cardio 1.ppt

8/9/2019 Cardio 1.ppt

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By: Cissette S. Ricardo, RN, MSN


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Objectives:

At the end of the discussion, thestudents should be able to:

Discuss the different assessent

!araeters for cardiac functionin".Describe nursin" care of clients

under"oin" dia"nostic tests to assess

cardiac functionin"Describe treatent odalities for clients

#ith cardiac disorders


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$%!lain the !atho!hysiolo"y, clinical

anifestations and collaborative

ana"eent of cardiac disorders

Desi"n a nursin" care !lan for clients

#ith cardiac disorders

&each client #ith cardiac disorders

about !revention, ana"eent and

rehabilitation factors that o!tii'e

health.


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Assess the client for clinical

anifestations associated #ith!eri!heral vascular disorders

Discuss the etiolo"y, ris( factors, basic

!atho!hysiolo"y and clinicalanifestations of !eri!heral vascular

disease

Develo! !lan of care for the !revention,collaborative ana"eent and

rehabilitation of clients #ith !eri!heral

vascular disease


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)!leent nursin" interventions that

o!tii'e *uality of life of clients #ith!eri!heral vascular disorders

$valuate !lanned outcoes, usin"

outcoe criteria develo!ed in the!lannin" !hase of care

Conduct nursin" history and !hysical

assessent of the client #ith an actualor !otential heatolo"ic disorder

&each a client about dia"nostic studies

used to detect heatolo"ic disorder


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Discuss ris( factors, basic !atho!hysiolo"y

and clinical anifestations of heatolo"ic

disordersDesi"n a !lan of care for the !revention,

collaborative ana"eent and rehabilitation

of clients #ith heatolo"ic disorders)!leentin" nursin" interventions that

o!tii'e the *uality of life of clients #ith

heatolo"ic disorders

$valuate !lanned clients outcoes, usin"

outcoe criteria develo!ed in the !lannin"

!hase of care


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B+OOD $SS$+S

-hich blood circulates fro the heart includes :

Arteries thic( elastic #alls to acce!t the !ulsatile

systolic flo# of o%y"enated blood a#ay fro the heart

Arterioles have thin less elastic #alls that are

sensitive to chan"es in o%y"en and #astes, and

constrict or dilate corres!ondin"ly /a ain

deterinate of B01

Capillaries very thin #alls throu"h #hich the

e%chan"e of cellular #astes and nutrients ta(es

!lace.

Venules obtain blood fro the ca!illaries and

de!osit it into veins.

Veins thin valvular #alls throu"h #hich

deo%y"enated blood returns to the heart.


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BLOOD

&he circulatory syste is the route by #hich the

cells in your body "et the o%y"en and nutrientsthey need, but blood is the actual carrier of the

o%y"en and nutrients

Blood is ade ostly of !lasa, #hich is a

yello#ish li*uid that is 234 #ater.

But in addition to the #ater, !lasa contains salts,

su"ar /"lucose1, and other substances. And, ost

i!ortant, !lasa contains !roteins that carryi!ortant nutrients to the body5s cells and

stren"then the body5s iune syste so it can

fi"ht off infection.


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&he avera"e an has bet#een 63 and 67 !ints

of blood in his body. &he avera"e #oan has

bet#een 8 and 2 !ints.&o "ive you an idea of ho# uch blood that is, 8

!ints is e*ual to 6 "allon /thin( of a "allon of

il(1.

-9A& )S B+OOD

Blood is actually a tissue. )t is thic( because it is

ade u! of a variety of cells, each havin" a

different job. )n fact, blood is actually about 834

#ater and 734 solid.


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-e (no# that blood is ade ostly of !lasa. But

there are ; ain ty!es of blood cells that circulate

#ith the !lasa:0latelets < #hich hel! the blood to clot. Clottin"

sto!s the blood fro flo#in" out of the body #hen

a vein or artery is bro(en. 0latelets are also called

throbocytes.Red blood cells < #hich carry o%y"en. Of the ;

ty!es of blood cells, red blood cells are the ost

!lentiful. )n fact, a healthy adult has about ;=trillion of the. &he body creates these cells at a

rate of about 7.> illion a second, and they each

have a life s!an of about 673 days. Red blood cells

are also called erythrocytes.


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-hite blood cells < #hich #ard off infection. &hese

cells, #hich coe in any sha!es and si'es, are

vital to the iune syste. -hen the body is

fi"htin" off infection, it a(es the in ever<

increasin" nubers. Still, co!ared to the nuber

of red blood cells in the body, the nuber of #hite

blood cells is lo#. Most healthy adults have about?33 ties as any red blood cells as #hite ones.

-hite blood cells are also called leu(ocytes.

Note:

Blood also contains horones, fats,

carbohydrates, !roteins, and "ases.


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FUNCTIONS:

Blood carries o%y"en fro the lun"s and nutrients

fro the di"estive tract to the body5s cells. )t alsocarries a#ay carbon dio%ide and all of the #aste

!roducts that the body does not need. /&he

(idneys filter and clean the blood.1 Blood also:

9el!s (ee! your body at the ri"ht te!erature

Carries horones to the body5s cells

Sends antibodies to fi"ht infection

Contains clottin" factors to hel! the blood toclot and the body5s tissues to heal


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BLOOD TYPES:

&here are > different blood ty!es:

A, B, AB, and O.@enes that you inherit fro your !arents /6

fro your other and 6 fro your father1

deterine your blood ty!e.Blood is al#ays bein" ade by the cells inside

your bones, so your body can usually re!lace

any blood lost throu"h sall cuts or #ounds.

But #hen a lot of blood is lost throu"h lar"e

#ounds, it has to be re!laced throu"h a blood

transfusion /blood donated by other !eo!le1.


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)n blood transfusions, the donor and

reci!ient blood ty!es ust beco!atible.

0eo!le #ith ty!e O blood are called

universal donors, because they candonate blood to anyone, but they can

only receive a transfusion fro other

!eo!le #ith ty!e O blood.


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BLOOD TEST FOR CARDIOVASCULAR

CONDITIONS:

Certain blood tests can be !erfored to see if thereis a !roble #ith your heart, lun"s, or blood

vessels.

6.Cardiac en'ye tests < #hich easure the cardiac

en'ye levels in the blood.

Certain en'yes #ill be !resent if the heart

uscle /yocardiu1 has been daa"ed by a

heart attac(, because daa"ed heart cellsrelease these en'yes into the blood.

&he ost coon cardiac en'ye that is

released is creatine (inase.


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7. &ro!onin tests < #hich easure the aount

of tro!onin /a ty!e of !rotein1 in the blood.

&ro!onin affects ho# the heart uscle

contracts.

)f there are hi"h levels of tro!onin in theblood /tro!onin & or tro!onin )1, there is

ost li(ely daa"e to the heart uscle.

&he aount of tro!onin released into the

blood correlates #ith the de"ree of

daa"e to the heart uscle.


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;. Arterial blood "as studies < #hich easure ho#

#ell the blood is bein" o%y"enated in the lun"s.

>. +i!o!rotein /cholesterol1 !rofile < #hicheasures ho# uch fat or li!id is in the blood.

=. Blood cultures < #hich can be used to deterine

if there are icroor"aniss /li(e the bacteria thatcauses endocarditis1 in the body5s syste.

After the blood is dra#n, it is !laced on a

culture, #hich hel!s the bacteria "ro#.

&he bacteria is then analy'ed to deterine

#hat ty!e it is and #hat edicines can be used

to (ill it.


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. Blood clottin" tests < #hich easure the blood5s

ability to clot.

Clottin" sto!s the blood fro flo#in" out of thebody #hen a vein or artery is bro(en

O&9$R $AM)NA&)ONS:

6.Revie# of Medical 9istory and 0hysical $%a7.$@ or $C@

;.Chest .$chocardio"ra

=.Cardiac Catheri'ation

.Cardiac 0erfusion Scan

?.Other Blood &est /Cholesterol etc.1


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VASCULATURE OF THE AR VASCULATURE OF THE LE!


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VASCULATURE OF THE HEAD


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ANA&OM OE &9$ 9$AR&


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&he heart #ei"hs bet#een ? and 6= ounces/733 to >7= "ras1

+ittle lar"er than the si'e of your fist.

By the end of a lon" life, a !ersonFs heart ayhave beat /e%!anded and contracted1 ore than;.= billion ties.

)n fact, each day, the avera"e heart beats633,333 ties, !u!in" about 7,333 "allons/?,=?6 liters1 of blood.

our heart is located bet#een your lun"s in theiddle of your chest, behind and sli"htly to theleft of your breastbone /sternu1


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)t is four chabered, !al!able at the =th

intercostal s!ace. )t is encased in the !ericardiu

/!ericardial sac1, ade u! of a visceral

/inner1 layer and a !arietal /outer1 layer.0ericardial s!ace is located bet#een

layers of !ericardial sac, !rovidin"lubrication to decrease friction #itheach contraction.


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> C9AMB$RS

Ri"ht atriu receives deo%y"enatedblood fro the body.

Ri"ht entricle receives blood fro

the ri"ht atriu+eft Atriu receives o%y"enated

blood fro the lun"s

+eft entricle receives blood fro theleft atriu.


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9$AR& +A$RS:

$ndocardiu /inner layer1

Myocardiu /iddle, uscular layer1

$!icardiu /outer layer1

CARD)AC A+$S:

Atrioventricular /A1 alve

&ricus!id and Mitral alves it !revents bloodfro flo#in" bac( into the atria durin" ventriculardiastole.

Seilunar alve0ulonic and Aortic alve it !revents blood

fro flo#in" bac( into the ventricles diastole.


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THE HEART VALVES


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Eour valves re"ulate blood flo# throu"h your heart

&he tricus!id valve re"ulates blood flo# bet#een

the ri"ht atriu and ri"ht ventricle.

&he !ulonary valve controls blood flo# fro the

ri"ht ventricle into the !ulonary arteries, #hich

carry blood to your lun"s to !ic( u! o%y"en.&he itral valve lets o%y"en


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Heart Soun's

S6 #hen closure of the A valves

/tricus!id G itral1 G ventricles

contract

S7 #hen closure of the seilunar

valves / !ulonic G aortic1 G

the ventricles rela%


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E(TRA HEART SOUNDS

S; &his occurs iediately after S7

-hy Resistance to fillin" of ventricles Note: also called a ventricular "allo!

H)t is caused by overload.

H use dia!hra" /it is a hi"h sound1

S> < &his occurs at the end of diastole, just

before the ne%t S6.

-hy &he atriu contract G !ush blood into

a non


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THE CONDUCTION SYSTE

$lectrical i!ulses fro your heart uscle /the

yocardiu1 cause your heart to beat /contract1&his electrical si"nal be"ins in the sinoatrial /SA1

node, located at the to! of the ri"ht atriu

&he SA node is soeties called the heartFsnatural !acea(er. -hen an electrical i!ulse

is released fro this natural !acea(er, it

causes the atria to contract

&he si"nal then !asses throu"h theatrioventricular /A1 node. &he A node chec(s

the si"nal and sends it throu"h the uscle fibers

of the ventricles, causin" the to contract.


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CONDUCTION SYSTE


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HEART CONTRACTILITY


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THE HEART BEAT

"T)o*part Pu+pin, A$tion#

As blood collects in the u!!er chabers /the

ri"ht and left atria1, the heartFs natural

!acea(er /the SA node1 sends out an

electrical si"nal that causes the atria tocontract. &his contraction !ushes blood

throu"h the tricus!id and itral valves into the

restin" lo#er chabers /the ri"ht and leftventricles1. &his !art of the t#o

called 'iastole.


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&he second !art of the !u!in" !hase be"ins

#hen the ventricles are full of blood. &he

electrical si"nals fro the SA node travel alon"a !ath#ay of cells to the ventricles, causin"

the to contract. &his is called s-stole

As the tricus!id and itral valves shut ti"ht to

!revent a bac( flo# of blood, the !ulonary and

aortic valves are !ushed o!en. -hile blood is

!ushed fro the ri"ht ventricle into the lun"s to!ic( u! o%y"en, o%y"en


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After blood oves into the !ulonary artery and

the aorta, the ventricles rela%, and the !ulonary

and aortic valves close. &he lo#er !ressure in the

ventricles causes the tricus!id and itral valves to

o!en, and the cycle be"ins a"ain

&his series of contractions is re!eated over andover a"ain, increasin" durin" ties of e%ertion and

decreasin" #hile you are at rest.

&he heart norally beats about 3 to 83 ties a

inute #hen you are at rest, but this can vary. As

you "et older, your restin" heart rate rises.


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our heart does not #or( alone, thou"h.

our brain trac(s the conditions around you

cliate, stress, and level of !hysicalactivityand adjusts your cardiovascular

syste to eet those needs.

&he huan heart is a uscle desi"ned to

reain stron" and reliable for a hundred

years or lon"er. By reducin" your ris( factors

for cardiovascular disease, you ay hel!

your heart stay healthy lon"er.


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SS&O+$ /Contraction1

Occurs #hen blood is ejected fro the

ventricles.

D)AS&O+$ /Rela%ation1

Occurs #hen ventricles are at rest.

CARD)AC OI&0I& S /stro(e volue1 9R

Measures the efficiency of the heart. &he aount

of blood ejected fro each ventricle in 6 inute.

Avera"e adult CO >to8 litersLinute.

S&RO$ O+IM$ easures the aount of

blood ejected fro the ventricle #ith each heart

beat.


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EAC&ORS AEE$C& CARD)AC OI&0I&:

9eart Rate re"ulated by the autonoic

nervous syste.Stro(e volue #hich is affected by:

0re


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HEART CONTRACTILITY


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BLOOD CIRCULATION OF THE HEART


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BLOOD CIRCULATION OF THE HEART


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Re"ulation of Cardiovascular Syste:

6. Autonoic Nervous Syste /ANS1

Sy!athetic NS

)ncreases heart rate and force ofcontractility

Stiulates the hearts beta adrener"icrece!tors for e!ine!hrine andnore!ine!hrine.

0arasy!athetic NSDecreases heart rate

Stiulates the va"us nerve


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7. Barorece!tors /located in the aortic arch andleft and ri"ht carotid arteries1

0erceive !ressure chan"es in the arterialsyste, res!ondin" #ith essa"es to thebrainste.

Results in a!!ro!riate increased or decreased

heart rate, and constriction and vasodilation viathe ANS in order to co!ensate.

Monitor the blood !ressure of the blood bein"delivered to the brain.

Barorece!tors can identify the chan"es in theblood !ressure #hich can increase or decreasethe heart rate.


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;. Cheorece!tor /located in the aortic archand carotid body1

0erceive cheical chan"es in the blood /e".Decreased in O7 and CO71

Results in vasoconstriction

>. Renal Syste

Senses #hen blood flo# to the (idneysdecrease resultin" in sodiu and #ater bein"retained and release of horones to further

retain fluids=. Others /$%ercise, $otion, &e!erature1


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Cardiovascular Assessent:

6. 9ealth 9istory

0ast health history

Medications /!ast, !resent, O&C,

herbal1Sur"eriesL!rocedures

Subjective e%aination /detailed

descri!tion of any sy!tos fro theclientP onset, descri!tion, activity,intolerance, dys!nea, ortho!nea1.

7 0hysical $%aination:


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7. 0hysical $%aination:

)ns!ection

@eneral activity level, color, alertness, !ain,

dys!nea, vital si"ns, !resence of distended nec(veins.

&hora%

isible scars fro !revious sur"eryP noral s(in

color &hora% syetrical #ith no visible !ulsation

/!ulsation of the aortic arch or innoinate arteriesaybe observe as noral1.

An"le of +ouis /raised notch #here theanubriu and body of the sternu are joined atthe 7nd intercostal1, aybe use as ar(er to countfor intercostal s!aces.


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0eri!heral chec( for edea, cyanosis,#ounds, uneven hair distribution, !ain.

0al!ationS(in should be #ar, dry

0oint of a%iu i!ulse /0M)1 aybe!al!ated at the =th intercostal s!ace at the

idclavicular line1 Abdoinal aorta ay be visibly and !al!ably

!ulsin" as noral.

0eri!heralEeet norally have !edal !ulses !resent

Ca!illary refill tie should be Q; seconds.


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0ercussion

Ri"ht sided heart border should not be

distin"uishable. Auscultation /ausculatory areas1

A 7nd )CS to the ri"ht of the sternu

0 7nd )CS to the left of the sternu& >th )CS left of the sternu

M /A!e%1 =th )CS at the left idclavicularline

Mururs are heard #hen there is aturbulent blood flo# throu"h noral orabnoral valves.


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=. +i!o!roteins /9D+, +D+1

S!ecific brea(do#n hel!ful for deterinin"

C ris( factors.

. 0otassiu, Ma"nessiu

$lectrolytes hi"h or lo# levels ay interfere

#ith cardiac rhyth.

?. 9e!arin +evel /0&& 0artial throbo!lastin

tie1

)t evaluates coa"ulation se*uence

9e!arin level "uides a!!ro!riate ) dosin" for

he!arin


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8.)nternational Norali'ed Ration /)NR1 0&

0rothrobin tie

)t evaluates coa"ulation se*uence$levated level desired to !revent clots for

those at ris(.

Noral level re*uired before the client hasinvasive !rocedure /to !revent bleedin"1

2. 9eo"lobin +evel /9"b1

Needed to trans!ort o%y"en to cells andreove carbon dio%ide.

Decrease level ay e%acerbate an"ina


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6>. Medication +evels /di"o%in,

*uinidine1$valuates thera!eutic dru" levels

Subthera!eutic or e%cessive levels

ay necessitate chan"es of dosin".

OTHER DIA!NOSTIC E(A FOR CVD


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OTHER DIA!NOSTIC E(A FOR CVD

"CARDIAC ONITORIN!#

6. $C@ /$lectrocardio"ra1)t is used to trace electrical activity of the

heart detected on the body surface.

)t is also hel!ful in detectin" cardiacdysrhytias, cardiac ischeia, M), and

any other conditions.

7. 9olter Monitorin")t is a readin" of $C@ rhyth for 7> to >8

hours on an out!atient basis.

; CR Ch t R


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;. CR Chest . $%ercise &readill &est /@raded e%ercise test1

Client #al(s on treadill or rides and e%ercise

bi(e #hile bein" onitored for $C@ rhyth and

vital si"ns in order to assess (CAD) or leftventricular function.

=. $chocardio"ra

I& #aves !ic(ed u! by a transducer !laced ondifferent !osition over the chest #all < to assess

flo# of blood, con"enital heart defects, estiates

left ventricular function.


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. Stress $chocardio"ra

Cobination e%ercise treadill and

echocardio"ra to co!are restin" ia"es#ith iediate !ost e%ercise < to assess for

change in left ventricular wall motion and

thickening.?. &ranseso!ha"eal $chocardio"ra /&$$1

A !robe #ith transducer ti! is s#allo#ed by

the client.isuali'ation for valvular abnoralities,

!ossible throbus, bacterial endocarditis,

con"enital heart defects.

NUCLEAR CARDIOLO!Y


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NUCLEAR CARDIOLO!Y

6. &9A++)IM

A radioactive isoto!e is injected ) so that thescintillation caera can count radioactive u!ta(e /areas

of !oor u!ta(e indicates infarction1

)t is useful for assessin" the e%tent of disease in CAD

and !redict the effectiveness of by!ass sur"ery oran"io!lasty.

7. D)0R)DAMO+$ &9A++)IM

)s injected to vasodilate coronary arteries so increase

blood flo# #ill a(e scannin" #ith thalliu oreeffective.

Ised #hen the client is unable to tolerate e%ercise such

as #ith severe 0D /!eri!heral vascular dse.1


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;. Cardiac Catheri'ation

)nsertion of a catheter into the heart via a

vein /for the ri"ht side of the heart1 or

feoral or brachial artery /for the left side of

the heart1

Iseful for obtainin" easureent of

ventricular function and dia"nosis of CAD

>. Coronary an"io"ra

Dye is injected to !rovide further

assessent of structure and otion of the

heart.

= 0 t C ) t ti /0C)1


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=. 0ercutaneous Coronary )ntervention /0C)1

)t is an atte!t to correct the bloc(a"e in the

artery can be ade.&0$:

An"io!lasty bloc(ed area of an artery is

JballoonedK o!en, #ith !la*ue left !ressed around

the #alls of the artery.

An"io!lasty #ith stent after bloc(a"e is

ballooned, a esh stent is left in !laced to hel!

su!!ort the #alls of the blood vessels to stayo!en.

Atherectoy !la*ue is JshavedK off by rotatin"

blade.


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. )ntracoronary I&

&iny I& !robe inserted into the coronary artery.

)t !rovides evaluation for !la*ue si'e andconsistency, artery #alls, and effectiveness of

treatent.

?. $lectro!hysiolo"y Study /$0S1

)nvasive study to assess the electrical activity of the

heart usin" catheters inserted via the veins to the

ri"ht side of the heart

8. 0acea(er Medical device that ta(es over the function of a

client5s alfunctionin" SA node or AN node.


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2. Coronary Artery By!ass @raft Sur"ery /CAB@1

Sur"ical 0laceent of ne# conduits to !rovide

coronary artery blood flo# #hen e%istin"coronary arteries are not !atent. /not o!en1

63.0eri!heral Arterio"ra!hy and eno"ra!hy

)njection of radio!a*ue dye to chec( the!atency of arteries or veins in the e%treities

/usually the le"s1

Serial


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Nursin" Dia"nosis:

)neffective tissue 0erfusion:Cardio!ulonay

Decrease Cardiac out!ut

Ris( for Activity )ntolerance

Acute 0ain

An%iety


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Sa!le uestion: No. 6

-hich of the follo#in" is a !riority for the

nurse to re!ort #hen obtainin" a historyfro the client scheduled for a coronary

an"io"ra

A.1 A history of Rheuatic 9eart diseaseB.1 A history of aller"y in shellfish

C.1 A recent dia"nosis of hy!erli!ideia

D.1 A !revious coronary an"io!lasty to theri"ht coronary artery.


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Ans)er: B

Rationale:

-hile obtainin" a clear record of the client5s cardiachistory it is i!ortant !rior to a coronary an"io"ra, )t

is !riority to notify the !hysician of an aller"y to

shellfish. &he client #ith shellfish aller"y is ore li(ely

to be aller"ic to the contrast dye used in the!rocedure. &he chart should be ar(ed for an aller"y

to shellfish.

$%a!le edication if aller"y:

Di!henhydraine /Benadryl1

Steroids and e%tra ) fluids


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Sa!le uestion No. 7

A client is scheduled for a di!yridaole

/0ersantine1 thalliu


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Ans)er: B

Rationale:&he test is an alternative to the e%ercise

thalliu 736 scan. &he di!yridaole

/!ersantine1 dilates the coronaryarteries as e%ercise #ould. Before the

!rocedure, any for of caffeine should

be #ithheld, as should aino!hylline

and theo!hylline. Aino!hylline ay

decrease the effects of di!yridaole.

cardio 1.ppt

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