Chapter 36 Cardiovascular System. Anatomy and Physiology Review Heart, its vasculature, and peripheral vascular system Functions: –Provides oxygen, nutrients,

Chapter 36

Cardiovascular System

Anatomy and Physiology Review

• Heart, its vasculature, and peripheral vascular system

• Functions:– Provides oxygen, nutrients, and hormones to

cells– Removes carbon dioxide and waste products

from cells– Maintains body temperature by distributing

heat produced by metabolic activity

Anatomy and Physiology Review

Anatomy and Physiology Review

Anatomy and Physiology Review

Anatomy and Physiology Review

Health History

• Goals:– Identify present and potential health problems– Identify possible familial and lifestyle risk

factors– Involve client in planning long-term health

care

(continued)

Health History

• Onset of symptoms

• Predisposing factors

• Treatment of symptoms

• Activity level or limitations

• Appetite

• Ability to sleep

• Cardiovascular risk factors

Assessment

• Subjective data:– Chest pain, dyspnea, edema, fainting,

palpitations, diaphoresis, fatigue, and orthopnea

(continued)

Assessment

• Objective data:– Cyanosis, poor skin turgor, distended neck

veins, poor quality of respirations, coughing, heart sounds, ascites, edema, skin temperature, pulses, capillary refill, and Homan’s sign

Assessment

Assessment

Assessment

Assessment

Echocardiography

Electrocardiography

Normal Sinus Rhythm

• Sinoatrial (SA) node– Natural pacemaker– Wave causes atria to contract

• Atrioventricular (AV) node– Impulse pauses

(continued)

Normal Sinus Rhythm

• AV bundle– Divides into right and left bundle branches– Divides into Purkinje fibers

• Causes ventricles to contract

Normal Sinus Rhythm

Dysrhythmias

• Irregularity in rate, rhythm, or conduction of electrical system of heart

• Most common causes:– Coronary artery disease, congestive heart

failure, and myocardial infarction

(continued)

Dysrhythmias

• Symptoms vary from none to cardiac arrest:– Fainting, seizures, fatigue, decreased energy

level, exertional dyspnea, chest pain, and palpitations

Types of Dysrhythmias

• Bradycardia– Heart rate of 60 beats per minute or less– Treatment:

• Atropine or pacemaker

• Tachycardia– Heart rate of 100 to 150 beats per minute– Treatment depends on cause

Bradycardia

Tachycardia

Atrial Dysrhythmias

• Occur from electrical conduction disturbances in atria:– Premature atrial contractions– Atrial tachycardia– Paroxysmal supraventricular tachycardia– Atrial flutter– Atrial fibrillation

(continued)

Atrial Flutter

Atrial Flutter

Atrial Fibrillation

Atrial Dysrhythmias

• Treatment depends on cause:– Pacemaker, vagal stimulation,

antidysrhythmic medication, and cardioversion

Ventricular Dysrhythmias

• Originate in ventricles

• More life-threatening

• Include:– Premature ventricular contractions– Ventricular tachycardia– Ventricular fibrillation– Ventricular asystole

(continued)

Premature Ventricular Contraction

Ventricular Fibrillation

Ventricular Fibrillation

Asystole

Ventricular Dysrhythmias

• Treatment depends on cause:– Oxygen, amiodarone (Cordarone),

magnesium sulfate, lidocaine, cardioversion or defibrillation, CPR, and advanced cardiac life support (ACLS) protocol

AV Blocks

• Electrical conduction interrupted to some degree between atria and ventricles at AV node

• Degrees:– First– Second– Third

(continued)

AV Blocks

• Treatment:– First degree

• None

– Second and third degree• Pacemaker

Rheumatic Heart Disease

• Complication of rheumatic fever

• Linked to group A streptococcus following upper respiratory infection

• Treat inflammation, prevent cardiac complications, and prevent recurrence

(continued)

Rheumatic Heart Disease

• Clients require prophylactic antibiotic therapy before dental procedures or invasive surgery

Infective Endocarditis

• Inflammation or infection of inside lining of heart– Including valves

• Acute symptoms:– Tachycardia, pallor, diaphoresis, and

symptoms of infection

(continued)

Infective Endocarditis

• Subacute symptoms:– Low-grade fever, malaise, weight loss, and

anemia

• Clients may develop murmurs, dyspnea, peripheral edema, or pulmonary congestion

• Treatment:– Surgery and antibiotics

Myocarditis

• Inflammation of myocardium

• Symptoms:– Flu-like symptoms of fever, pharyngitis,

myalgias, GI complications, chest pain, and pericardial friction rub

• Treatment:– Digoxin, antibiotics, anti-inflammatories,

oxygen, and bed rest to prevent congestive heart failure

Pericarditis

• Inflammation of membranous sac surrounding heart

• Symptoms:– Severe chest pain and pericardial friction rub

• Complication:– Cardiac tamponade

(continued)

Pericarditis

Pericarditis

• Treatment:– Pericardiocentesis, surgery, and medications

Valvular Heart Diseases

• Occurs when valves do not open and close properly

• Stenosis and insufficiency

• Mitral valve prolapse

• Treatment:– Prophylactic antibiotics before dental

procedures, surgery, medications, and valve replacement

Valvular Heart Diseases

Arteriosclerosis

• Narrowing and hardening of arteries

• Causes decreased perfusion to cells beyond narrowed or hardened area

• Vessels lose elasticity– Results in arteriosclerotic heart disease,

angina, myocardial infarction, stroke, and peripheral vascular disease

Atherosclerosis

Angina Pectoris

• Caused by myocardial ischemia

• Squeezing pain under sternum radiating to left or right shoulder, jaw, or ear

• Pain may be mild or immobilizing

(continued)

Angina Pectoris

Angina Pectoris

Angina Pectoris

• Treat to increase blood supply to affected area via medication or surgical procedures– E.g., percutaneous transluminal coronary

angioplasty (PTCA), stent, coronary artery bypass graft (CABG)

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

Angina Pectoris

It’s time for report…

Prioritize the five nursing interventions as you would do them

initially:

A – Take the vital signs.

B – Assist to commode.

C – Perform a body systems assessment.

D – Check oxygen saturation level.

E – Talk with Mrs. T.

Myocardial Infarction

• Obstruction in coronary artery resulting in necrosis to tissues supplied by artery

• Symptoms:– Chest heaviness, lower sternal pain, dyspnea,

diaphoresis, nausea, anxiety, vomiting, change in pulse and blood pressure, pallor, and cyanosis

• Women may have different symptoms

(continued)

Myocardial Infarction

Myocardial Infarction

Myocardial Infarction

• Treat to reduce oxygen demands, increase oxygen supply, relieve pain, improve tissue perfusion, and prevent complications and further tissue damage

• Treatment:– Medications, surgery, diet, and bed rest

Myocardial Infarction

Myocardial Infarction

Right-Sided Heart Failure

• Develops when heart no longer capable of meeting body’s oxygen needs

• Causes:– Untreated left ventricular failure, right

ventricular myocardial infarction, chronic obstructive coronary disease, cor pulmonale, and pulmonic valve stenosis

(continued)

Right-Sided Heart Failure

• Symptoms:– Edema (may be pitting) in extremities and

trunk, anorexia, hepatomegaly, splenomegaly, distended jugular veins, and oliguria

Left-Sided Heart Failure

• Causes:– Left ventricular myocardial infarction, aortic

valve stenosis, prolapsed valve complications, and hypertension

• Symptoms:– Lung congestion, cyanosis, dyspnea,

restlessness, and blood-tinged sputum (hemoptysis)

Treatment of Heart Failure

• Treat to improve circulation to coronary arteries and decrease workload of left ventricle

• Treatment:– Medication, diet changes, fluid restriction,

oxygen, and surgery• E.g., ventricular assist device (VAD), intra-aortic

balloon pump

Cor Pulmonale

• Heart affected because of lung condition that interferes with exchange of carbon dioxide and oxygen in alveoli

• Symptoms and medical and nursing care same as right-sided heart failure

The nurse admits a 69-year-old male with HF. The physician orders furosemide 60mg IV stat,

digoxin 0.25mg po and KCl 20mEq po now. Which assessment finding is most indicative of

an ineffective response 2 hours after the administration of all the medications?

A. Pulse 89, irregular.

B. Urine output 60mL.

C. Pulse oximetry 94%.

D. Pitting edema in the lower extremities.

B is the answer

Although output falls within the parameters of renal function, the client received furosemide IV and diuresis is the desired effect.

Options A, C and D are expected findings in a client with HF.

The home health nurse visits a client with HF. In reviewing the client’s medications, the nurse

notes that the client takes the following daily oral medications: digoxin 0.25mg, furosemide

10mg and captopril 0.625mg. After speaking to the client and wife, the nurse suspects digitalis toxicity. Which question helps the nurse gather

more information specific to digitalis toxicity?

A. “Do you get light-headed when you get out of bed?”B. “Do you need to sleep with more than one pillow?”C. “Do you have to get up to urinate more frequently?”D. “Have you had a nausea, vomiting or diarrhea?”

D is the answer

Although these signs and symptoms are frequently seen with all drug therapy, they are frequently early side effects of digitalis toxicity.

Options A, B and C relate to the action of the other drugs.

The nurse is assigned to a client with HF. The nurse’s morning lung assessment indicates

crackles and wheezes in the mid to lower lung bases, R 32, client restless. Which nursing

intervention is of priority initially?

A. Assess capillary refill.

B. Take the pulse oximetry.

C. Limit client activity.

D. Assess fluid intake.

B is the answer

Client assessment indicates rapid breathing and possible hypoxia. To fully assess the respiratory status of the client, it is important to take the pulse oximetry.

Options A, C and D are important – but not priority – interventions.

It’s time for report…

Prioritize the five nursing interventions as you would do them

initially:

A – Assess respiratory rate.

B – Obtain urinary output data.

C – Assess rate/rhythm and quality of pulse.

D – Assess complaints of visual disturbances.

E – Check current lab data.

Cardiac Transplantation

• Done for cardiomyopathy, end-stage coronary artery disease, and valvular disease

• Recipient must remain on immunosuppressant medication for remainder of life

Cardiac Transplantation

Chapter 60

Infants with Special Needs:Birth to 12 Months

Congenital Cardiovascular Defects

• Categorized according to blood flow:– Increased pulmonary blood flow– Decreased pulmonary blood flow– Obstructed blood flow out of heart– Mixed blood flow

(continued)

Congenital Cardiovascular Defects

• Symptoms vary with type of disease

• Treatment:– Medications and surgery

Chapter 61

Common Problems: 1–18 Years

Cardiovascular, Hematologic, and Lymphatic Systems

• Rheumatic fever

• Leukemia

• Idiopathic thrombocytopenic purpura

• Hemophilia