                                                                              • Slide 60
                                                                                                                                                                                                                              • Treatment of Hyperlipidemia
                                                                                                                                                                                                                              • Slide 62
                                                                                                                                                                                                                              • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                              • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                              • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                              • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                              • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                              • CARDIOMYOPATHIES
                                                                                                                                                                                                                              • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                              • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                              • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                              • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                              • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                              • Infective endocarditis
                                                                                                                                                                                                                              • Infective endocarditis (2)
                                                                                                                                                                                                                              • Infective endocarditis (3)
                                                                                                                                                                                                                              • Infective endocarditis (4)
                                                                                                                                                                                                                              • Infective endocarditis (5)
                                                                                                                                                                                                                              • Infective endocarditis (6)
                                                                                                                                                                                                                              • Infective endocarditis (7)
                                                                                                                                                                                                                              • Infective endocarditis (8)
                                                                                                                                                                                                                              • Infective endocarditis (9)
                                                                                                                                                                                                                              • Infective endocarditis (10)
                                                                                                                                                                                                                              • Infective endocarditis (11)
                                                                                                                                                                                                                              • Infective endocarditis (12)
                                                                                                                                                                                                                              • CARDIOGENIC SHOCK
                                                                                                                                                                                                                              • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                              • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                              • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                              • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                              • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                              • Slide 100
                                                                                                                                                                                                                              • HYPERTENSION
                                                                                                                                                                                                                              • HYPERTENSION (2)
                                                                                                                                                                                                                              • Slide 103
                                                                                                                                                                                                                              • Slide 104
                                                                                                                                                                                                                              • Slide 105
                                                                                                                                                                                                                              • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                              • Buergerrsquos Disease
                                                                                                                                                                                                                              • Slide 108
                                                                                                                                                                                                                              • Manifestations
                                                                                                                                                                                                                              • Slide 110
                                                                                                                                                                                                                              • Diagnosis amp Treatment
                                                                                                                                                                                                                              • Rynaudrsquos Disease
                                                                                                                                                                                                                              • Manifestations (2)
                                                                                                                                                                                                                              • Slide 114
                                                                                                                                                                                                                              • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                              • Slide 116
                                                                                                                                                                                                                              • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                              • Slide 118
                                                                                                                                                                                                                              • Slide 119
                                                                                                                                                                                                                              • Slide 120
                                                                                                                                                                                                                              • Slide 121

                                                                                                                                                                                                                                Care Plan for Clients with Altered Cardiovascular Oxygenation

                                                                                                                                                                                                                                A Assessment

                                                                                                                                                                                                                                1 Hx of symptoms (pain esp chest pain palpitations dyspnea)

                                                                                                                                                                                                                                2 vsB Nursing Dx

                                                                                                                                                                                                                                1 ineffective tissue perfusion (cardiopulmonary)

                                                                                                                                                                                                                                2 Impaired gas exchange

                                                                                                                                                                                                                                3 Anxiety due to fear of death (clients with MI or Angina)

                                                                                                                                                                                                                                C Goals

                                                                                                                                                                                                                                1 Relief of pain amp symptoms

                                                                                                                                                                                                                                2 Prevention of further cardiac damage

                                                                                                                                                                                                                                D Nursing Interventions

                                                                                                                                                                                                                                1 Pain control

                                                                                                                                                                                                                                2 Proper medications

                                                                                                                                                                                                                                3 Decrease clientrsquos anxiety

                                                                                                                                                                                                                                4 Health teachings (meds activities diet exercise etc)

                                                                                                                                                                                                                                • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                                • Slide 2
                                                                                                                                                                                                                                • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                                                • Slide 5
                                                                                                                                                                                                                                • ASSESSING CHEST PAIN
                                                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                                • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                                • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                                • Pathophysiology
                                                                                                                                                                                                                                • Types
                                                                                                                                                                                                                                • Slide 12
                                                                                                                                                                                                                                • Slide 13
                                                                                                                                                                                                                                • Slide 14
                                                                                                                                                                                                                                • Conthellip
                                                                                                                                                                                                                                • Conthellip (2)
                                                                                                                                                                                                                                • Drug Therapy
                                                                                                                                                                                                                                • Classification
                                                                                                                                                                                                                                • Nursing Management
                                                                                                                                                                                                                                • Nursing Management (2)
                                                                                                                                                                                                                                • Acute Coronary Syndrome
                                                                                                                                                                                                                                • Slide 22
                                                                                                                                                                                                                                • Conthellip (3)
                                                                                                                                                                                                                                • Slide 24
                                                                                                                                                                                                                                • Conthellip(MI)
                                                                                                                                                                                                                                • Slide 26
                                                                                                                                                                                                                                • Pathophysiology (2)
                                                                                                                                                                                                                                • Tissue Changes After MI
                                                                                                                                                                                                                                • Management of MI
                                                                                                                                                                                                                                • Slide 30
                                                                                                                                                                                                                                • Slide 31
                                                                                                                                                                                                                                • ASSESSMENT
                                                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                                • NURSING CARE PLAN
                                                                                                                                                                                                                                • NURSING CARE PLAN (2)
                                                                                                                                                                                                                                • NURSING CARE PLAN (3)
                                                                                                                                                                                                                                • NURSING CARE PLAN (4)
                                                                                                                                                                                                                                • NURSING CARE PLAN (5)
                                                                                                                                                                                                                                • NURSING CARE PLAN (6)
                                                                                                                                                                                                                                • NURSING CARE PLAN (7)
                                                                                                                                                                                                                                • NURSING CARE PLAN (8)
                                                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                                                • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                                • PATHOPHYSIOLOGY
                                                                                                                                                                                                                                • ASSESSMENT (2)
                                                                                                                                                                                                                                • ASSESSMENT (3)
                                                                                                                                                                                                                                • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                                • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                                • Slide 49
                                                                                                                                                                                                                                • NURSING CARE PLAN (9)
                                                                                                                                                                                                                                • NURSING CARE PLAN (10)
                                                                                                                                                                                                                                • NURSING CARE PLAN (11)
                                                                                                                                                                                                                                • NURSING CARE PLAN (12)
                                                                                                                                                                                                                                • NURSING CARE PLAN (13)
                                                                                                                                                                                                                                • EVALUATION
                                                                                                                                                                                                                                • Slide 56
                                                                                                                                                                                                                                • Slide 57
                                                                                                                                                                                                                                • Slide 58
                                                                                                                                                                                                                                • Slide 59
                                                                                                                                                                                                                                • Slide 60
                                                                                                                                                                                                                                • Treatment of Hyperlipidemia
                                                                                                                                                                                                                                • Slide 62
                                                                                                                                                                                                                                • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                                • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                                • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                                • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                                • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                                • CARDIOMYOPATHIES
                                                                                                                                                                                                                                • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                                • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                                • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                                • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                                • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                                • Infective endocarditis
                                                                                                                                                                                                                                • Infective endocarditis (2)
                                                                                                                                                                                                                                • Infective endocarditis (3)
                                                                                                                                                                                                                                • Infective endocarditis (4)
                                                                                                                                                                                                                                • Infective endocarditis (5)
                                                                                                                                                                                                                                • Infective endocarditis (6)
                                                                                                                                                                                                                                • Infective endocarditis (7)
                                                                                                                                                                                                                                • Infective endocarditis (8)
                                                                                                                                                                                                                                • Infective endocarditis (9)
                                                                                                                                                                                                                                • Infective endocarditis (10)
                                                                                                                                                                                                                                • Infective endocarditis (11)
                                                                                                                                                                                                                                • Infective endocarditis (12)
                                                                                                                                                                                                                                • CARDIOGENIC SHOCK
                                                                                                                                                                                                                                • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                                • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                                • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                                • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                                • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                                • Slide 100
                                                                                                                                                                                                                                • HYPERTENSION
                                                                                                                                                                                                                                • HYPERTENSION (2)
                                                                                                                                                                                                                                • Slide 103
                                                                                                                                                                                                                                • Slide 104
                                                                                                                                                                                                                                • Slide 105
                                                                                                                                                                                                                                • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                                • Buergerrsquos Disease
                                                                                                                                                                                                                                • Slide 108
                                                                                                                                                                                                                                • Manifestations
                                                                                                                                                                                                                                • Slide 110
                                                                                                                                                                                                                                • Diagnosis amp Treatment
                                                                                                                                                                                                                                • Rynaudrsquos Disease
                                                                                                                                                                                                                                • Manifestations (2)
                                                                                                                                                                                                                                • Slide 114
                                                                                                                                                                                                                                • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                                • Slide 116
                                                                                                                                                                                                                                • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                                • Slide 118
                                                                                                                                                                                                                                • Slide 119
                                                                                                                                                                                                                                • Slide 120
                                                                                                                                                                                                                                • Slide 121
                                                                                                                                                                                                                                  • CARDIOVASCULAR DISEASES
                                                                                                                                                                                                                                  • Slide 2
                                                                                                                                                                                                                                  • GENERAL CARDIAC ASSESSMENT
                                                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                                                  • Slide 5
                                                                                                                                                                                                                                  • ASSESSING CHEST PAIN
                                                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
                                                                                                                                                                                                                                  • COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
                                                                                                                                                                                                                                  • Angina Pectoris Myocardial Ischemia
                                                                                                                                                                                                                                  • Pathophysiology
                                                                                                                                                                                                                                  • Types
                                                                                                                                                                                                                                  • Slide 12
                                                                                                                                                                                                                                  • Slide 13
                                                                                                                                                                                                                                  • Slide 14
                                                                                                                                                                                                                                  • Conthellip
                                                                                                                                                                                                                                  • Conthellip (2)
                                                                                                                                                                                                                                  • Drug Therapy
                                                                                                                                                                                                                                  • Classification
                                                                                                                                                                                                                                  • Nursing Management
                                                                                                                                                                                                                                  • Nursing Management (2)
                                                                                                                                                                                                                                  • Acute Coronary Syndrome
                                                                                                                                                                                                                                  • Slide 22
                                                                                                                                                                                                                                  • Conthellip (3)
                                                                                                                                                                                                                                  • Slide 24
                                                                                                                                                                                                                                  • Conthellip(MI)
                                                                                                                                                                                                                                  • Slide 26
                                                                                                                                                                                                                                  • Pathophysiology (2)
                                                                                                                                                                                                                                  • Tissue Changes After MI
                                                                                                                                                                                                                                  • Management of MI
                                                                                                                                                                                                                                  • Slide 30
                                                                                                                                                                                                                                  • Slide 31
                                                                                                                                                                                                                                  • ASSESSMENT
                                                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES
                                                                                                                                                                                                                                  • NURSING CARE PLAN
                                                                                                                                                                                                                                  • NURSING CARE PLAN (2)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (3)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (4)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (5)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (6)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (7)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (8)
                                                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                                                  • CONGESTIVE HEART FAILURE
                                                                                                                                                                                                                                  • PATHOPHYSIOLOGY
                                                                                                                                                                                                                                  • ASSESSMENT (2)
                                                                                                                                                                                                                                  • ASSESSMENT (3)
                                                                                                                                                                                                                                  • Left Ventricular Compared with Right Ventricular Heart Failure
                                                                                                                                                                                                                                  • ANALYSIS NURSING DIAGNOSES (2)
                                                                                                                                                                                                                                  • Slide 49
                                                                                                                                                                                                                                  • NURSING CARE PLAN (9)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (10)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (11)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (12)
                                                                                                                                                                                                                                  • NURSING CARE PLAN (13)
                                                                                                                                                                                                                                  • EVALUATION
                                                                                                                                                                                                                                  • Slide 56
                                                                                                                                                                                                                                  • Slide 57
                                                                                                                                                                                                                                  • Slide 58
                                                                                                                                                                                                                                  • Slide 59
                                                                                                                                                                                                                                  • Slide 60
                                                                                                                                                                                                                                  • Treatment of Hyperlipidemia
                                                                                                                                                                                                                                  • Slide 62
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
                                                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
                                                                                                                                                                                                                                  • DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
                                                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY
                                                                                                                                                                                                                                  • HYPERTROPHIC CARDIOMYOPATHY (2)
                                                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY
                                                                                                                                                                                                                                  • RESTRICTIVE CARDIOMYOPATHY Pathophysiology
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES (2)
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES (3)
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES (4)
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES (5)
                                                                                                                                                                                                                                  • CARDIOMYOPATHIES (6)
                                                                                                                                                                                                                                  • Infective endocarditis
                                                                                                                                                                                                                                  • Infective endocarditis (2)
                                                                                                                                                                                                                                  • Infective endocarditis (3)
                                                                                                                                                                                                                                  • Infective endocarditis (4)
                                                                                                                                                                                                                                  • Infective endocarditis (5)
                                                                                                                                                                                                                                  • Infective endocarditis (6)
                                                                                                                                                                                                                                  • Infective endocarditis (7)
                                                                                                                                                                                                                                  • Infective endocarditis (8)
                                                                                                                                                                                                                                  • Infective endocarditis (9)
                                                                                                                                                                                                                                  • Infective endocarditis (10)
                                                                                                                                                                                                                                  • Infective endocarditis (11)
                                                                                                                                                                                                                                  • Infective endocarditis (12)
                                                                                                                                                                                                                                  • CARDIOGENIC SHOCK
                                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (2)
                                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (3)
                                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (4)
                                                                                                                                                                                                                                  • CARDIOGENIC SHOCK (5)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (2)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (3)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (4)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (5)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (6)
                                                                                                                                                                                                                                  • CARDIAC TAMPONADE (7)
                                                                                                                                                                                                                                  • Slide 100
                                                                                                                                                                                                                                  • HYPERTENSION
                                                                                                                                                                                                                                  • HYPERTENSION (2)
                                                                                                                                                                                                                                  • Slide 103
                                                                                                                                                                                                                                  • Slide 104
                                                                                                                                                                                                                                  • Slide 105
                                                                                                                                                                                                                                  • Alterations in Blood Flow in the Systemic Circulation
                                                                                                                                                                                                                                  • Buergerrsquos Disease
                                                                                                                                                                                                                                  • Slide 108
                                                                                                                                                                                                                                  • Manifestations
                                                                                                                                                                                                                                  • Slide 110
                                                                                                                                                                                                                                  • Diagnosis amp Treatment
                                                                                                                                                                                                                                  • Rynaudrsquos Disease
                                                                                                                                                                                                                                  • Manifestations (2)
                                                                                                                                                                                                                                  • Slide 114
                                                                                                                                                                                                                                  • Diagnosis amp Treatment (2)
                                                                                                                                                                                                                                  • Slide 116
                                                                                                                                                                                                                                  • Care Plan for Clients with Altered Cardiovascular Oxygenation
                                                                                                                                                                                                                                  • Slide 118
                                                                                                                                                                                                                                  • Slide 119
                                                                                                                                                                                                                                  • Slide 120
                                                                                                                                                                                                                                  • Slide 121

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