cardiovascular disorders proper
DESCRIPTION
Cardiovascular DisordersTRANSCRIPT
Cardiovascular Disorders
Nio C. Noveno, RN
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Chest x-rayFluoroscopyCardiac Enzymes
LDH - elevated in 48 hrsSGOT CPK – elevated 4-24 hrs
CPK-MM [skeletal muscles]CPK-BB [brain]CPK-MB [myocardium, cardio-specific]
Echocardiography [Ultrasound cardiography]Electrocardiography [ECG] – electrical activity
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CARDIAC ENZYMES
AST/SGOT 5 – 40 U/LCPK
M 12 – 70F 10 – 55
CPK-MB 0 %LDH 45 – 90 U/LMyoglobin < 85 ng/mLTroponin I < 0.03Troponin T < 0.2CRP < 0.8 mg/dL
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ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Electrocardiography [ECG] – graphic record of the electrical activity of the heart
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Electrocardiography [ECG]
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Stress test (treadmill)Transesophageal echocardiography [TEE]AngiocardiographyPositron Emission Tomography [PET]Coronary ArteriographyCardiac catheterizationHemodynamic monitoring
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Coronary Arteriography - introduction of radiopaque catheter into brachial or femoral artery [arteriotomy w/ percutaneous puncture] to ascending aorta to coronary artery for fluoroscopy
Nursing InterventionNPOVital signsCheck for bleeding at puncture siteCheck color of extremity and pulses
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ARTERIOGRAPHYCARDIAC
CATHETERIZATION
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENTCardiac Catheterization - catheter into heart & BV to :
measure O2 conc., saturation, tension & pressure of heart chambersDetect shunts, heart output & pulmonary outflowRight CC – antecubital v → VC → R A&V → Pulm a. Left CC – brachia/femoral a → aorta → R V
Nursing InterventionBefore: NPO, allergic hx, mark distal pulse, instruct pt thudding sensations in chest & strong desire to cough and transient heat
After: VS, peripheral pulses, site, chest pain, bed rest for 12-24hrs;Femoral site – bleeding inflammation, tenderness, apply sandbag & ice on site, HOB >30°, avoid flexing femoral region
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Hemodynamic Monitoring: assessment of circulatory status
Central Venous Pressure [CVP] (N= 5-12 cms H2O)Catheter into external jugular vein → antecubital or femoral v. → vena cava
Provides information on blood volume & adequacy of venous return
Reveals right atrial pressure
Route for drawing blood samples, administration of fluids or meds and pacing
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CVP
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENTHemodynamic Monitoring (CVP)
Nursing InterventionPt. in supine. Changes in position, coughing or straining during reading may result to inaccuracies of readings
Zero point of manometer should be at a level with the pt’s R atrium (midaxillary line)
To measure CVP: turn stopcock so that IV solution flows into manometer filling to about 20-25cm level, then turn stopcock to let flow the solution in the manometer into pt.
Observe the fall in the height of column of fluid in manometer. Read where it stops.
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENTHemodynamic Monitoring
Swan-Ganz Pressure (N=5-12 cms H2O)Catheter into external jugular vein/subclavian → superior vena cava → R atrium → tricuspid valve → R vent → pulm a. → pulm capillary [pulm capillary wedge pressure]Interpretations of Pressure Readings:
Pulmonary Artery Pressure [PAP]: 10-20 mmHg;- increased in pts w/ chronic pulmonary disease & CHF
Pulmonary Capillary Wedge Pressure: 4-12 mmHg- indicative of pressure in the L cardiac chambers
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Swan-Ganz Procedure
PAWP CATHETER
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The PRESSURE Guidelines
P ressure monitor
R ise slowly to reduce orthostatic hypotension
E ating must be considered
S tay on medications
S topping or skipping is discouraged
U ndesirable responses
R emind to exercise, stop alcohol
E liminate smoking, educate
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Pharmacology
Nitroglycerin
MOA: relaxes vascular smooth system, ↓myocardial demand for O2, ↓ LV preload by dilating veins, thus indeirectly ↓afterload
Interventions:Monitor BP & APHave client sit or lie
down (first time)NO defibrillation over
area of nitro patchAssist during ambulation
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PharmacologyNitroglycerin cont…
Health Teachings:Oral:
– Take on an empty stomach, with a glass of water.SL:
– Take at first sign of anginal pain– Take every 5 mins to a maximum of 3 doses
• NO relief, seek MD– Stinging or biting sensation– Protect from light, moisture and heat
Transderm patch:– OD in AM– Rotate sites
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Pharmacology
Lidocaine
MOA: decreases cardiac excitability, cardiac conduction is delayed in the atrium or ventricle
Undesirable effects:– ↓ or ↑ HR– ↓ BP– Confusion– Drowsiness (1st sign of
toxicity)– Dizziness– Nausea, vomiting – Seizures (severe toxicity)– Cardiac arrest
Drug interactions:– ↑ effects with Phenytoin,
Procainamide, Propranolol, quinidine,
– ↑ risk of toxicity with ß-adrenergic blockers, cimetidine
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Pharmacology Lidocaine cont…
Interventions:• Give I.V.• Monitor serum levels: 1.5-5 mcg/ml• Monitor EKG, BP, PR• Monitor I & O• Do not mix syringes with cefazolin and amphotericin
B• Have Dopamine available for circulatory collapse• Assist and provide safety
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Pharmacology ACE INHIBITORS
MOA: suppress the RAAS; blocks the conversion of angiotensin I to angiotensin II
Undesirable effects:– Gastric irritation– Headache– Dizziness– ↑ HR– Angioedema– Cough– Maculopapular rash– Pruritus– Infection– Hyperkalemia
Interactions:– Probenecid: ↓
elimination– NSAIDs: hypotensive
effect– Other anti-HTN: ↑
hypotensive effects– Hyperkalemia
Interventions:– Assess for renal function– Do not give with food– Do not take potassium-
rich foods
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Pharmacology ACE INHIBITORS cont…
S VR/PVR decreased
T reatment for MI
R elease of aldosterone is low
O occult diabetic nephropathy
L VD after MI is low
ACE INHIBITORS cont…
C ough; contraindicated with renal artery stenosis
H ypotension; hyperlipidemia
F ood has less taste; WOF hypotension
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Pharmacology Angiotensin II receptor blockers (ARB)
MOA: blocks angiotensin II from binding with angiotensin receptors; lowering BP
Information:– Same with ACE inhibitors
A dminister without regard to meals
R enal function tests –review
B locks vasoconstriction effect of RAAS
S alt substitution or potassium supplements is not allowed
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Pharmacology Alpha adrenergic blockers
MOA: blocks alpha1adrenergic receptors resulting in vasodilation of arteries and veins; decreases PVR; relaxes smooth muscles of bladder and prostate
Undesirable effects:– Same as other anti-HTN
meds– WOF: 1st dose syncope
• 2-3 H post initial dose
S yncope; sexual dysfunction
I ncreased drowsiness; orthostatic hypotension, HR
N eed to be recumbent for 3-4 H after the initial dose
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Pharmacology Beta adrenergic blockers
MOA: blocks ß1 (heart) or ß2 (lungs) receptors to prevent the release of catecholamines; decreases contractility, renin release and sympathetic output
Caution: – COPD– CHF– Sinus bradycardia– Heart block– DM
B radycardia
L ipidemia/libido decreased
br O nchospasm
C HF; conduction abnormalities
K onstriction, peripheral vascular
E exhaustion; emotional depression
R educes glucose
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Pharmacology Calcium channel blockers
MOA: blocks Ca2+ influx into the cells causing decreased contractility, decreased PVR and low BP
Undesirable effects:– Hypotension– Headache – Dizziness– Peripheral edema– Constipation
Interventions:• Elevate extremity affected• Increased dietary fiber;
increase OFI• Take with meals or milk
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Pharmacology Central alpha2 agonist
MOA: decreased release of adrenergic hormones from the brain resulting in a decrease PVR, hence BP
C ontrols release of adrenergic hormones
A dverse effects: low BP, hepatotoxicity, hemolytic anemia
T ransient drowsinessA rterial pressure is
loweredP aradoxical HTN with
propranololR ecord baseline VSE valuate weight and liver
functionS lowly taper the doses
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Pharmacology
Vasodilators
MOA: direct relaxation of vascular smooth muscles, decreases afterload
D ilates vascular musclesI ncreases renal and
cerebral flowL upus-like reaction (fever,
facial rash, muscle and joint ache, splenomegaly)
A ssess for peripheral edemaT ake with foodO ther SE: headache,
dizziness, anorexia, tachycardia, hypotension
R eview BP
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D iet high in K+ for all except aldactone
I ntake and output daily
U undesirable effects: fluid & electrolye imbalance
R review HR, BP
E lderly with caution
T ake with or after meals in AM
I ncrease risk of orthostatic hypotension; move slowly
C ancel alcohol
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CORONARY ARTERY DISEASE or Coronary Ischemic HD
Myocardial impairment due to imbalance between coronary blood flow myocardial O2 demandManifested as:
Ischemia [Angina Pectoris] – reversibleInfarction – irreversible
Ischemia – reversible if myocardial blood flow is ↑ or the need for the demand is ↓
may progress to infarction
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
Angina PectorisChest pain associated w/ transient myocardial ischemia
Causes:Atherosclerosis – most common VasospasmAortic stenosis
Kinds:Stable [Effort] APUnstable [Preinfarction] AP
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ASSESSMENT OF PAIN
P rovoking/precipitating
Q uality
R adiation
S everity
T iming
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
Angina PectorisSigns & Symptoms:
Substernal or precordial pain radiating to L shoulder lasting for 3-5 mins, relieved by restHeaviness, tightness, squeezing precipitated by exertion, emotion and exposure to coldVS may be normal
Diagnostic Tests:Nitroglycerine test – relieves painBlood chemistry - ↑ cholesterolStress test, abnormal ECG – inverted T-wavesCardiac enzymes – NCoronary arteriography – plaque accumulation
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAngina Pectoris
Nursing Intervention↑ O2 to the myocardium & relief of acute attacksAdminister meds as ordered.
Short & long acting nitrates [NG]β-adrenergic agonists [Propranolol]
Reducing demand for O2Limit activities, moderate exerciseSedatives, tranquilizers, antidepressants
Helping client prevent future attacksDiet – low calorie, saturated fat5-6 small frequent feedingsDaily exercise; avoid cold environment, smoking
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
Myocardial InfarctionLife threatening condition caused by occlusion of coronary artery or its branches leading to death of myocardial cells
Causes:AtherosclerosisThrombus EmbolusCoronary artery spasm
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
Myocardial InfarctionSigns & Symptoms:
Steady constrictive substernal chest pain, sever, not relieved by rest & NitroglycerineSymptoms of shock, increase in tempNausea & vomiting, diaphoresis, pallorAnxiety and apprehension
Management:Provide rest – CBR, use bedside commodeRelieve pain – demerol or morphineO2 by mask, cannula or nasal catheterECG monitoringIVF to KVO
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
Myocardial Infarction
Management:Diureticsβ-adrenergic agonistsAnti-arrhythmics [Procainamide, Lidocaine]Diet: no iced or very hot drinks, may precipitate arrhythmias, no gas-forming foodsMild laxatives, stool softenersIf due to thrombus: give
Thrombolytics [Streptokinase]Follow up therapy w/ anticoagulant
Heparin, Coumadin, ASA, Dicumarol
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONGESTIVE HEART FAILURE (CHF)
Inability of the heart to pump blood from the ventricles as quickly as it enters the atria leading to congestion in the lungs & systemic circulation
Causes:inflow of blood → heart is greatly reducedinflow of blood → heart is greatly increasedoutflow of blood from the heart is obstructedmyocardial damageincreased metabolic state
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONGESTIVE HEART FAILURE (CHF)
Cardiac Compensatory Mechanisms:Ventricular dilatationVentricular hypertrophyTachycardia
Forms of CHF:Left ventricular failureRight ventricular failure
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESSigns and Symptoms of CHF
Left-sided HF Right-sided HF
Forward Effects:Weakness, fatiguemental confusion, insomnia, anxiety, oliguria
Backward Effects:breathlessness, cough, orthopnea, crackles, ↑ PCWP, frothy sputum
Forward Effects:Decreased volume to the lungs
Backward Effects:ankle/pretibial swelling, pitting edema, abdominal distention, ascites, anorexia, JV distention, hepatomegaly splenomegaly, wt. gain, ↑ CVP
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Congestive Heart Failure
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONGESTIVE HEART FAILURE (CHF)Interventions:
Improve ventricular pump performanceInotropic agents [Digitalis]Administer O2 therapy
Reduce myocardial workloadPreload:
Administer diureticsRestrict fluid & Na intakeUpright positionPhlebotomy
Afterload:VasodilatorsReduce physical and emotional stress
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
ACUTE PULMONARY EDEMA
Complication of L-sided HFEdema results from the heart’s inability to pump adequatelyResults in impaired oxygenation & hypoxia
Causes:Heart failureAtherosclerosisValvular disease
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
ACUTE PULMONARY EDEMA
Assessment findings:• Dyspnea• Paroxysmal cough• Blood-tinged frothy sputum• Orthopnea• Restlessness
Diagnostic test findings:CXR: interstitial edemaABGs: respiratory alkalosis or acidosisECG: tachycardia, ventricular enlargementEMODYNAMICS: ↑ PAWP, CVP, ↓ CO
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
ACUTE PULMONARY EDEMA
Medical management:Low-sodium diet; limit fluidsO2 therapyHigh-Fowler’s positionVS, I/O, ECG, & hemodynamicsAnalgesics VasodilatorsCardiac inotropes & glycosidesNitratesBronchodilatorsPulse oximetry
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
ACUTE PULMONARY EDEMA
Nursing management:Assess CV & respiratory statusWithhold food & fluidProvide:
SuctioningTurningCoughingDeep breathing
Keep in High-Fowler’sAllay anxietyNote the color, amount & consistency of sputum
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
ACUTE PULMONARY EDEMA
Home instructions:• Recognize the signs of fluid overload &
respiratory distress• Sleep with the head of the bed elevated
Complications:Digitalis toxicityFluid overloadPulmonary embolismHypokalemiaHyernatremia
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
Failure of the heart to pump adequately, thereby educing the CO & compromising tissue perfusion
Causes:MIMyocarditisAdvanced heart blockHeart failureMetabolic abnormalitiesCardiac tamponadePulmonary embolus
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
Assessment findings:Hypotension
SBP <90 mm HgOliguria:
<30 mL/HCold, clammy, pale skinTachycardiaRestlessness
Diagnostic findings:ABGs: metabolic acidosis, hypoxemiaECG: MI (enlarge Q wave, ST elevation)
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Injury ↓Myocardial contractility
↑ HR↓ SV
↓ LV emptying
Compensation
Decompensation & death
↓ Coronary artery
perfusion
↓ CO
Myocardial hypoxia
↓Myocardial contractility
↑ Preload
Pulmonary congestion
LV dialtion & backup of blood
OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
Management:O2 therapySemi-Fowler’s positionIntra-aortic balloon pumpDiureticsVasodilatorsCardiac inotropesVasopressorsAdrenergic agents
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
Nursing management:Administer:
IVF, O2, medicationsAssess CV, respiratory status, & fluid balanceMonitor & record:
VS I/OHemodynamicsLOCLab values
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CARDIOGENIC SHOCK
Complications:• Arrhythmias• Cardiac arrest• Infection
Surgical interventions:CABGHeart transplantation
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESMITRAL STENOSIS
Narrowing of the mitral valve openingDue to:
Rheumatic endocarditisCongenital
Assessment findings:• Fatigue• Dyspnea on exertion• Peripheral edema• Orthopnea
Diagnostic findings:CXR: enlargement of the LA & RV; pulmonary congestionECHOCARDIOGRAM: thickened mitral valve & LA enlargement
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
MITRAL STENOSIS
Management:Low-sodium diet; fluid restrictionsSemi-Fowler’s positionCardiac glycosidesNitratesDiureticsAnti-arrhythmicsAni-coagulantsAntibiotics
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
MITRAL STENOSIS
Nursing management:Administer:
IVF, O2, medicationsAssess CV & respiratory responseMonitor & record:
VS I/OHemodynamicsECG readingsLab values
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESMITRAL STENOSIS
Home care:Signs & symptomsActivity limitationsInfection controlOccult blood
Complications:ThrombosisEmbolismHFAtrial fibrillation
Surgery:Valve replacementOpen mitral commissurotomy
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
MITRAL INSUFFICIENCYIncomplete closure of the mitral valveDue to:
↑ LA pressurePulmonary HTNLA hypertrophy
Assessment findings:• Fatigue• Dyspnea on exertion• Peripheral edema• Angina pectoris• Orthopnea
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
MITRAL INSUFFICIENCYDiagnostic findings:
ECHOCARDIOGRAM: enlarged LA, abnormal movement of the mitral valveCARDIAC CATH: ↑ LA pressure & ↑ LV pressure
Management:Low-sodium diet; fluid restrictionsSemi-Fowler’s positionCardiac glycosidesNitratesDiureticsAnti-arrhythmicsAni-coagulants
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
MITRAL INSUFFICIENCY
Nursing management:Maintain on diet; limit OFIKeep on semi-Fowler’s positionAssess peripheral edema
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
AORTIC STENOSISNarrowing of the aortic valveLower CO leads to increased congestion in the lungs causing RSHF
Causes:SyphilisRheumatic feverAtherosclerosisCongenital malformations
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
AORTIC STENOSIS
Assessment findings:• Angina pectoris• Pulmonary HTN• LSHF• Orthopnea
Diagnostic findings:ECG: L bundle branch block, 10 heart block, LV hypertrophy ECHOCARDIOGRAM: thickened LV wall, thickened aortic valve that moves abnormally
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC STENOSIS
Management:• Low-sodium diet; fluid restrictions• Monitor lab studies• Cardiac glycosides• Nitrates• Diuretics• Anti-arrhythmics• Percutaneous transluminal valvuloplasty
Nursing management:Maintain on diet; limit OFIAssess CV & respi statusMonitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab values
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC STENOSIS
Complications:• HF• Pulmonary edema
Surgery:Aortic valve replacementCommissurotomy
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC INSUFFICIENCY
Retrograde flow of blood from the aorta to the LVAn incomplete closure of the aortic valve
Causes:SyphilisRheumatic feverInfective endocarditisAtherosclerosisCongenital defect
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC INSUFFICIENCY
Assessment findings:• Signs of LSHF• Dyspnea on exertion• Dizziness• Angina pectoris
Diagnostic findings:CXR: enlarged LV, aortic valve calcificationECHOCARDIOGRAM: LV enlargement, abnormal valve movement
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC INSUFFICIENCY
Management:• Low-sodium diet; fluid restrictions• Antibiotics • Cardiac glycosides• Nitrates• Diuretics• ACE inhibitors • Anti-arrhythmics• Percutaneous transluminal valvuloplasty
Nursing management:Maintain on diet; limit OFIAssess CV & respi statusMonitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab values
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESAORTIC INSUFFICIENCY
Complications:• HF• Thrombosis• Embolism• Infection
Surgery:ValvuloplastyValve replacement
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Chronic inadequate blood flow in the lower extremities
Types:1. Arteriosclerosis obliterans – sclerosis of arterioles
resulting in thickening of the walls & occlusion2. Raynaud’s phenomenon – intermittent
vasoconstriction & ischemia of fingers & toes accompanied by pallor & cyanosis
3. Buerger’s disease (thromboangiitis obliterans) –inflammation of BV resulting in occlusion of the vessel
Causes:AtherosclerosisVasospasmInflammation
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Assessment findings:Intermittent claudicationPain at restTrophic changes: thickened nails, absence of hair, & taut skinDiminished or absent pulses in extremities (unilateral)Temperature changes in extremitiesColor changes:
Rubor, cyanosis, pallorUlcerations in extremities
Diagnostic findings:ARTERIOGRAPHY: location of obstructionDOPPLER STUDIES: decreased blood flow & arterial pressure
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Buerger’s disease
Raynaud’s phenomenon
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Management:• Active ROM & isometric exercises• Antiplatelet agents• Vasodilators• Anticoagulants• Antilipemics
Nursing management:Assess for:
PulsesColorTemperatureComplaints of abnormal sensations
Numbness or tingling
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Home care:Symptoms of ↓ peripheral circulationSkin breakdownFoot careAvoid stress
Prolonged standingExtremes of temperatureConstrictive clothingCrossing legs at knee when seated
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE
Complication:• Gangrene• Septicemia• Pressure sores• Acute vascular occlusion
Surgery:Bypass graftingEndarterectomySympathectomyAmputationEmbolectomy
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESTHROMBOPHLEBITIS
Massing of RBCs in a fibrin networkObstruction by enlarged thrombusResults to inflammation of the venous wall causing clots to form
Causes:Venous stasis
Varicose veins, pregnancy, HF, prolonged bed rest
HypercoagulabilityCancer, blood dyscrasias, oral contraceptives
Injury to venous wallIV, fractures, antibiotics
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESTHROMBOPHLEBITIS
Assessment findings:SUPERFICIAL VEINS:
Red, warm skin that’s tender to touchDEEP VEINS:
Major venous trunks: Edema(+) Homans signTendernessCramping pain,Cyanosis Venous distention
SMALL VEINS:TendernessInduration Minimal to no distention
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESTHROMBOPHLEBITIS
Diagnostic findings:VENOGRAPHY/ PHLEBOGRAPHY : venous filling defectsUTZ: ↓ blood flow
Management:Activity limitationAntiembolism stockingsAnticoagulants
Nursing management:Assess for Homans signApply warm, moist compressMeasure & record circumference of thighs & calvesKeep patient I bed & elevate extremities
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESTHROMBOPHLEBITIS
Complications:• Pulmonary embolism• Stroke
Surgical intervention:Vena cava filterVein ligation & strippingThrombectomy
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Obstruction or narrowing of the aorta’s lumen & its major branchesReduced perfusionObstruction: endogenous or exogenous
Causes:AtherosclerosisEmboliThrombosisTrauma or fracture
Risk factors:Age DMFamily historyHyperlipidemiaHTNSmoking
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Assessment findings:Femoral, popliteal or innominate arteries:
↓ decreased distal pulsesMottling & pallorParalysis & paresthesiaSudden & localized pain*
Internal & external carotid arteries:stroke., TIA
Subclavian:Subclavian steal syndrome
Vertebral & basilar:TIA
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Angiography findings:The type (thrombus or embolus), location, & degree of obstructionCollateral circulation
Medications:AntilipemicsAntiplateletsPentoxyfillineAnticoagulantsThrobolytics
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Nursing management:Assess distal pulses, skin color, & temperatureAssess pain & give analgesicsAdminister IV fluids, O2, & medications as RxMonitor for signs of stroke
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESABDOMINAL AORTIC ANEURYSM
Dilation of or localized weakness in the medial layer of an abdominal artery
Causes:AtherosclerosisHTNSmoking
4 types:1. Saccular – unilateral, pouch-like bulge2. Fusiform – spindle-shaped bulge; encompasses entire
diameter of the vessel3. Dissecting – hemorrhagic separation of the medial
layer of vessel wall; creates a false lumen4. False – pulsating hematoma; often mistaken for an
abdominal aneurysm
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Assessment findings:AsymptomaticLower abdominal pain, lower back painAbdominal mass to the left of the midlineAbdominal pulsationsBruits
Diagnostic findings:Apparent on CXR, abdominal UTZ, aortography
Medications:Analgesicsß-blockers
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Nursing management:Check peripheral circulationObserve for signs of shock:
AnxietyRestlessnessDecreased pulse pressureIncreased thready pulsePale, cool, moist, clammy skin
Palpate abdomen for distentionTeach signs & symptoms of decreased peripheral circulation
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE
Complication:Rupture of aneurysmHemorrhage Renal insufficiency
Surgery:Resection of aneurysmEndovascular graft repair
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESCARDIOMYOPATHY
Disease of the heart’s muscle impacting the structure & function of the ventricleHeart failure develops laterMyocardium becomes flabby
Types:1. Congestive (dilated) – chronic alcoholism2. Hypertrophic – idiopathic hypertrophic subaortic
stenosisPressure overload hypertension or aortic valve stenosisHypertrophic cardiomyopathy
3. Restrictive (obliterative) – amyloidosis, cancer
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESCARDIOMYOPATHY
Major manifestations:• Dyspnea• Dry cough• Fatigue• Palpitations• Weakness
Diagnostic findings:ECG: LV hypertrophyECHOCARDIOGRAM: decreased myocardial functionCXR: cardiomegaly
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESCARDIOMYOPATHY
Management:• Low-sodium diet; fluid restrictions• LV assist device• Diuretics• ß-blockers• Anticoagulants • CCBs• ACE inhibitors
Nursing management:Keep in semi-Fowler’s positionMonitor ECG resultsAdminister O2 & medications
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESCARDIOMYOPATHY
Home care:Signs & symptoms of HFWeigh daily
Report increments of 3 lbs.Demonstrate exercises to increase CORefrain from smoking & drinking alcohol
Complications:• Heart failure• Arterial emboli
Surgery:Ventricular myomectomyHeart transplant
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESENDOCARDITIS
Endocardial lining inflammationDestruction of heart valve leaflets
Causes:ß-hemolytic strep infections
S. aureus, Candida, G(-)Rheumatic heart diseaseDental proceduresInvasive monitoringIV drug abuse
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESENDOCARDITIS
Assessment findings:• Elevated temperature• Heart murmur• Malaise
Diagnostic findings:• BLOOD CULTURES: (+) microorganisms• ECHOCARDIOGRAPHY: valvular damage,
vegetations
Medical management:Antibiotics(+) inotropic agentsAntipyreticsAnticoagulants
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESENDOCARDITIS
Nursing management:• Administer medications• Asses CV status• Encourage rest periods
Home care:• Avoid infections• Monitor for infections specially after dental or gynecologic
exam; seek treatment• Wear ID
Complications:• Embolism• HF• Mycotic aneurysm
Surgery:Valve replacement
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERICARDITIS
Inflammation of the pericardiumMay be: fibrinous or effusive
Causes:InfectionNeoplasmsHigh dose radiation to the chestHypersensitivity or autoimmune diseaseHydralazine or procainamidePostcardiac injuryAortic aneurysmMyxedema
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OXYGENATION (Cardiovascular)
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERICARDITIS
Assessment findings:
Pain characteristics:
Sharp, usually sudden over the sternum
Radiates to the neck, shoulders, back & arms
Increases with deep inspiration or when lying down
Decreases when sitting up & leaning forward
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERICARDITIS
Diagnostic findings:ECGElevated ST segmentsQRS segments may be diminished with pericardial effusionRhythm changes may occur:
Atrial ectopic rhythms – atrial fibrillation & sinus arrhythmia
Echocardiography reveals the problem
Management:Bed as long as fever & pain persistNSAIDSCorticosteroidsAntibiotics
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASESPERICARDITIS
Nursing management:• Maintain CBR• Place on upright position• Monitor & record VS, I/O, & hemodynamics• Assess pain & give analgesics as Rx
Complications:• Pericardial effusion• HF• Chronic RSHF• Cardiac tamponade
Surgery:Pericardectomy
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONDUCTION ARRHYTHMIASDisruption in the normal events of cardiac cycleSinus Tachycardia – HR > 100 beats/min originating from
the SA node (100-160bpm); regular rhythm
Causes: fever, apprehension, physical activity, anemia, hyperthyroidism, epinephrine, caffeine
Management:Correction of underlying
causeNo stimulantsDrug of choice:
propranolol [Inderal], Digoxin
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONDUCTION ARRHYTHMIAS
Sinus Bradycardia – HR < 60 beats/min; regular rhythm
May be caused by: Excessive vagal/or ↓ sympathetic toneMI, intracranial tumors, meningitisN variation of HR in well-trained athlete
Management:Not needed, unless CO is inadequatePharmacotherapy: Atropine, IsuprelPacemakers – pulse generator to control potentially dangerous dysrhythmias
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONDUCTION ARRHYTHMIAS
Atrial Fibrillation: Atrial rate: 35-600bpm;Vent. rate: 100-160 bpm; irregular
May be seen it pts with: Rheumatic mitral stenosis, thyrotoxicosis, hypertensive disease, cardiomyopathy, pericarditis and CHD
ManagementDigitalis, PropranololVerapamil in conjunction w/ digitalisDirect-current cardioversion
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OXYGENATION (Cardiovascular)
CONDUCTION ARRHYTHMIASVentricular Tachycardia – run of 3 or more consec. PVCs;
Atrial rate: 60-100bpm; Vent. rate: 110-250bpm; occ’lventricular irregularity
May be caused by: Acute MI, CAD, intoxication, hypokalemia
ManagementIV push Lidocaine, then IV dripProcainamide via IV infusionPropranolol [Inderal], BretyliumDirect-current cardioversion
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OXYGENATION (Cardiovascular)
COMMON CARDIOVASCULAR DISEASES
CONDUCTION ARRHYTHMIAS
Premature Ventricular Contractions – HR varies according to number of PVCs; irregular rhythm
May be caused by: Myocardial dse, CHD, hypoxiaElectrolyte imbalance [hypokalemia]Digitalis tx, stimulants
ManagementIV push Lidocaine, then IV dripProcainamide [Pronestyl]Treatment of underlying cause
Cardiovascular Disorders
THANK YOU!
Nio C. Noveno, RN