copyright © 2011. f.a. davis company linda s. williams / paula d. hopper understanding medical...

Copyright © 2011. F.A. Davis Company

Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition

Chapter 21

Cardiovascular System Function, Assessment, and Therapeutic

Measures



The Heart In Mediastinum Pericardial Sac: Three Layers

Fibrous Pericardium Parietal Pericardium Visceral Pericardium (Epicardium) Serous Fluid Between Inner Layers



Anterior Heart View



Frontal Heart View



Cardiac Structure and Vessels Four Chambers

Right/Left Atrium, Right/Left Ventricle

Cardiac Layers Epicardium, Myocardium, Endocardium



Cardiac Structure and Vessels (cont’d)

Coronary Arteries Valves

Tricuspid, Pulmonic, Mitral, Aortic



Blood FlowVena Cava » Right Atrium» Tricuspid »

Right Ventricle» Pulmonic » Pulmonary

Artery » Lungs » Pulmonary Veins» Left

Atrium » Mitral » Left Ventricle» Aortic

Valve » Aorta



Cardiac Conduction SA Node AV Node Bundle of His Right and Left Bundle Branches Purkinje Fibers



Cardiac Output Amount of Blood Ejected from the Left

Ventricle in 1 Minute Stroke Volume x Heart Rate = CO



Nervous System Regulation of the Heart



Hormones and the Heart Epinephrine

Increases Heart Rate Force of Contraction Cardiac Output Systolic BP



Hormones and the Heart (cont’d) Aldosterone

Regulates Sodium/Potassium

Atrial Natriuretic Peptide Excretes Sodium



Blood Vessels Arteries Veins Capillaries



Structure of Blood Vessels



Blood Pressure Blood Force Against Blood Vessel Walls Normal

Systolic <120 mm Hg Diastolic <80 mm Hg



Renin-Angiotensin-Aldosterone Mechanism



Pathways of Circulation Pulmonary Systemic



Aging and the Cardiovascular System



Aging and the Cardiovascular System (cont’d)

Atherosclerosis Arteriosclerosis Blood Pressure Increases Vein Valves More Incompetent Heart Muscle Less Efficient Dysrhythmias Common



Cardiovascular Disease Number 1 Killer Healthy Lifestyle

Smoking Cessation Dietary Fat Reduction Two Servings of Fish Weekly Exercise



Cardiovascular Disease (cont’d)

Go Red for Women American Heart Association’s Nationwide

Movement to Celebrate the Power Women Have to Band Together to Wipe Out Heart Disease

Color Red and Red Dress Linked with This Ability



Cardiovascular Assessment Health History Physical Assessment Diagnostic Studies



Health History Symptoms – WHAT’S UP? Allergies Past Medical History Medications Family History Health Promotion Methods



Physical Assessment Vital Signs

Blood Pressure Pulse Respirations Temperature



Physical Assessment (cont’d) Inspection

Oxygenation, Skin Color Extremities: Hair , Skin, Nails, Edema, Color JVD Capillary Refill Clubbing



Clubbing



Physical Assessment (cont’d) Palpation

Point of Maximum Impulse Extremity Temperature

Poikilothermy

Edema Homans’ Sign



Edema



Homans’ Sign



Physical Assessment (cont’d) Auscultation

Heart Sounds S1 S2 S3 S4



Heart Sounds



Physical Assessment (cont’d) Auscultation (cont’d)

Murmurs Pericardial Friction Rub



Diagnostic Studies Joint Commission

National Patient Safety Goal Improve Accuracy of Patient Identification

Use at Least Two Patient Identifiers (Neither Patient's Location) Whenever Collecting Laboratory Samples or Administering Medications or Blood Products



Diagnostic Studies Joint Commission National Patient Safety Goal (cont’d)

Use Two Identifiers to Label Sample Collection Containers in Presence of Patient




National Patient Safety Goal (cont’d)

Immediately Prior to Any Invasive Procedure, Conduct Final Verification Process to Confirm Correct Patient, Procedure, Site, and Availability of Appropriate Documents



Noninvasive Diagnostic Studies

Chest X-Ray CT Scan Magnetic Resonance Imaging



Electrocardiogram Records Cardiac Electrical Activity

Signal-averaged ECG Risk for Ventricular Dysrhythmias

Ambulatory Electrocardiogram Monitoring Holter Monitoring



Echocardiogram Ultrasound Records Motion

Heart Structures Valves Heart Size, Shape, Position



Transesophageal Echocardiogram

Probe in Esophagus Clearer Picture NPO Until Gag Reflex Returns



Exercise StressTest Cardiac Stress Test

Cardiac Response to Exercise and Increased Oxygen Needs

Peripheral Vascular Stress Test Vascular Response to Walking



Cardiac Stress Test



Noninvasive Diagnostic Studies

Plethysmography Diagnoses Deep Vein Thrombosis/Pulmonary

Emboli/Peripheral Vascular Disease

Pressure Measurement BP Readings Along Extremity



Noninvasive Diagnostic Studies (cont’d)

Arterial Stiffness Index Atherosclerosis/Cardiovascular Disease

Tilt Table Test Lying to Standing BP and HR

Doppler Ultrasound Impaired Blood Flow Reduces Sound Waves



Radioisotope Imaging Radioisotopes IV, Gamma Camera Scan Detects Cardiac Ischemia/ Damage/

Perfusion Thallium Imaging Technetium Pyrophosphate Scan Technetium 99m Sestamibi MUGA Scan Positron Emission Tomography



Blood Studies Blood Lipids

Triglycerides, Cholesterol, Phospholipids

hs-CRP Homocysteine Cardiac Biomarkers

Creatine Kinase, Troponin, Myoglobin

Magnesium




National Patient Safety Goal Improve Effectiveness of Communication

Among Caregivers For Orders/Telephonic Reporting of Critical

Test Results, Verify Complete Order/Test Result by Reading Back Complete Order/ Test Result to Person Giving it



Invasive Studies Angiography Cardiac Catheterization Hemodynamic Monitoring Electrophysiology Study



Cardiac Catheterization



Pulmonary Artery Catheter



Therapeutic Interventions Exercise: Walking Program Cardiac Rehab Smoking Cessation Balanced Diet, Weight Loss Oxygen



Therapeutic Interventions (cont’d)

Antiembolism Devices Elastic Stockings Intermittent Pneumatic Compression




Medications Cardiac Glycosides Vasodilators Antihypertensives Antidysrhythmics Antianginals




Medications (cont’d) Anticoagulants Thrombolytics



Lifestyle and Cardiac Care Risk Factors Support Groups Sexual Activity



Cardiac Surgery Preparation for Surgery Cardiopulmonary Bypass

Video-assisted Thoracoscope

General Procedure for Cardiac Surgery Minimally Invasive Cardiac Surgery



Cardiopulmonary Bypass Pump



Cardiopulmonary Bypass Pump in Use