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Cardiovascular
System
By:
Ms. Irene M. Magbanua
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FOUR STAGES OF LIFE
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CARDIOVASCULAR SYSTEM
IMPORTANT FUNCTION:
- provide oxygen in everytissue in the body which
is essential in performingits function
CONSISTS of:
HEART
BLOOD VESSEL
BLOOD
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HEART Hollow, muscular
4-chambered
Located in middle of thoracic cavitybetween lungs in space calledmediastinum(The space between the
lungs, which includes the heart,pericardium, aorta and vena cava)
Inverted cone
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The Cardiovascular System
HEART
Normal Anatomy: Microscopic
Consists of Three layers- epicardium,myocardium and endocardium
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The Cardiovascular System
The epicardiumcovers the outer surfaceof the heart
The myocardium is the middle muscularlayer of the heart
The endocardium lines the chambers andthe valves
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The Cardiovascular System
The layer that covers the heart is the
PERICARDIUM
There are two parts- parietal and visceralpericardium
The space between the two pericardial
layers is the pericardial space
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PERICARDIAL EFFUSION
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The Cardiovascular System
Normal Anatomy: Gross
The heart is located in the LEFT side of
the mediastinum
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The Cardiovascular System
The heart chambers are guarded byvalves
The Atrio-ventricular valves-
The Semilunar valves-
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BLOOD VESSELS
Great vessels:
large veins and
arteries leadingdirectly to and
away from heart SUPERIOR VENA CAVA
AND INFERIOR VENACAVA
PULMONARY ARTERY
PULMONARY VEIN
AORTA
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LAUGH BREAK
BOY: Isang babaeng siopao nga!
LEA: Babaeng siopao?
BOY: Oo, yung may saping papel, may
napkin!
LEA: Ah ganun ba? Mayrun kaming
siopao na bading
BOY: Bading na siopao?
LEA: May sapin din, pero may itlog sa
loob!
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LAUGH BREAK
AMO: Day, gamitin mo sa pader itongchalk pamatay ng ipis.MAID: Yis ati!
NEXT DAY... nagulat ang amo, nakasulat sa pader:EPES MAMATAY KAYUNG LAHAT!
SYET! PAKYO!
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LAUGH BREAK
PASYENTE: Dok bakit pag tuwingumiinm ako ng alak sumasakit ang tyanko? Pero pag libre, di naman?
DKTOR: Normal yan, manipis kasi ataymo. Tapos makapal mukha mo!
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LAUGH BREAK
BUS HINOLDAP!Holdaper: Re-reypin ko lahat ng babaedito!
Prosti: Ako na lang po, maawa kayo saiba..
Lola: Sinabi na ngang LAHAT eh!Sasagot pa!
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CORONARY ARTERIES
The Blood supply ofthe heart comesfrom the Coronary
arteries1. Right coronary
artery
2. Left coronaryartery
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Cardiophysiology
Conduction system
Cardiac (heart) sounds
Heart rate and Blood pressure Cardiac cycle
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CHARACTERISTICS OF THE
CARDIAC MUSCLE
Inherent abilities of cardiac muscle cells:
AutomaticityConductivity
Excitability
Refractoriness
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The Cardiovascular System
The CONDUCTING SYSTEM OF THEHEART
Consists of the
1. SA node- the pacemaker 2. AV node- slowest conduction
3. Bundle of Hisbranches into the
Right and the Left bundle branch 4. Purkinje fibers- fastest conduction
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LAUGH BREAK
HONEYMOON:
Wife: Hon wag mo ako bibiglain ha?I'm still a virginHusband: You mean ako ang una?Wife: Yes, do it na please!
Husband: I did it na, kanina pa!!Wife: Ah ganon ba? Aray pala, shit!!!
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The Cardiovascular System
Heart rate
Normal range is 60-100 beats per minute
Tachycardia is greater than 100 bpm Bradycardia is less than 60 bpm
Sympathetic system INCREASES HR
Parasympathetic system (Vagus)DECREASES HR
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The Heart: Physiology
The amount of blood the heart pumpsout in each beat is called the STROKEVOLUME
When this volume is multiplied by thenumber of heart beat in a minute (heartrate), it becomes the CARDIACOUTPUT
When the Cardiac Output is multipliedby the Total Peripheral Resistance, itbecomes the BLOOD PRESSURE
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The Cardiovascular System
Blood pressure is:Cardiac output X peripheral
resistance
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Cardiac Output Regulation
The heart pumps approximately 5 L of
blood every minute
The heart rate increases with exercise;
therefore cardiac output increases
The cardiac output will vary according to
the amount of venous return.
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The Cardiovascular System
Blood pressure
Control is neural (central and
peripheral) and hormonal Baroreceptors in the carotid and aorta
Hormones- ADH, Adrenergic hormones,
Aldosterone and ANF
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The Cardiovascular System
Blood pressure Hormones- ADH, Adrenergic hormones,
Aldosterone and ANF
ADH increases water retention
Aldosterone increases sodium retentionand water retention secondarily
Epinephrine and NE increase HR and BP ANF= causes sodium excretion
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LAUGH BREAK
Bakla at Macho nagkasabay sa CR...
Bakla: Ang laki naman nyan sayo...
Macho: Wala na tong silbi kasi iniwanna ako ng GF ko... puputulin ko nalang at ipapakain ko sa aso!
Bakla: aw! aw! aw!
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The Heart: Physiology
The PRELOAD is the degree ofstretching of the heart muscle
when it is filled-up with blood
The AFTERLOAD is the resistance
to which the heart must pump toeject the blood
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Anatomy & PhysiologyTerminologyChronotropic
effect
Dromotropiceffect
Inotropiceffect
Refers to a change in heart rate
A positive chronotropic effect refers to anincrease in heart rate A negative chronotropic effect refers to a
decrease in heart rate
Refers to a change in the speed of conduction
through the AV junction A positive dromotropic effect results in an
increase in AV conduction velocity A negative dromotropic effect results in a
decrease in AV conduction velocity
Refers to a change in myocardial contractility A postive inotropic effect results in an
increase in myocardial contractility A negative inotropic effect results in a
decrease in myocardial contractility
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LAUGH BREAK
PATIENT: Nurse bakit TAE ko may
kasamang plema?
NURSE: Ok lang yan! Mas delikado kung
pag singa mo may kasamang TAE!
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Factors regulating StrokeVolume
1. Degree of stretch of the cardiac musclebefore contraction (Starling s Law);determined by the volume of blood in theventricle at the end of diastole or diastolicfilling.
2. Contactility: ability of the myocardium
to contract; contractility is increased bycirculating catecholamines andmedications like digitalis
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Factors regulating StrokeVolume
3. Preload : the filling of the ventricles atthe end of diastole. The more the
ventricles fill, the more the cardiacmuscles are stretched, and the greater the
force of the contraction during systole
(Starlings Law). If there is a decrease in
contractility and in cardiac output.
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Factors regulating StrokeVolume
4. Afterload: the pressure in the aorta thatthe ventricles must overcome to pump
blood into the systemic circulation.
A decrease in the afterload causes a
decrease in the workload of the ventricles;
this in turn will assist to increase the stroke
volume and the cardiac output
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Factors that increasemyocardial oxygen demands
Increased heart rate
Increased force of contractions
Increased afterload
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Cardiac compensatory
mechanisms When the normal compensatory
mechanisms cannot maintain cardiac
output to meet body needs, the client isin a state ofcardiacdecompensation.
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SUKO SA MISTER:
Misis 1: Suko na ako sa mister ko, lagina lang ako binubugbog bagoniroromansa. ..
Misis 2: Mas grabe yung mister ko.
Binubugbog ako tapos si Inday angniroromansa.
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The Cardiovascular System
The vascular system consists of thearteries, veins and capillaries
The arteries are vessels that carry blood
away from the heart to the periphery The veins are the vessels that carry blood
to the heart
The capillaries are lined with squamouscells, they connect the veins and arteries
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The Cardiovascular System
The lymphatic system also is part of the
vascular system and the function of this
system is to collect the extravasated fluid
from the tissues and returns it to the blood
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Differences Between Blood VesselTypes
Slide 11.26
Walls of arteries are the thickest
Lumens of veins are larger
Skeletal muscle milks blood in veinstoward the heart
Walls of capillaries are only one celllayer thick to allow for exchangesbetween blood and tissue
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Movement of Blood ThroughVessels
Slide 11.27
Most arterial blood is
pumped by the heart Veins use the milking
action of muscles to
help move blood
Figure 11.9
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Tutpik!
Kustomer: Ano ba naman itongtutpik nyo, iisa na nga lang, angdali pang mabali!
Waiter (inis): Alam nyo, sir, ang
dami nang gumamit nyan, perokayo lang nakabali!
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Major Arteries of Systemic Circulation
Slide 11.30
Figure 11.11
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Blood Supply to:
Bone Haversian canal and Volkmann s canal Blood Vessel vasa vasorum Heart coronary arteries Brain common carotid artery external and
internal carotid artery,anterior, middle and posterior cerebral artery(Circle of Willis)
Upper Extremities basillic cephalic brachial radial and ulnar
Lower Extremitiesiliac femoral poplitealsaphenous tibial
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Blood Supply to:
Eyes choroids (between sclera and retina)cornea gets 02 from the atmosphere
Kidneys renal artery interlobar arteryarcuate artery interlobular artery afferentarteriole glomerulus efferent arteriole - vasarecta back to the heart
Liver celiac artery hepatic artery and hepaticportal vein (food laden) - liver sinusoids (mixedblood) hepatic cells extract 02, nutrients anddetoxify toxic substances.
Organs of the GIT celiac trunk Lungs bronchial arteries
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Major Veins of Systemic Circulation
Slide 11.31
Figure 11.12
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Arterial Supply of the Brain
Slide 11.32
Figure 11.13
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Hepatic Portal Circulation
Slide 11.33
Figure 11.14
Circulation to the Fetus
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Circulation to the Fetus
Slide 11.34
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LAUGH BREAK
DALAWANG MADRE NIREREYP:
MADRE 1: Jusko! Patawarin nyo po
sya, di po nya alam ang ginagawanya!
MADRE 2: Sister yung akin
marunong!!!! Whooooo! Yeeaahhh!!!
Bl d P
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Blood Pressure
Measure of force exerted by blood against
the wall
Blood moves through vessels because of
blood pressure
Measured by listening for Korotkoff sounds
produced by turbulent flow in arteries as
pressure released from blood pressurecuff
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Blood Pressure: Effects of Factors
Slide 11.39b
Temperature
Heat has a vasodilation effect
Cold has a vasoconstricting effect
Chemicals
Various substances can cause increases ordecreases
Diet
F t D t i i Bl d P
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Factors Determining Blood Pressure
Slide 11.40
Figure 11.19
P l
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Pulse
Slide 11.35
Pulse pressure waveof blood
Monitored atpressurepoints wherepulse is easilypalpated
Figure 11.16
P l P
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Pulse Pressure
Difference betweensystolic and diastolicpressures
Increases whenstroke volumeincreases or vascularcompliancedecreases
Pulse pressure can
be used to take apulse to determineheart rate andrhythmicity
V i ti i Bl d P
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Variations in Blood Pressure
Slide 11.41
Human normal range is variable
Normal
140110 mm Hg systolic
8075 mm Hg diastolic
Hypotension
Low systolic (below 110 mm HG)
Often associated with illness
HypertensionHigh systolic (above 140 mm HG)
Can be dangerous if it is chronic
Effects of Aging on the
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Effects of Aging on theHeart
Gradual changes in heart function,minor under resting condition, more
significant during exercise
Hypertrophy of left ventricle Maximum heart rate decreases
Increased tendency for valves to
function abnormally and arrhythmias tooccur
Increased oxygen consumption required
to pump same amount of blood
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The Cardiovascular System
CardiacAssessment
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The Cardiovascular System
Cardiac History Interview
Focused assessment
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CARDIAC ASSESSMENT
Health HistoryObtain description of
present illness and the chiefcomplaintChest pain, DOB, Edema,
etc.Assess risk factors
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CARDIAC ASSESSMENT
Physical examinationVital signs- BP, PP,
Inspection of the skin Inspection of the thoraxPalpation of the PMI, pulsesAuscultation of the heart
sounds
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Fig. 13.23
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WHY NURSING?
Do you know why I took up nursing? Itwas in 4th year high school that I saw avision of a great woman bearing a light
in her right hand wearing a long gownand a headress calling me to serveher.
STATUE OF LIBERTY
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STATUE OF LIBERTY
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CARDIAC ASSESSMENT
Laboratory and diagnosticstudies CBC
Cardiac catheterization
Lipid profile
Arteriography
Cardiac enzymes and proteins
CXR
CVP
ECG
Holter monitoring
Exercise ECG
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The Cardiovascular System
Laboratory Test Rationale
1. To assist in diagnosing MI
2. To identify abnormalities
3. To assess inflammation
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The Cardiovascular System
Laboratory Test Rationale
4. To determine baseline value
5. To monitor serum level ofmedications
6. To assess the effects ofmedications
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
CK- MB ( creatine kinase)
Elevates in MI within 4hours, peaks in 18 hoursand then declines till 3days
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
CK- MB ( creatine kinase)
Normal value is 0-7 U/L
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
Lactic Dehydrogenase (LDH)
Elevates in MI in 24 hours,peaks in 48-72 hours
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
Lactic Dehydrogenase (LDH)
Normal value is 70-200 IU/L
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
Myoglobin
Rises within 1-3 hoursPeaks in 4-12 hours
Returns to normal in a day
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Troponin I and TTroponin I is usually utilized for
MI
Elevates within 3-4 hours, peaks
in 4-24 hours and persists for 7
days to 3 weeks!Normal value for Troponin I is
less than 0 6 ng/mL
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LABORATORY PROCEDURES
Troponin I and T
REMEMBER to AVOID IM
injections before obtainingblood sample!
Early and late diagnosis can bemade!
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LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
Myoglobin
Not seen alone in cardiacproblems
Muscular and RENAL disease
can have elevated myoglobin
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LABORATORY PROCEDURES
SERUM LIPIDSLipid profile measures the
serum cholesterol,triglycerides and lipoproteinlevels
Cholesterol=
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LABORATORY PROCEDURES
SERUM LIPIDS
LDL- 130 mg/dL
HDL- 30-70- mg/dL
NPO post midnight(usually 12 hours)
AFTER THE WEDDING
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AFTER THE WEDDING:
Husband: Sinungaling ka, sabi movirgin ka! Bakit kagabi maluwag
na!
Wife: Ulol ka! Dahil lasing ka,katabi mo kagabi si mama!
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
ELECTROCARDIOGRAM(ECG)
A non-invasive procedurethat evaluates the electricalactivity of the heart
Electrodes and wires areattached to the patient
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
ELECTROCARDIOGRAM(ECG)
Tell the patient that there isno risk of electrocution
Avoid muscularcontraction/movement
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Holter MonitoringA non-invasive test in
which the client wears aHolter monitor and an
ECG tracing recordedcontinuously over aperiod of 24 hours
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Stress TestA non-invasive test that
studies the heart duringactivity and detects andevaluates CAD
Exercise test,pharmacologic test andemotional test
The Cardiovascular System
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yLABORATORY PROCEDURES
Stress TestTreadmill testing is the most
commonly used stress testUsed to determine CAD,
Chest pain causes, drugeffects and dysrhythmias inexercise
The Cardiovascular System
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yLABORATORY PROCEDURES
Stress TestPre-test: consent may be
required, adequate rest, eata light meal or fast for 4hours and avoid smoking,alcohol and caffeine
The Cardiovascular System
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yLABORATORY PROCEDURES
Post-test: instruct client tonotify the physician if any
chest pain, dizziness orshortness of breath
Instruct client to avoid takinga hot shower for 10-12 hoursafter the test
The Cardiovascular System
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yLABORATORY PROCEDURES
Pharmacological stress test
Use of dipyridamole
Maximally dilates coronaryartery
Side-effect: flushing of face
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LABORATORY PROCEDURES
Pharmacological stresstest
Pre-test: 4 hours fasting,avoid alcohol, caffeine
Post test: report symptomsof chest pain
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LABORATORY PROCEDURES
CARDIAC catheterization Insertion of a catheter into
the heart and surroundingvessels
Determines the structure and
performance of the heartvalves and surroundingvessels
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
CARDIAC catheterizationUsed to diagnose CAD,
assess coronary arterypatency and determine
extent of atherosclerosis
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LABORATORY PROCEDURES
Pretest: Ensure Consent,assess for allergy to
seafood and iodine, NPO,document weight andheight, baseline VS, bloodtests and document theperipheral pulses
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Pretest: Fast for 8-12hours, teachings,medications to allayanxiety
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LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Post-test: Monitor VS and cardiac rhythm
Monitor peripheral pulses, color andwarmth and sensation of theextremity distal to insertion site
Maintain sandbag to the insertionsite if required to maintain pressure
Monitor for bleeding and hematomaformation
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Maintain strict bed rest for 6-12 hours Client may turn from side to side but
bed should not be elevated more than
30 degrees and legs always straight Encourage fluid intake to flush out the
dye
Immobilize the arm if the antecubitalvein is used
Monitor for dye allergy
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LABORATORY PROCEDURES
CVPThe CVP is the pressure
within the SVCReflects the pressure
under which blood isreturned to the SVC andright atrium
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LABORATORY PROCEDURES
CVPNormal CVP is 0 to 8 mmHg/
4-10 cm H2O
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LABORATORY PROCEDURES
CVPElevated CVP indicates
increase in blood volume,excessive IVF or heart/renalfailure
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LABORATORY PROCEDURES
CVPLow CVP may indicate
hypovolemia, hemorrhageand severe vasodilatation
LABORATORY PROCEDURES
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LABORATORY PROCEDURES
Measuring CVP 1. Position the client supine with
bed elevated at 45 degrees (CBQ)
2. Position the zero point of theCVP line at the level of the rightatrium. Usually this is at the MAL,4th ICS
3. Instruct the client to be relaxedand avoid coughing and straining.
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CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
1. Assess the cardio-pulmonarystatus
VS, BP, Cardiac assessment
2. Enhance cardiac output
Establish IV line to administerfluids
CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
3. Promote gas exchange
Administer O2
Position client in SEMI-Fowler sEncourage coughing and deep
breathing exercises
CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
4. Increase client activity tolerance
Balance rest and activity
periodsAssist in daily activities
Provide strict bed rest if
indicatedSoft foods
Assistance in self-care
CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
5. Promote client comfortAssess the client s description
of pain and chest discomfort
Administer medication asprescribed
Morphine for MINitroglycerine for Angina
Diuretics to relieve congestion
(CHF)
CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
6. Promote adequate sleep7. Prevent infection
Monitor skin integrity of lower
extremitiesAssess skin site for edema,
redness and warmth
Monitor for fever
Change position frequently
CARDIAC IMPLEMENTATION
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CARDIAC IMPLEMENTATION
8. Minimize patient anxiety
Encourage verbalization offeelings, fears and concerns
Answer client questions.
Provide information aboutprocedures and medications
ActivityIntolerance
Monitor TPR and BPSpace activities in the dayPermit rest periods before activityLimit activity 1 hour before meals
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Limit activity 1 hour before mealsTeach energy conservation measures like bed rest
Edema Instruct patient to avoid constricting garmentsInstruct to elevate edematous areasInstruct patient to avoid dependent positionsTeach patient to prepare low sodium meals
Apply anti-embolic stockings
Pain Instruct patient to stop activity when pain occursAdminister nitroglycerine for anginaPace activities within patient s limitsInstruct patient to avoid cold temperatures andsmokingInstruct to report unrelieved pain immediately
CARDIAC DISEASES
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CARDIAC DISEASES
Coronary Artery DiseaseMyocardial Infarction
Congestive Heart FailureInfective Endocarditis
Cardiac TamponadeCardiogenic Shock
VASCULAR DISEASES
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VASCULAR DISEASES
Hypertension
Buerger s disease
Aneurysm
Varicose veins
Deep vein thrombosis
CAD
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CORONARY ARTERY DSEresults from the focal
narrowing of the large andmedium-sized coronaryarteries due to deposition of
atheromatous plaque in thevessel wall
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CAD
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RISK FACTORS
Most important MODIFIABLEfactors:
SmokingHypertension
Diabetes
Cholesterol abnormalities
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CAD
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Pathophysiology
There is decreased perfusion ofmyocardial tissue and inadequatemyocardial oxygen supply
If 50% of the left coronary arteriallumen is reduced or 75% of theother coronary artery, this
becomes significant
CAD
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Pathophysiology Potential for Thrombosis and
embolism
Angina Pectoris
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Angina Pectoris
Chest pain resulting fromcoronary atherosclerosis
or myocardial ischemia
Angina Pectoris: Clinical Syndromes
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THREE COMMON TYPES OF ANGINA
1. STABLE ANGINAThe typical angina that
occurs during exertion,relieved by rest and drugsand the severity does not
change
Angina Pectoris: Clinical Syndromes
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Three Common Types of ANGINA
2. Unstable angina
Occurs unpredictably
during exertion andemotion, severity increases
with timeand pain may notbe relieved by rest and drug
Angina Pectoris: ClinicalSyndromes
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Syndromes
Three Common Types of ANGINA
3. Variant angina
Prinzmetal angina, resultsfrom coronary arteryVASOSPASMS, may occur
at rest
Angina Pectoris
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g
ASSESSMENT FINDINGS1. Chest pain- ANGINA
The most characteristic symptom
PAIN is described as mild tosevere retrosternal pain,
squeezing, tightness or burningsensation
Radiates to the jawand left arm
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Angina Pectoris
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g
ASSESSMENT FINDINGS2. Diaphoresis
3. Nausea and vomiting4. Cold clammy skin
5. Sense of apprehension and
doom6. Dizziness and syncope
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Angina Pectoris
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g
LABORATORY FINDINGS2. Cardiac catheterizationProvides the MOST DEFINITIVE
source of diagnosis by showing thepresence of the atheroscleroticlesions
Angina Pectoris
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g
NURSING DIAGNOSES:Decreased cardiac output
Impaired gas exchange
Activity intolerance
Anxiety
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Angina Pectoris
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2. Teach the patient management ofanginal attacks
Advise patient to stop all activities
Put one nitroglycerin tablet under the
tongue Wait for 5 minutes
If not relieved, take another tablet and wait
for 5 minutes Another tablet can be taken (third tablet)
If unrelieved after THREE tablets seekmedical attention
Angina Pectoris
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3. Obtain a 12-lead ECG
Angina Pectoris
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4. Promote myocardial perfusion Instruct patient to maintain bed rest
Administer O2 @ 3 lpm
Advise to avoid valsalva maneuvers
Provide laxatives or high fiber dietto lessen constipation
Encourage to avoid increasedphysical activities
Angina Pectoris
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5. Assist in possible treatmentmodalities
PTCA- percutaneous transluminalcoronary angioplasty
To compress the plaque against thevessel wall, increasing the arteriallumen
CABG- coronary artery bypass graftTo improve the blood flow to the
myocardial tissue
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Angina Pectoris
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6. Provide information to familymembers to minimize anxietyand promote family
cooperation7. Assist client to identify risk
factors that can be modified
8. Refer patient to properagencies
Myocardial infarction
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Death of myocardialtissue in regions of the
heart with abruptinterruptionof coronary
blood supply
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Myocardial infarction
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ETIOLOGY and Risk factors1. CAD
2. Coronary vasospasm3. Coronary artery occlusion by
embolus and thrombus
4. Conditions that decreaseperfusion- hemorrhage, shock
Myocardial infarction
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Risk factors 1. Hypercholesterolemia
2. Smoking
3. Hypertension
4. Obesity
5. Stress 6. Sedentary lifestyle
Myocardial infarction
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PATHOPHYSIOLOGY Interrupted coronary blood flow
myocardial ischemia anaerobic
myocardial metabolism for severalhours myocardial death depressed cardiac function
triggers autonomic nervoussystem response furtherimbalance of myocardial O2demand and supply
Myocardial infarction
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ASSESSMENT findings1. CHEST PAIN
Chest pain is described assevere, persistent, crushingsubsternal discomfort
Radiates to the neck, arm, jawand back
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Myocardial infarction
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Laboratory findings1. ECG- the ST segment is
ELEVATED, T wave inversion,presence of Q wave
2. Myocardial enzymes-elevated CK-MB, LDH andTroponin levels
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Myocardial infarction
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Laboratory findings3. CBC- may show elevated
WBC count
4. Test after the acute stage-Exercise tolerance test,
thallium scans, cardiaccatheterization
Myocardial infarction
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Pain
Decreased cardiac output
Impaired gas exchangeActivity intolerance
Altered tissue perfusion
Constipation
Myocardial infarction
Nursing Interventions
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Nursing Interventions
1. Provide Oxygen at 2 lpm, Semi-fowler s
2. Administer medications
Morphine to relieve pain
Nitrates, thrombolytics, aspirinand anticoagulants
Stool softener and hypolipidemics
Myocardial infarction
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Nursing Interventions3. Minimize patient anxiety
Provide information as to
procedures and drug therapyAllow verbalization of feelings
Morphine can be administered
Myocardial infarction
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4. Provide adequate rest periods
Bed rest during acute stage
5. Minimize metabolic demandsProvide soft diet
Provide a low-sodium, low
cholesterol and low fat diet
Myocardial infarction
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6. Assist in treatment modalitiessuch as PTCA and CABG
7. Monitor for complications of MI-
especially dysrhythmias, sinceventricular tachycardia can happenin the first few hours after MI
8. Provide client teaching
MI
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Medical Management1. ANALGESIC
The choice is MORPHINE It reduces pain and anxiety
Relaxes bronchioles to enhance
oxygenation
MI
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Medical Management2. ACE inhibitors
Prevents formation ofangiotensin II
Limits the area of infarction
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Myocardial infarction
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NURSING INTERVENTIONS AFTER ACUTEEPISODE
1. Maintain bed rest for the first 3
days 2. Provide passive ROM exercises
3. Progress with dangling of the feetat side of bed
Myocardial infarction
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NURSING INTERVENTIONS AFTERACUTE EPISODE
4. Proceed with sitting out of bed,
on the chair for 30 minutes TID5. Proceed with ambulation in the
room toilet hallway TID
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CARDIOMYOPATHIES
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Heart muscle diseaseassociated with cardiac
dysfunction
CARDIOMYOPATHIES
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1. Dilated Cardiomyopathy2. Hypertrophic
Cardiomyopathy3. Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY
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ASSOCIATED FACTORS1. Heavy alcohol intake
2. Pregnancy3. Viral infection
4. Idiopathic
DILATED CARDIOMYOPATHY
PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
Diminished contractile proteinspoor contraction decreased
blood ejection
increased bloodremaining in the ventricleventricular stretching and
dilatation.SYSTOLIC DYSFUNCTION
HYPERTROPHICCARDIOMYOPATHY
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Associated factors:1. Genetic
2. Idiopathic
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RESTRICTIVECARDIOMYOPATHY
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PathophysiologyRigid ventricular wall
impaired stretch and diastolicfilling decreased output
Diastolic dysfunction
CARDIOMYOPATHIES
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Assessment findings 1. PND
2. Orthopnea
3. Edema
4. Chest pain
5. Palpitations 6. dizziness
7. Syncope with exertion
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CARDIOMYOPATHIES
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Nursing Management1. Improve cardiac output
Adequate restOxygen therapy
Low sodium diet
CARDIOMYOPATHIES
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Nursing Management2. Increase patient tolerance
Schedule activities with restperiods in between
CARDIOMYOPATHIES
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Nursing Management3. Reduce patient anxiety
Support patientOffer information about
transplantations
Support family in anticipatorygrieving
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Infective endocarditis
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Can be acute, sub-acuteor chronic
Infective endocarditis
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Etiologic factors1. Bacteria- Organism
depends on several factors2. Fungi
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Infective endocarditisPathophysiology
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Pathophysiology
Direct invasion of microbes
microbes adhere to damaged valve surface
and proliferate
damage attracts platelets causing clot
formation
erosion of valvular leaflets and the clot and
ve etation can embolize
Infective endocarditis
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Assessment findings1. Intermittent high grade fever
2. anorexia, weight loss3. cough, back pain and joint
pain
4. splinter hemorrhages undernails
Infective endocarditis
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Assessment findings5. Osler s nodes- painful
nodules on fingerpads6. Roth s spots- pale
hemorrhages in the retina
Infective endocarditis
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Assessment findings7. Heart murmurs
8. Heart failure= usuallyacute heart failure
Infective endocarditis
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PreventionAntibiotic prophylaxis if
patient is undergoingprocedures like dentalextractions, bronchoscopy,surgery, etc.
Infective endocarditis
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PreventionAny invasive procedure that is
associated with transientbacteremia may cause themicrorganism to lodge in thedamaged, irregular valves
Infective endocarditis
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LABORATORY EXAMBlood Cultures to determine
the exact organismUsually, 3 culture specimensare obtained and antibioticsensitivity done
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Infective endocarditis
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Medical management2. Surgery
Valvular replacement
CHF
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A syndrome of congestionof both pulmonary andsystemic circulation caused
by inadequate cardiacfunction and inadequate
cardiac output to meet themetabolic demands oftissues
CHF
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Inability of the heart topump sufficiently
The heart is unable tomaintain adequatecirculation to meet the
metabolic needs of thebody
CHF
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This can happen acutely orchronically
Acute in Myocardial infarction
Chronic cardiomyopathies
CHF
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Classified according to themajor ventriculardysfunction:
1. Left Ventricular failure
2. Right ventricular failure
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New York Heart Association
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Class 1Ordinary physical activity does
NOT cause chest pain and
fatigueNo pulmonary congestion
AsymptomaticNO limitation of ADLs
New York Heart Association
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Class 2SLIGHT limitation of ADLs
NO symptom at rest
Symptoms with INCREASEDactivity
Basilar crackles and S3
New York Heart Association
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Class 3Markedly limitation on ADLs
Comfortable at rest BUTsymptoms present in LESS
than ordinary activity
New York Heart Association
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Class 4SYMPTOMS are present at
rest
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CHF
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PATHOPHYSIOLOGYLEFT ventricular failure
Decreased cardiac outputDecreased perfusion to the brain,
kidney and other tissues
Cerebral anoxia, fatigue, oliguria,dizziness
CHF
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PATHOPHYSIOLOGYRIGHT ventricular failure
blood pooling in the venouscirculation
increased hydrostatic pressure
peripheral edema
CHF
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PATHOPHYSIOLOGYRIGHT ventricular failure
Venous blood pooling
venous congestion in the kidney,liver and GIT
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RIGHT SIDED CHFASSESSMENT FINDINGS
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1. Peripheral dependent,pitting edema
2. Weight gain
3. Distended neck vein
4. hepatomegaly
5. Ascites
RIGHT SIDED CHFASSESSMENT FINDINGS
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6. Body weakness 7. Anorexia, nausea 8. Pulsus alternans
9. Nocturia= urination at night atfrequent intervals as the bloodmoves from interstitial space tothe intravascular space and isexcreted
CHF
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LABORATORY FINDINGS1. CXR may reveal
cardiomegaly2. ECG may identify Cardiac
hypertrophy
3. Echocardiogram may showhypokinetic heart
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CHF
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NURSING INTERVENTIONS1. Assess patient's cardio-
pulmonary status2. Assess VS, CVP and
PCWP. Weigh patient daily tomonitor fluid retention
CHF
NURSING INTERVENTIONS
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3. Administer medications-usually cardiac glycosides aregiven- DIGOXIN or DIGITOXIN,Diuretics, vasodilators andhypolipidemics are prescribed
CHFCardiotonics
Positive inotropic
To increase cardiac
contractility
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Positive inotropic
agents
y
Diuretics To decrease the
intravascular volume in thecirculation
Low Sodium Diet To minimize water retention
Hypolipidemics To decrease the lipid levels
of high risk patients
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CHF
NURSING INTERVENTIONS
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Digoxin Health teaching
Withhold the drug if apical
pulse is less than 60Note for early signs of toxicity:
NAVDA
Provide potassiumsupplements
CHF
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NURSING INTERVENTIONS4. Provide a LOW sodium diet.
Limit fluid intake as necessary
5. Provide adequate restperiods to prevent fatigue
CHF
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NURSING INTERVENTIONS6. Position on semi-fowler s to
fowler s for adequate chest
expansion7. Prevent complications of
immobility
CHF
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NURSING INTERVENTION AFTER THEACUTE STAGE
1. Provide opportunities for
verbalization of feelings 2. Instruct the patient about the
medication regimen- digitalis,vasodilators and diuretics
3. Instruct to avoid OTC drugs,Stimulants, smoking and alcohol
CHF
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NURSING INTERVENTION AFTER THEACUTE STAGE
4. Provide a LOW fat and LOW
sodium diet5. Provide potassium
supplements
6. Instruct about fluid restriction
CHF
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NURSING INTERVENTION AFTER THEACUTE STAGE
7. Provide adequate rest periods
and schedule activities8. Monitor daily weight and report
signs of fluid retention
CARDIOGENIC SHOCK
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Heart fails to pumpadequately resulting to adecreased cardiac output
and decreased tissueperfusion
CARDIOGENIC SHOCK
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ETIOLOGY 1. Massive MI
2. Severe CHF
3. Cardiomyopathy 4. Cardiac trauma
5. Cardiac tamponade
CARDIOGENIC SHOCKASSESSMENT FINDINGS
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1. HYPOTENSION 2. Oliguria (less than 30 ml/hour)
3. Tachycardia
4. Narrow pulse pressure 5. weak peripheral pulses
6. cold clammy skin
7. changes in sensorium/LOC 8. pulmonary congestion
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CARDIOGENIC SHOCK
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NURSING INTERVENTIONS 1. Place patient in a modified
Trendelenburg (shock ) position
2. Administer IVF, vasopressors andinotropics such as DOPAMINE and
DOBUTAMINE
CARDIOGENIC SHOCK
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NURSING INTERVENTIONS 3. Administer O2
4. Morphine is administered todecreased pulmonary congestion
and to relieve pain, relieveanxiety
CARDIOGENIC SHOCK
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5. Assist in intubation,mechanical ventilation, PTCA,CABG, insertion of Swan-Ganz
cath and IABP 6. Monitor urinary output, BP and
pulses
7. cautiously administer diureticsand nitrates
CARDIAC TAMPONADE
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A condition where the heartis unable to pump blood
due to accumulation of fluidin the pericardial sac(pericardial effusion)
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CARDIAC TAMPONADE
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This condition restrictsventricular filling resulting todecreased cardiac output
Acute tamponade may happenwhen there is a suddenaccumulation of more than 50
ml fluid in the pericardial sac
CARDIAC TAMPONADE
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ASSESSMENT FINDINGS 1. BECK s Triad- Jugular vein
distention, hypotension and
distant/muffled heart sound
2. Pulsus paradoxus
3. Increased CVP 4. Decreased cardiac output
CARDIAC TAMPONADE
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ASSESSMENT FINDINGS 5. Syncope
6. Anxiety
7. Dyspnea
8. Percussion- Flatness across
the anterior chest
CARDIAC TAMPONADE
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Laboratory FINDINGS1. Echocardiogram= shows
accumulated fluid in thepericardial sac
2. Chest X-ray
CARDIAC TAMPONADE
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NURSING INTERVENTIONS 1. Assist in
PERICARDIOCENTESIS
2. Administer IVF
3. Monitor ECG, urine output and
BP 4. Monitor for recurrence of
tamponade
Pericardiocentesis
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Patient is monitored by ECGMaintain emergency equipments
Elevate head of bed 45-60degrees
Monitor for complications-
coronary artery rupture,dysrhythmias, pleural lacerationand myocardial trauma
General Measures to ImprovePeripheral Circulation
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1. Implement Regular Physical Activity to facilitate movement of venous blood
2. Eliminate cigarette smoking- toprevent vasoconstriction
3. Control hyperlipidemia and cholesterollevels- to prevent the progression ofatherosclerosis
HYPERTENSION
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A systolic BP greater than140 mmHg and a diastolicpressure greater than 90mmHg over a sustainedperiod, based on two or more
BP measurements.
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HYPERTENSION
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PATHOPHYSIOLOGYMulti-factorial etiology
BP= CO (SV X HR) x TPR
Any increase in the aboveparameters will increase BP
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HYPERTENSION
PATHOPHYSIOLOGY
A i i h b
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Any increase in the above parameterswill increase BP
3. Increased activity of the RAAS 4. Increased vasoconstriction of the
peripheral vessels
5. Insulin resistance
HYPERTENSION
ASSESSMENT FINDINGS
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ASSESSMENT FINDINGS1. Headache
2. Visual changes3. chest pain
4. dizziness
5. N/V
HYPERTENSION
DIAGNOSTIC STUDIES
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DIAGNOSTIC STUDIES 1. Health history and PE
2. Routine laboratory- urinalysis,ECG, lipid profile, BUN, serumcreatinine , FBS
3. Other lab- CXR, creatinineclearance, 24-huour urine protein
HYPERTENSION
MEDICAL MANAGEMENT
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MEDICAL MANAGEMENT1. Lifestyle modification
2. Diet therapy3. Drug therapy
HYPERTENSION
MEDICAL MANAGEMENT
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Drug therapy Diuretics Beta blockers Calcium channel blockers ACE inhibitors A2 Receptor blockers
Vasodilators
HYPERTENSION
NURSING INTERVENTIONS
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NURSING INTERVENTIONS1. Provide health teaching topatient
Teach about the diseaseprocess
Elaborate on lifestyle changes
Assist in meal planning to loseweight
HYPERTENSION
NURSING INTERVENTIONS
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1. Provide health teaching to thepatient
Provide list of LOW fat , LOWsodium diet of less than 2-3grams of Na/day
Limit alcohol intake to 30 ml/dayRegular aerobic exerciseAdvise to completely stop
smoking
HYPERTENSION
Nursing Interventions
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2. Provide information about anti-hypertensive drugs
Instruct proper compliance and notabrupt cessation of drugs even if ptbecomes asymptomatic/ improvedcondition
Instruct to avoid over-the-counterdrugs that may interfere with thecurrent medication
HYPERTENSION
N i I t ti
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Nursing Intervention3. Promote Home care management
Instruct regular monitoring of BP
Involve family members in care
Instruct regular follow-up
HYPERTENSION
N i I t ti
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Nursing Intervention4. Manage hypertensive emergency
and urgency properly
ANEURYSM
Dil ti i l i t
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Dilation involving an arteryformed at a weak point inthe vessel wall
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ANEURYSM
RISK FACTORS
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RISK FACTORS1. Atherosclerosis
2. Infection= syphilis
3. Connective tissue disorder
4. Genetic disorder= Marfan s
Syndrome
ANEURYSM
PATHOPHYSIOLOGY
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PATHOPHYSIOLOGYDamage to the intima and media
weakness outpouching of vessel
wall
Dissecting aneurysm tear in the
intima and media with dissectionof blood through the layers
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ANEURYSM
LABORATORY:
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LABORATORY: CT scan
Ultrasound
X-ray
Aortography
ANEURYSM
Medical Management
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Medical Management: Anti-hypertensives
Synthetic graft
ANEURYSM
Nursing Management:
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Nursing Management: Administer medications
Emphasize the need to avoid
increased abdominal pressure No deep abdominal palpation
Remind patient the need for serialultrasound to detect diameterchanges
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Refers to arterial insufficiency of
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Refers to arterial insufficiency ofthe extremities usuallysecondary to peripheral
atherosclerosis.Usually found in males age 50
and above
The legs are most often affected
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ARTERIOSCLEROSIS
OF THE EXTREMITIES
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OF THE EXTREMITIES
Arteriosclerosis of the extremities is a disease of the peripheral blood vesselsthat is characterized by narrowing and hardening of the arteries that supply the
legs and feet. The narrowing of the arteries causes a decrease in blood flow.
Symptoms include leg pain, numbness, cold legs or feet and muscle pain in the
thighs, calves or feet.
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
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Risk factors for Peripheral Arterialocclusive disease
Non-Modifiable
1. Age
2. gender
3. family predisposition
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Risk factors for Peripheral Arterialocclusive disease
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occlusive disease
Modifiable
1. Smoking
2. HPN
3. Obesity
4. Sedentary lifestyle 5. DM
6. Stress
WALANGORIGINA-LITY!HHMMPP!
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HHMMPP!
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
ASSESSMENT FINDINGS
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ASSESSMENT FINDINGS 1. INTERMITTENT
CLAUDICATION-the hallmark of
PAOD This is PAIN described as
aching, cramping or fatiguing
discomfort consistentlyreproduced with the same degreeof exercise or activity
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
ASSESSMENT FINDINGS
1 INTERMITTENT
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1. INTERMITTENTCLAUDICATION-the hallmark of
PAODThis pain is RELIEVED by REST
This commonly affects the
muscle group below the arterialocclusion
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Assessment Findings
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Assessment Findings2. Progressive pain on the
extremity as the disease
advances
3. Sensation of cold andnumbness of the extremities
ARTERIOSCLEROSIS OF THE EXTREMITIES
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PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Assessment FindingsS
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Assessment Findings 4. Skin is pale when elevated
and cyanotic and ruddy when
placed on a dependent position
5. Muscle atrophy, leg ulceration
and gangrene
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PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Diagnostic Findings
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Diagnostic Findings1. Unequal pulses between the
extremities
2. Duplex ultrasonography
3. Doppler flow studies
PAODMedical Management
1 Drug therapy
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1. Drug therapy Pentoxyfylline (Trental) reduces
blood viscosity and improves
supply of O2 blood to muscles Cilostazol (Pletaal) inhibits platelet
aggregation and increases
vasodilatation2. Surgery- Bypass graft and
anastomoses
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Nursing Interventions
1 Maintain Circulation to the extremity
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1. Maintain Circulation to the extremity
Evaluate regularly peripheral pulses,temperature, sensation, motor functionand capillary refill time
Administer post-operative care to patientwho underwent surgery
Administer heat modalities to the legcautiously to promote vasodilatation
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Nursing Interventions
2 M it d
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2. Monitor and managecomplications
Note for bleeding, hematoma, anddecreased urine output
Elevate the legs to diminish edema
Encourage exercise of the extremitywhile on bed
Teach patient to avoid leg-crossing
PERIPHERAL ARTERIALOCCLUSIVE DISEASE
Nursing Interventions
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Nursing Interventions3. Promote Home management
Encourage lifestyle changes Instruct to AVOID smoking
Instruct to avoid leg crossing
BUERGER S DISEASE
Thromboangiitis obliterans
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Thromboangiitis obliteransA disease characterized by
recurring inflammation of the
medium and small arteries andveinsof the lower extremities
BUERGER S DISEASE
Thromboangiitis obliterans
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Thromboangiitis obliteransOccurs in MEN ages 20-35
RISK FACTOR: SMOKING!
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BUERGER S DISEASE
ASSESSMENT FINDINGS
1 Leg PAIN
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1. Leg PAIN
Foot cramps in the arch
(INSTEP CLAUDICATION) afterexercise
Relieved by rest
Aggravated by smoking, emotionaldisturbance and cold chilling
BUERGER S DISEASE
ASSESSMENT FINDINGS
2 Digit l t i t h g d b
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2. Digital rest pain not changed byactivity or rest
BUERGER S DISEASE
ASSESSMENT FINDINGS3 I RUBOR ( ddi h bl
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ASSESSMENT FINDINGS 3. Intense RUBOR(reddish-blue
discoloration), progresses to
CYANOSIS as disease advances
4. Paresthesias
BUERGER S DISEASE
Diagnostic Studies
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Diagnostic Studies1. Duplex ultrasonography
2. Contrast angiography
BUERGER S DISEASE
Nursing Interventions
1 Assist in the medical and s rgical
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1. Assist in the medical and surgicalmanagement
Bypass graft amputation
2. Strongly advise to AVOID smoking
3. Manage complicationsappropriately
BUERGER S DISEASE
Nursing Interventions
Post-operative care: after amputation
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Post-operative care: after amputation
Elevate stump for the FIRST 24 HOURSto minimize edema and promote venous
return Place patient on PRONE position after 24
hours several times a day
Assess skin for bleeding and hematoma Wrap the extremity with elastic bandage
RAYNAUD S DISEASE
A form of intermittent arteriolarVASOCONSTRICTION that results in
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VASOCONSTRICTION that results incoldness, pain and pallor of thefingertips or toes
RAYNAUD S DISEASE
Cause : UNKNOWN
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Cause : UNKNOWN
Most commonly affects WOMEN,
16- 40 years old
RAYNAUD S DISEASE
ASSESSMENT FINDINGS1 R d h
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ASSESSMENT FINDINGS1. Raynaud s phenomenon
A localized episode of
vasoconstriction of the smallarteries of the hands and feetthat causes color andtemperature changes
RAYNAUD S DISEASE
W-B-R is the acronym for the colorchange
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W B R is the acronym for the colorchange
Pallor- due to vasoconstriction,
then Blue- due to pooling of
Deoxygenated blood
Red- due to exaggerated reflow orhyperemia
RAYNAUD S DISEASE
ASSESSMENT FINDINGS2 Tingling sensation
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ASSESSMENT FINDINGS2. Tingling sensation
3. Burning pain on the hands and
feet
RAYNAUD S DISEASE
Medical management
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Medical managementDrug therapy with the use of
CALCIUM channel blockers
To prevent vasospasms
RAYNAUD S DISEASE
Nursing Interventions
1. instruct patient to avoid situations thatb f l
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pmay be stressful
2. instruct to avoid exposure to cold and
remain indoors when the climate is cold 3. instruct to avoid all kinds of nicotine
4. instruct about safety. Careful handling
of sharp objects
LAUGH BREAK
Bisaya 1: " Gara ng kutsi, siguro kay Miyur
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y g , g y y
iyan."!
Bisaya 2: " Dili bay!"
Bisaya 1: " Kay Hipi?"Bisaya 2: " Tuntu ka man. Kay
FATHER iyan. Gisulat niya sa
likud o,"'SAFARI'."
VARICOSE VEINS
THESE are dilated veinsll i h l
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THESE are dilated veinsusually in the lower
extremities
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VARICOSE VEINS
Predisposing FactorsPregnancy
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PregnancyProlonged standing or
sittingIncompetent venous valves
VARICOSE VEINS
Pathophysiology
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PathophysiologyFactors venous
stasis increasedhydrostatic pressure edema
VARICOSE VEINS
Assessment findings
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Assessment findingsTortuous superficial veins
on the legsLeg pain and Heaviness
Dependent edema
VARICOSE VEINS
Laboratory findings
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Laboratory findingsVenography
Duplex scanpletysmography
VARICOSE VEINS
Medical management
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Medical managementPharmacological therapy
Leg vein stripping andligation
Anti-embolic stockings
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VARICOSE VEINS
Nursing management1 Advise patient to elevate
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Nursing management1. Advise patient to elevate
the legs with pillow to
increase venous return2. Caution patient to avoid
prolonged standing orsitting
VARICOSE VEINS
Nursing management3 P id hi h fib f d
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Nursing management3. Provide high-fiber foods
to prevent constipation4. Teach simple exercise to
promote venous return
VARICOSE VEINS
Nursing management
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Nursing management5. Caution patient to
avoid constrictiveclothing
VARICOSE VEINS
Nursing management6 A l ti b li
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Nursing management6. Apply anti-embolic
stockings as directed7. Avoid massage on theaffected area
DVT- Deep Vein Thrombosis
Inflammation of the deepveins of the lower
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a at o o t e deepveins of the lowerextremities and the pelvicveins
The inflammation results to
formation of blood clots inthe area
DVT- Deep Vein Thrombosis
Predisposing factorsProlonged immobility
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g y
Varicosities
Traumatic procedures
Increased age
Malignancy
Estrogen therapySmoking
DVT- Deep Vein Thrombosis
Complication
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ComplicationPULMONARY
thromboembolism
DVT- Deep Vein Thrombosis
Assessment findings
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Assessment findingsLeg tenderness
Leg pain and edemaPositive HOMAN s SIGN
DVT- Deep Vein Thrombosis
HOMAN s SIGNTh f t i FLEXED d
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HOMAN s SIGN The foot is FLEXED upward
(dorsiflexed) , there is a sharp pain
felt in the calf of the leg indicative of venous inflammation
DVT- Deep Vein Thrombosis
Laboratory findings
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Laboratory findingsVenography
Duplex scan
DVT- Deep Vein Thrombosis
Medical managementA i l l i i
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ed ca a age e tAntiplatelets- aspirin
AnticoagulantsVein stripping and
graftingAnti-embolic stockings
DVT- Deep Vein Thrombosis
Nursing management1 Provide measures to avoid
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g g1. Provide measures to avoid
prolonged immobility
Repositioning Q2
Provide passive ROMEarly ambulation
DVT- Deep Vein Thrombosis
Nursing management2 Provide skin care to
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g g2. Provide skin care toprevent the complication of
leg ulcers
3. Provide anti-embolicstockings
DVT- Deep Vein Thrombosis
Nursing management
4. Administer anticoagulants as
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4. Administer anticoagulants asprescribed
5. Monitor for signs ofpulmonary embolism sudden respiratory distress
The End
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The End
Thank You!