A. Cardiovascular

8/9/2019 A. Cardiovascular

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a. atrioventricular valves: prevent backflo from ventricles to atria during systole

i. tricuspid - right heart valve

ii. mitral - left heart valve #bicuspid$

b. semilunar valves prevent backflo from aorta and pulmonary arteries into ventricles during diastole

i. pulmonic

ii. aortic

c. %lood supply to heart

i. arteries

Cardiovascular: Arteries of the Heart

a. right coronary artery supplies right ventricle and part of left ventricle

b. left coronary artery supplies mostly left ventricle

ii. veins

a. coronary sinus veins

b. thebesian veins

d. Conduction system


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i. &A #sinoatrial$ node - referred to as the 'pacemaker' of the heart

ii. (unctional tissue - often referred to as the atrioventricular node #A) node$

iii. bundle branch Purkin(e system

Physiology

1. *unction of the heart is the transport of o+ygen! carbon dio+ide! nutrients and aste products

2. Cardiac cycle - atria and ventricles ork in an asynchronous manner

a. systole - phase of contraction during hich the ventricles e(ect blood

b. diastole - the phase of rela+ation during hich the chambers fill ith blood, hen the heart pumps!myocardial layer contracts and rela+es

. %lood flo

a. deo+ygenated blood enters the right atrium through the superior and inferior vena cava

b. enters the right ventricle via the tricuspid valve

c. travels through the pulmonic valve to pulmonary arteries and lungs

d. o+ygenated blood returns from lungs through the pulmonary veins into left atrium and enters the leftventricle via bicuspid #mitral$ valve

e. finally! the blood! from the left ventricle! goes through the aortic valve into the aorta and into thesystemic circulation


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. /he vascular system is a continuous netork of blood vessels.

a. the arterial system consists of arteries! arterioles and capillaries and delivers o+ygenated blood totissues

b. o+ygen! nutrients and metabolic aste are e+changed at the microscopic level

c. the venous system! veins and venules! returns the blood to the heart

0. /he heart itself is supplied ith blood by the left and right coronary arteries


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"eart nfections

A. Pericarditis

1. efinition and related terms: inflammation of the pericardial sac

a. due to a bacterial or fungal infection! collagen disease! e.g.! systemic lupus erythematosus#&L3$! or as a complication of an acute myocardial infarction

b. there may or may not be pericardial effusion or constrictive pericarditis

c. ressler4s syndrome #also called post myocardial infarction syndrome$

i. a combination of pericarditis! pericardial effusion and constrictive pericarditis,etiology is unclear

ii. occurs several eeks to months after a myocardial infarction

%. 3pidemiology

1. may be acute or chronic and may occur at any age

2. pericarditis occurs in up to 105 of persons ith a transmural infarction

C. *indings

1. sharp chest pain often relieved by leaning forard

2. pericardial friction rub

Listen

. dyspnea

. fever! seating! chills

0. dysrhythmias

6. pulsus parado+us

7. client cannot lie flat ithout pain or dyspnea

. iagnostics

1. history and physical e+am

2. serum studies

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a. increased

i. hite blood cells

ii. sedimentation rate

b. positive

i. blood cultures

ii. antinuclear antibody #A8A$ if due to connective tissue disease

. 39 changes on 12-lead

. echocardiography - to determine pericardial effusion or cardiac tamponade! may sho pleuralthickening

3. ;anagement

1. pharmacological

a. antibiotics to treat underlying infection

b. corticosteroids usually reserved for clients ith pericarditis due to &L3! or clients ho do notrespond to 8&As

c. 8&A& or aspirin for pain! inflammation! and fever control

d. avoid anticoagulants - may increase the possibility of cardiac tamponade from bleeding risk

2. o+ygen: to prevent tissue hypo+ia

. surgical

a. emergency pericardiocentesis if cardiac tamponade develops

b. for recurrent constrictive pericarditis! partial pericardiectomy #pericardial indo$ or totalpericardiectomy

*. 8ursing interventions

1. manage pain and an+iety

2. semi-*oler4s or high-*oler4s position

. the cardio-care si+

. maintain a pericardiocentesis set at the bedside in case of cardiac tamponade

0. observe for pericarditis complications

a. dysrhythmias

b. cardiac tamponade

c. heart failure

6. assess respiratory! cardiovascular! and renal status often

7. rotate ) sites often and observe for findings of infiltration or inflammation at the venipuncture site#possible complication of long-term ) administration$


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a. viral infection

b. bacterial infection

c. fungal infection

d. serum sickness

e. rheumatic fever

f. chemical agent

g. complication of a collagen disease! e.g.! &L3

2. 3pidemiology

a. may be acute or chronic and may occur at any age

b. usually an acute virus and self-limited! but it may lead to acute heart failure

. *indings

a. depends on the type of infection! degree of myocardial damage! capacity of myocardium to recover!and host resistance

b. may be minor or unnoticed! i.e.! fatigue and dyspnea! palpitations! occasional precordial discomfortmanifested as a mild chest soreness and persistent fever

c. recent upper-respiratory infection ith fever! viral pharyngitis! or tonsillitis

d. cardiac enlargement

e. abnormal heart sounds: murmur! & or gallop or friction rub

Listen

f. possible findings of congestive heart failure such as pulsus alternans! dyspnea! and crackles

g. tachycardia disproportionate to the degree of fever

. iagnostic studies

a. 39 for changes and arrhythmias

b. labs

i. increases erythrocyte sedimentation rate #3&=$

ii. increases myocardial en>ymes such as:

• aspartate aminotransferase #A&/$

• creatine kinase #C9$

• lactic dehydrogenase #L"$

c. endomyocardial biopsy #3;%$

d. myocardial imaging

0. ;anagement

a. pharmacological

i. antibiotics to treat underlying infection

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ii. corticosteroids to decrease inflammation

iii. analgesics for pain

b. o+ygen to prevent tissue hypo+ia

6. 8ursing interventions and assessments

a. the cardio-care si+ ith modified bedrest and less help ith ALs

b. assess for edema! eigh daily, record intake and output

c. assess cardiovascular status fre?uently

d. observe for findings of left-sided heart failure! e.g.! dyspnea! hypotension and tachycardia

e. check often for changes in cardiac rhythm or conduction, auscultate heart sounds

f. evaluate arterial blood gas levels as needed to ensure ade?uate o+ygenation

g. client and family teaching

i. physical activity may be sloly increased to sitting in chair! alking in room! then outdoors

ii. avoid pregnancy! alcohol! and competitive sports

iii. immuni>e against infections

iv. teach client about anti-infective drugs, stress importance of taking drugs as ordered

v. teach clients taking digitalis at home to

• check pulse for one full minute before taking the dose! and ithhold the drug if heart

rate falls belo 6@ beatsminute

• monitor for findings of digitalis to+icity! e.g.! anore+ia! nausea! vomiting! blurred

vision! cardiac arrhythmias

vi. teach client to report rapidly beating heart

Endocarditis

1. efinition - inflammation of the endocardium, can involve any portion of the endocardial lining

a. usually infectious

b. usually affects the valves

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2. nfection can lead to vegetation or abscess formation ith resultant thrombus or embolus

. 3ndocarditis can be classified as

a. native valve endocarditis

b. endocarditis in ) drug users

c. prosthetic valve endocarditis

. 3pidemiology

a. ith proper treatment! ma(ority of clients recover

b. the prognosis is orse hen endocarditis damages valves severely or involves a prosthetic valve

c. infective endocarditis occurs in many clients ith previous valvular disorders

d. systemic lupus erythematosus #&L3$ often leads to nonbacterial endocarditis

e. in some clients ith subacute endocarditis! lesions produce clots that sho the findings of splenic!renal! cerebral or pulmonary infarction! or peripheral vascular occlusion

0. *indings of endocarditis

a. cardiac murmurs in great ma(ority of persons ith infective endocarditis

b. fever

c. especially! a murmur that changes suddenly! or a ne murmur that develops in the presence of afever

d. pericardial friction rub

e. anore+ia! abdominal pain

f. malaise

g. clubbing of fingers

h. neurologic se?uelae of embolus

i. petechiae of the skin #especially on the chest$

(. splinter hemorrhage under the nails

k. infarction of spleen: pain in the upper left ?uadrant! radiating to the left shoulder! and abdominalrigidity

l. infarction in kidney: hematuria! pyuria! flank pain! and decreased urine output

m. infarction in brain: hemiparesis! aphasia! and other neurologic deficits

n. infarction in lung: cough! pleuritic pain! pleural friction rub! dyspnea and hemoptysis

o. peripheral vascular occlusion: numbness and tingling in an arm! leg! finger! or toe! or signs ofimpending peripheral gangrene

6. iagnostics

a. health history

b. laboratory data

1. C%C - elevated B%C

2. blood cultures - positive for microbe

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. erythrocyte sedimentation rate #3&=$ - elevated

c. chest +-ray to detect heart failure or cardiomegaly

d. transesophageal echocardiogram to detect vegetation and abscesses on valves

e. 39 to detect dysrhythmias

7. ;anagement - clients at risk for prosthetic valves

a. pharmacological

1. antibiotics - to treat underlying infection #used prophylactically to prevent endocarditis! mitralvalve prolapse$

2. antipyretics - to control fever

. anticoagulants - to prevent emboli>ation

b. o+ygen - to prevent tissue hypo+ia

c. surgical - possible valve replacement

ation! or guided imagery$ to cope ithstress! pain! or insomnia

0. e+plain endocarditis and the need for long-term therapy

6. may need prophylactic antibiotics before dental ork and other invasive procedures

7. teach client to report fever! tachycardia! dyspnea and shortness of breath

Rheumatic heart disease (rheumatic endocarditis)

1. efinition and related terms

a. rheumatic heart disease: damage to the heart by one or more episodes of rheumatic fever, pathogenis group A streptococcus

b. rheumatic endocarditis: damage to the heart! particularly the valves! resulting in valve leakage

#regurgitation$ andor stenosis, to compensate! the heart4s chambers enlarge and alls thicken

2. 3pidemiology

a. fairly rare in developed countries, more common in developing countries

i. more common here malnutrition and croded living are common! in children beteen ages0 and 10 years-old

ii. strikes most often during cool! damp eather

b. could be prevented by finding and treating streptococcal pharyngitis

c. it is unknon ho and hy group A streptococcal infections cause the lesions called Aschoff bodies

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i. damage depends on site of infection, most often the mitral valve in females and the aorticvalve in males

ii. malfunction of these valves leads to severe pericarditis! and sometimes pericardial effusionand fatal heart failure, about 2@5 die ithin ten years

. *indings

a. streptococcal pharyngitis

i. sudden sore throat

ii. throat reddened ith e+udate

iii. sollen! tender lymph nodes at angle of (a

iv. headache and fever to 1@ degrees *ahrenheit

b. polyarthritis manifested by arm and sollen (oints

c. carditis

d. chorea

e. erythema marginatum #avy! thin red-line rash on trunk and e+tremities$

f. subcutaneous nodules

g. fever to 1@ degrees *ahrenheit

h. heart murmurs pericardial friction rub and pericardial rub

Listen

i. no lab test confirms rheumatic fever! but some support the diagnosis

. iagnostics

a. antistreptolysin #A&$ titer - increased

b. 3&= - increased

c. throat culture - positive for streptococci

d. B%C count - increased

e. =%C parameters - normocytic! normochromic anemia

f. C-reactive protein #C=P$ - positive for streptococci

0. ;anagement

a. pharmacological

i. provide analgesics - for paininflammation

ii. o+ygen to prevent tissue hypo+ia

iii. give antibiotics steadily to maintain level in blood

b. surgical - commissurotomy! valvuloplasty! prosthetic heart valve

8ursing interventions

a. the cardio-care si+

b. help the client ith chorea to grasp ob(ects, prevent falls

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c. encourage family and friends to spend time ith client and fight boredom during the long! tediousconvalescence

d. client and family teaching

i. e+plain all tests and treatments

ii. nutrition

iii. hygienic practices

iv. to resume ALs sloly and schedule rest periods

v. to report penicillin reaction! e.g.! rash! fever! chills

vi. to report findings of streptococcal infection

• sudden sore throat

• diffuse throat redness and oropharyngeal e+udate

• sollen and tender cervical lymph glands

• pain on salloing

• temperature of 1@1 to 1@ degrees *ahrenheit

• headache

• nausea

vii. keep client aay from people ith respiratory infections

viii. e+plain necessity of long-term antibiotics

i+. arrange for a visiting nurse if necessary

+. help the family and client cope ith temporary chorea

)alve isorders

A. Mitral stenosis

1. efinition: mitral valve thickens and gets narroer! blocking blood flo from the left atrium to leftventricle

2. 3pidemiology


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a. of clients ith mitral stenosis! 2 are female

b. most cases of mitral stenosis are caused by rheumatic fever

%. *indings

1. mild - no findings

2. moderate to severe

a. dyspnea on e+ertion

b. paro+ysmal nocturnal dyspnea

c. orthopnea

d. eakness! fatigue! and palpitations

. peripheral and facial cyanosis in severe cases

. (ugular vein distention

0. ith severe pulmonary hypertension or tricuspid stenosis - ascites

6. edema

7. hepatomegaly

ation

0. chest +-ray

. ;anagement

1. antiarrhythmics if needed

2. if medication fails! atrial fibrillation is treated ith cardioversion

. lo-sodium diet - to prevent fluid retention

. o+ygen if needed - to prevent hypo+ia

0. surgery - mitral commissurotomy or valvotomy

6. medications used in severe cases

a. vasodilators #nitroprusside! nitrogylcerin$

b. positive inotropes #dobutamine! dopamine! digo+in$

c. aminophylline #decrease bronchospasm$

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3. 8ursing interventions and assessment

1. the cardio-care si+

2. observe closely for findings of heart failure! pulmonary edema! and reactions to drug therapy

. if client has had surgery! atch for hypotension! arrhythmias! and thrombus formation

. monitor the cardio seven

0. client and family teaching

a. e+plain the need for long-term antibiotic therapy and the need for additional antibiotics beforedental care

b. report early findings of heart failure such as dyspnea or a hacking! nonproductive cough

Mitral insufficiency (or regurgitation)

1. efinition and related terms

a. a damaged mitral valve allos blood from the left ventricle to flo back into the left atrium duringsystole

b. to handle the back flo! the atrium enlarges, the left ventricle also enlarges! in part to make up for itsloer output of blood

2. 3pidemiology

a. follos birth defects such as transposition of the great arteries

b. in older clients! the mitral annulus may have become calcified

c. cause unknon, may be linked to a degenerative process

d. occurs in 0 to 1@5 of adults

. *indings

a. client may be asymptomatic

b. orthopnea! dyspnea! fatigue! eakness! eight loss

c. chest pain and palpitations

d. (ugular vein distention

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.html


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e. peripheral edema

f. hepatomegaly

. iagnostics

a. 39 for arrhythmias and changes of left atrial enlargement

b. echocardiogram - to visuali>e regurgitant (ets and flail chordaeleaflets

c. cardiac catheteri>ation shos regurgitation of blood from left ventricle to left atrium

d. chest +-ray shos cardiomegaly! pulmonary congestion

0. ;anagement

a. lo-sodium diet - to prevent fluid retention

b. o+ygen as needed - to prevent tissue hypo+ia

c. antibiotics - to treat infection #prophylactic antibiotics - to prevent infection$

d. surgery - mitral valvuloplasty or valve replacement



b. monitor the cardio seven

c. monitor for left-sided heart failure! pulmonary edema! adverse reactions to drug therapy! and cardiacdysrhythmias #especially atrial and ventricular fibrillation$

d. if client has surgery! monitor postoperatively for hypotension! arrhythmias and thrombus formation

e. client and family teaching

1. diet restrictions and drugs

2. e+plain tests and treatments

. prepare client for long-term antibiotic and follo-up care

. stress the need for prophylactic antibiotics during dental care

0. teach client and family to report findings of heart failure! i.e.! dyspnea and hacking!nonproductive cough

Tricuspid stenosis

1. efinition: narroing of the tricuspid valve beteen right atrium and right ventricle

2. 3pidemiology

a. relatively uncommon

b. usually associated ith lesions of other valves

c. caused by rheumatic fever

. *indings

a. dyspnea! fatigue! eakness! syncope

b. peripheral edema

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.html


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c. (aundice ith severe peripheral edema and ascites can mean that tricuspid stenosis has led to rightventricular failure

d. may appear malnourished

e. distended (ugular vein

. iagnostics

a. 39 - for arrhythmias

b. echocardiogram - right ventricular dilation and parado+ical septal motion

0. ;anagement: surgery - valvulotomy or valve replacement, valvuloplasty




c. monitor for findings of heart failure! pulmonary edema! and adverse reactions to the drug therapy

d. post valve surgery! monitor client for hypotension! arrhythmias and thrombus formation

e. hen client sits! elevate legs to prevent dependent edema

f. client and family teaching

i. teach the cardio five

ii. client must comply ith long-term antibiotic and follo up care

iii. emphasi>e the need for prophylactic antibiotics during dental care

Tricuspid insufficiency (regurgitation)

1. efinition - tricuspid valve lets blood leak from the right ventricle back into the right atrium

2. 3pidemiology

a. results from dilation of the right ventricle and tricuspid valve ring

b. most common in late stages of heart failure from rheumatic or congenital heart disease

. *indings

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.html


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a. dyspnea! fatigue! eakness and syncope

b. peripheral edema may cause discomfort

. iagnostics - echocardiogram for abnormal valve movement

0. ;anagement: surgical - valve replacement





d. post-op monitor client for hypotension! arrhythmias and thrombus formation

e. hen sitting! client should raise legs to prevent dependent edema

f. client and family teaching

i. the cardio five

ii. emphasi>e the need for prophylactic antibiotics during dental care

iii. instruct client to raise legs hen sitting - to prevent dependent edema

Pulmonic stenosis

1. efinition - obstructed right ventricular outflo resulting in right ventricular hypertrophy

2. 3pidemiology

a. usually congenital! often ith other birth defects such as /etralogy of *allot

b. rare among the elderly

c. may result from rheumatic fever

. *indings

a. dyspnea! fatigue! chest pain and syncope


http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.html


18/50

. iagnostics - echocardiogram for abnormal valve or blood movement

0. ;anagement: surgical - replace the valve via balloon and cardiac catheter

6. 8ursing interventions

a. same as tricuspid stenosis and tricuspid insufficiency

b. monitor for findings of heart failure! pulmonary edema! and adverse reactions to to the drug therapy

c. post-op: monitor client for hypotension! dysrhythmias and thrombus formation

d. monitor the cardio seven

e. client and family teaching - same as tricuspid stenosis and tricuspid insufficiency

Pulmonic insufficiency (regurgitation)

1. efinition - pulmonary valve fails to close! so that blood flos back into the right ventricle

2. 3pidemiology

a. a birth defect! or a result of pulmonary hypertension

b. rarely! result of prolonged use of a pressure-monitoring catheter in the pulmonary artery

. *indings

a. dyspnea! fatigue! chest pain and syncope


c. if advanced: (aundice ith ascites and peripheral edema

d. possible malnourished appearance

. iagnostics - echocardiogram for abnormal blood or valve movement

0. ;anagement

a. pharmacological

i. diuretics - to mobili>e edematous fluid to reduce pulmonary venous pressure

ii. anticoagulants - to prevent blood clots

iii. digitalis - to increase the force or strength of cardiac contractions #inotropic action$

b. sodium-restricted diet - to control underlying heart disease

c. surgery for severe cases: valvulotomy or valve replacement




c. monitor for findings of heart failure! pulmonary edema! and adverse reactions to drug therapy

d. post-op: monitor client for hypotension! arrhythmias and thrombus formation

e. provide rest periods

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.html


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f. hen client sits! elevate legs

g. client and family teaching - same as tricuspid stenosis! tricuspid insufficiency! and pulmonic stenosis

i. the cardio five teaching plan

ii. client4s dentist must give client prophylactic antibiotics to prevent infection

iii. instruct client to raise legs hen sitting to prevent dependent edema

Aortic stenosis

1. efinition - aortic valve stiffens to narro opening

2. 3pidemiology

a. most significant valvular lesion seen among elderly people. t usually leads to left-sided heart failure

b. incidence increases ith age

c. occurs in 15 of the population

d. about


20/50

2. digitalis - to increase the force or strength of cardiac contractions #inotropic action$

. diuretics - to mobili>e edematous fluid and to reduce pulmonary venous pressure

b. lo-sodium diet - to prevent fluid retention

c. o+ygen - to prevent hypo+ia

d. surgery - percutaneous balloon valvuloplasty! then valve replacement





d. post-op: monitor client for hypotension! arrhythmias and clots

e. hen client sits! elevate legs to prevent dependent edema

f. client and family teaching: #same as tricuspid stenosis! tricuspid insufficiency! pulmonic stenosis andpulmonic insufficiency$

1. the cardio five teaching plan

2. client4s dentist must administer prophylactic antibiotics

. client should elevate legs hen sitting

Aortic insufficiency (regurgitation)

1. efinition

a. blood flos back into the left ventricle during diastole overloading the ventricle and causing it tohypertrophy.

b. e+tra blood also overloads the left atrium and! eventually! the pulmonary system.

2. 3pidemiology

a. by itself! most common among males

b. ith mitral valve disease! more common among females

c. may accompany marfan4s syndrome! ankylosing spondylitis! syphilis! essential hypertension or adefect of the ventricular septum

. *indings

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.html


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a. uncomfortable aareness of heartbeat

b. palpitations along ith a pounding head

c. dyspnea ith e+ertion

d. paro+ysmal nocturnal dyspnea! ith diaphoresis! orthopnea and cough

e. fatigue and syncope ith e+ertion or emotion

f. anginal chest pain unrelieved by sublingual nitroglycerin

g. heartbeat that seems to (ar the client4s entire body

h. client4s nail beds appear to be pulsating

i. if nail tip is pressed! the root ill flush and then pale #Euincke4s sign$

(. if left ventricle fails! client may sho ankle edema and ascites

k. pulsus bisferiens: a double-beat pulse #palpated over the carotid or brachial arteries$

. iagnostics

a. chest +-ray

b. echocardiogram

c. cardiac catheri>ation

0. ;anagement

a. pharmacological

1. digitalis - increases the heart4s contractility #inotropic action$

2. diuretics - to mobili>e edematous fluids and to reduce pulmonary venous pressure

. anticoagulant agents - to prevent blood clots

. AC3 inhibitors - decrease cardiac orkload and assist to increase o+ygenation

b. sodium-restricted diet - to prevent fluid retention

c. surgical - valve replacement! hoever! aortic insufficiency often damages the ventricle before it isdetected

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a643cf27a86a7387.html


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a. same as all other valve disorders - the cardio-care si+ e+cept don4t need to elevate head unless

pulmonary problems have begun


c. monitor for signs of heart failure! pulmonary edema! and drug reactions

d. post-op: monitor client for hypotension! arrhythmias and clots

e. client and family teaching

1. same as all other valve disorders - the cardio five teaching plan

2. emphasi>e the need for prophylactic antibiotics during dental care

. instruct client to raise legs hen sitting

*ailures of the "eart ;uscle

A. Myocardial infarction (MI)

1. efinition - insufficient o+ygen supply kills #causes necrosis of$ myocardial tissue, may be sudden orgradual and total event may take to 6 hours

2. 3pidemiology

a. almost e?ual for men and omen

b. client history of smoking! obesity! high cholesterollo density lipoprotein diet!physicalemotional stress

c. a common killer in 8orth America and Bestern 3urope

d. mortality

i. mortality about 205, of the sudden deaths from ;! more than half happen ithin anhour

ii. of those ho survive the initial ; and recover! up to 1@5 die ithin the first year

iii. factors affecting mortality: age! number of occluded vessels! previous history of ;!presence of cardiogenic shock

*indings

http://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a48116b5f77401ca.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a495bed0fae78ee5.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a491f4e807cd1e59.htmlhttp://ncsbn.myncsbnlx.com/data/companies/ncsbn/scorm/rn-lesson-8a-cardiovascular_2004%20-%20Online%20Course%20(SCORM)_1027/Scorm2004Content/7f000001-12927a35-5a612-9414-a4a53e5bc2bea398.html


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a. classic findings: persistent! crushing substernal chest pain

i. pain that may radiate to the left arm! (a! neck and shoulder blades! ith a feeling of impendingdoom

ii. pain does not resolve ith rest

iii. some clients report no pain or call it mild indigestion

• more likely in the elderly or clients ith diabetes

• clues suggesting 'silent' ; #acute or sudden$: heart failure! change in mental status!

une+plained abdominal pain! dyspnea! fatigue

iv. some clients #especially older omen$ report only fatigue! nausea or vomiting! shortness of breath!or flu-like symptoms

b. sudden death

c. ithin the first hour after an anterior ;! about 205 of clients e+perience tachycardia or hypertension

d. up to 0@5 of clients ith an inferior ; e+perience the opposite! i.e.! bradycardia or hypotension

. iagnostics

a. history and physical

b. 39 - monitor for changes! arrhythmias

c. serum cardiac markers

i. isoen>ymes - C9-;% isoen>yme: rises to 6 degrees after acute ;, returns to normal in to days

ii. muscle proteins - /roponin rises ?uickly but remains elevated for to eeks

0. ;anagement

a. cardiac monitoring for arrhythmias

b. o+ygen - to prevent tissue hypo+ia

c. induced hypothermia #target temperature of 2 to degrees Celsius$ - initiated as soon as possibleafter return of spontaneous circulation

d. bed rest - to decrease the orkload of the heart



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e. pharmacologic agents - to stabili>e client

i. stool softeners - to decrease the orkload of the heart caused by straining! hich can causevagal stimulation producing bradycardia and arrhythmias

ii. narcotic analgesics - to reduce pain! an+iety and fear and decrease the orkload of the heart

iii. beta-blocking agents - to slo heart rate! decrease contractility! and decrease orkload of

heart

iv. sedatives - to decrease an+iety and fear and to decrease the orkload of the heart

v. antiarrhythmics - only used if serious arrhythmia develops or client is symptomatic itharrhythmia

vi. thrombolytic agents - to dissolve the thrombus in the coronary artery and re-perfuse themyocardium

vii. nitrates- to decrease pain and decrease preload and afterload hile increasing themyocardial o+ygen supply

viii. anticoagulants - to prevent blood clots

f. pulmonary artery #&an-an>$ catheter to monitor pressure in pulmonary artery #measuresfunctioning of left ventricle$

g. intra-aortic balloon counterpulsation may be used for cardiogenic shock

h. cardiac catheteri>ation may be performed for percutaneous transluminal coronary angioplasty#P/CA$! i.e.! stent insertion

i. surgery - coronary atherectomy or graft of a coronary artery bypass

/herapeutic treatment for ;: ' O BATMAN '

O F+ygen B F%eta blocker A FA&A #aspirin$ T F/hrombolytics #heparin$ M F;orphine A FAC3 #especially for those ith heart failure or a loer 3*$ N F8itroglycerin


a.the cardio-care si+ plus monitor the folloing to prevent heart failure! infections and complications



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i. temperature

ii. daily eight

iii. intake and output

iv. respiratory rate

v. breath sounds

vi. blood pressure

vii. serum en>yme levels

viii. 39 readings

i+. peripheral pulses

+. heart sounds especially & and gallop

Listen

b. assess pain and administer analgesics as ordered, record the severity! location! type! and duration of pain

c. do not give intramuscular in(ections #or C9 ill be falsely elevated$

d. atch for crackles! cough! tachypnea! and edema! hich may predict left ventricle is failing

Listen

e. use anti-embolism stockings to prevent venostasis and thrombophlebitis

f. assistance ith range-of-motion e+ercises


i. cardio five teaching plan

ii. e+plain the intensive care #or coronary care$ unit routine and machinery

iii. ask dietitian to speak ith the client and family to reinforce teaching

iv. encourage client to (oin the cardiac rehab e+ercise program

v. counsel gradual resumption of se+ual activity, taking nitroglycerin before se+ may prevent chest pain

vi. advise the client to report typical or atypical chest pain

vii. describe post-myocardial infarction syndrome, have client report it to physician

viii. stress that client must modify high-risk behaviors

h! "eart failure

i. efinition

a. heart fails to pump enough blood to support the body4s functions

b. types of C"* depend on hich part of the heart is failing: the left half that pumps to the bodyor the right half that pumps to the lungs

ii. 3tiology

a. coronary artery disease

b. myocarditis

c. cardiomyopathy

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d. infiltrative disorders! i.e.! amyloidosis! tumors! sarcoidosis

e. collagen-vascular disease: systemic lupus erythematosus! scleroderma

f. dysrhythmias that reduce cardiac filling time

g. disorders that increase cardiac orkload: hypertension! valve disease! anemia!hyperthyroidism

h. cardiac tamponade

iii. *indings

"eart #ailure symptoms listed in order of earliest to later findings

Right Bilateral $eft

8octuria

%ulging neck veins #G)$

Ankle H foot edema

Liver enlargement #hepatomegalyith abdominal pain! anore+ia! andnausea$

*atigue in adults anddecreased play activity in

children

/achycardia

"ypotension

=estlessness! irritability!hostility! agitation! an+iety

Cough #often dry initially$Beight gain&hortness ofbreathorthopnea/achypneaCrackles& heart soundPulmonary edema*rothy! sputum #may beblood-tinged$iaphoresisCyanosis

. iagnostics - the primary goal is to determine the underlying cause of the heart failure

a. history and physical e+am

b. chest +-ray to determine heart si>e and pleural effusions

c. 39 for changes! arrythmias

d. echocardiogram to measure valvular abnormalities

e. nuclear imaging - to determine myocardial contractility! myocardial perfusion! and acute cell in(ury

f. hemodynamic monitoring of arterial blood pressure! pulmonary artery pressure! pulmonary arteryedge pressure and cardiac output

0. ;anagement - ob(ective is to restore balance beteen myocardial o+ygen supply and demand

a. o+ygen

b. pharmacological: positive inotropes! e.g.! digitalis! vasodilators! nitrates! antihypertensives!cardiac glycosides! diuretics

c. intra-aortic balloon counterpulsation! ventricular assist pumping! pacemaker


a. the cardio care si+

b. administer medications as ordered

c. administer o+ygen as ordered - to prevent tissue hypo+ia

d. monitor hemodynamic indicators

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e. monitor for findings of hyponatremia! hypokalemia

f. restrict fluids and assess for findings of fluid retention


i. medications and side effects

ii. ho to conserve energy and thus o+ygen

iii. teach client to report

• eight gain of more than 2 pounds in 2 hours #e?uals 1 liter$ or 0 pounds in 1 eek

• dyspnea - sudden or progressive ith ALs

• decreased e+ercise tolerance

iv. importance of sodium-restricted diet

%ardiac tamponade

1. efinition: fluid fills pericardial sac and limits cardiac output, a medical emergency

2. 3tiology

a. acute pericarditis

b. post-op after cardiac surgery

c. pericardial effusions

d. chest trauma

e. myocardial rupture

f. aortic dissection

g. anticoagulant therapy

. *indings: classic triad of findings

a. hypotension ith

b. muffled heart sounds ith

c. high (ugular venous pressure #increased C)P$


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. iagnostics

0. ;anagement: pericardiocentesis #needle aspiration of pericardial sac$


a. bed rest ith elevated head of bed

b. prepare client for pericardiocentesis

c. provide emotional support

d. prepare for surgery if pericardiocentesis is ineffective

isorders of the Circulatory &ystem

A. "ypertension

1. efinitions

a. hypertension - systolic blood pressure of 1@ mm "g or greater! diastolic blood pressure ofD@ mm "g or greater! or taking antihypertensive medication

b. chronic hypertension of pregnancy - high blood pressure already present before eek 2@ ofgestation

c. accelerated hypertension - a hypertensive crisis hen blood pressure rises very rapidly

i. threat of immediate vascular necrosis and target organ damage! particularly to theheart! kidneys! retina and brain

ii. blood pressure is usually greater than 1


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iii. Cushing4s syndrome

iv. diabetes mellitus

v. dysfunction of the thyroid! pituitary! or parathyroid

vi. coarctation of the aorta

vii. pregnancy

viii. neurologic disorders

e. *indings

i. often asymptomatic

ii. findings reflect the effect of hypertension on organ systems

iii. occipital headache! blurred vision! di>>iness

iv. eakness! fatigue! and impotence

v. epista+is

vi. nocturia! hematuria

vii. chest pain! palpitations! and dyspnea! if heart is involved

f. iagnostics

i. based on the average of to or more blood pressure readings! to minutes apart! at each of to or

more visits after an initial screening visit #measuring blood pressure$

ii. classification of adult hypertension

iii. hypertension is classified according to its cause:

a. primary or essential hypertension #about D@5 of clients$

b. secondary hypertension #results from another disease, about 05 to 1@5 of clients$

c. pregnancy-induced hypertension #P"$

d. accelerated hypertension - a hypertensive crisis

0. ;anagement: initial treatment for prehypertension and uncomplicated stage 1 hypertension is lifestylemodifications, if life changes fail to decrease the %P to an acceptable level than medication is added

a. initial treatment for prehypertension and uncomplicated stage 1 hypertension - lifestyle modifications

b. pharmacological - if life changes fail to decrease the blood pressure to an acceptable level!medication is added

i. initial therapy includes one of the folloing classification of medications: thia>ide diuretic!

beta-adrenergic blocking agent! or angiotensin converting en>yme #AC3$ inhibitor

ii. angiotensin-converting en>yme #AC3$ inhibitors are the first choice for clients ith left-sidedheart failure and diabetics

iii. antilipemics

c. goals of treatment: to prevent end organ damage

i. %P I1@


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iii. control diabetes mellitus! if indicated

iv. increase activity

6. 8ursing interventions - reinforce client and family teaching regarding:

a. use of self-monitoring blood pressure cuff

b. the need to record blood pressure readings at least tice eekly in a (ournal or calendar #for revieby care provider during visits$

c. a routine or schedule for taking antihypertensive medications

d. the need to avoid high-sodium antacids and cold or sinus remedies ith vasoconstrictors! e.g.!antihistamines

e. a diet that is lo sodium! cholesterol and saturated fat

f. hen to report e+tremely high blood pressure readings

g. lifestyle modifications

i. optimi>ing body eight

ii. drinking alcohol based on current guidelines

iii. reducing dietary sodium! e.g.! 2 gram sodium diet

iv. participating in regular and moderately intense aerobic activity

v. avoiding tobacco products

vi. managing stress trigger and responses to triggers

%omplementary and Alternati&e Medicine

• arlic! ginseng dried root! hathorn! and snakeroot have been used to treat

hypertension, hoever! thereJs not enough research to support the efficacy and safetyof these herbal therapies.

• &upplements:

• Coen>yme E1@ #CoE1@$ supplements may cause small decreases in blood

pressure, lo blood levels of CoE1@ have been found in people ithhypertension

• mega- fatty acids supplements may loer blood pressure

• Amino acid L-arginine diet supplements may temporarily loer blood pressure

• Alternative systems of care

• /raditional Chinese medicine

• Avurveda

• 8ote: Licorice and ephedra should not be used by people ith hypertension because

they can increase blood pressure.

Malignant "ypertension

1. efinition: a sudden and rapid development of e+tremely high blood pressure, systolic is greater than 1


31/50

2. 3tiology: the most common cause is suddenly hen client stops taking antihypertensive medication

. *indings: headache! confusion! blurred vision! restlessness! motor sensory deficits

. ;anagement

a. goal: to reduce blood pressure by no more than 205 ithin minutes to one hour! then toard16@1@@ ithin 2 to 6 hours, must avoid rapidly dropping blood pressure because this could causeischemia to body systems

b. pharmacological

i. sodium nitroprusside

ii. nitroglycerin


a. monitor for end organ damage

b. monitor urine output, assess level of consciousness

c. monitor %K8! creatinine! arterial blood gases! urinalysis

d. continuous cardiac monitoring

e. vital signs every 0 to @ minutes #hile titrating medication$

%oronary artery disease (%A')

1. efinition - fatty deposits in coronary arteries #atheroma or pla?ue$ narro the artery #by 705 or more$ and

cut flo of blood and o+ygen to the heart muscle

2. 3pidemiology and etiology

a. CA is epidemic in the estern orld

b. more than @5 of men age 6@ or older sho signs of CA on autopsy

c. most common cause: Atherosclerosis

d. risk factors:

i. over @ hite male

ii. family history of CA

iii. high blood pressure


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iv. high cholesterol

v. smokers are tice as likely to have a myocardial infarction and four times as likely to diesuddenly, the risk drops sharply ithin one year after smoking cessation

vi. obesity! particularly aist circumference, added eight increases the risk of diabetes!hypertension and high cholesterol

vii. sedentary life style

. *indings: angina

. iagnostics

a. serum elevations

i. homocysteine levels

ii. C-reactive protein

iii. L" cholesterol

iv. triglycerides

b. cardiac catheri>ation

;anagement

a. pharmacological

i. nitrates such as nitroglycerin! isosorbide dinitrate #sordil$! or beta-adrenergic neuron-blockingagents

ii. diuretics and beta-adrenergic blocking agents

iii. antiplatelet agents #aspirin ation

e. rotational ablation



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f. laser coronary angioplasty

g. surgical treatment - cardiovascular bypass graft surgery #CA%$


a. help client ith AL #activities of daily living$

b. partial bed rest

c. reassure client

d. assist ith turning! deep breathing and coughing e+ercises

e. relieve chest pain by o+ygen and medication as ordered

f. during angina attacks! monitor blood pressure! heart rate! pain! medications! symptoms, getelectrocardiogram

g. keep nitroglycerin available for immediate use

h. post cardiac catheteri>ation and percutaneous transluminal coronary angioplasty

i. maintain heparini>ation

ii. observe for bleeding systemically at the site

iii. keep the affected leg straight and immobile for 6 to 12 hours

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iv. check for distal pulses

v. to counter the diuretic effect of the dye! increase ) fluids and make sure client drinks plenty of fluids

vi. assess potassium level and observe for dysrhythmias

vii. observe findings of hypotension! bradycardia! diaphoresis! di>>iness, give atropine and lay the clientflat

i. post rotational ablation

i. monitor the client for chest pain! hypotension! coronary artery spasm and bleeding from the cathetersite

ii. provide heparin and antibiotic therapy for 2 to < hours or as ordered

(. client and family teaching

i. risks

•

teach the risk factors for coronary artery disease #CA$

• encourage client to lose e+cess eight, revie lo-fat! lo-cholesterol diet

• teach smoking cessation

• teach side effects of drugs for CA

• stress - teach stress reduction techni?ues

ii. avoid

• activities knon to cause angina

• physical activities for to hours after meals

• very cold and very hot eather

• alcohol and caffeine drinks

• diet pills! nasal decongestants! or any remedy that can raise heart rate or blood pressure

iii. use

• nitroglycerin tablets and carry at all times

• if necessary nitroglycerin patch

iv. report

• angina

• go to clinic or hospital hen angina lasts more than 10 minutes

hoc

1. efinition - a clinical syndrome marked by inade?uate perfusion and o+ygenation of cells! tissues and

organs.

2. *our physiologic components for homeostatic regulation - if one or more of these components malfunctionsshock may follo

a. ade?uate cardiac output

b. uncompromised vascular system

c. ade?uate blood volume


35/50

d. ability of tissue to e+tract and use o+ygen

. ;a(or categories or types of shock

a. cardiogenic #pump failure$

b. obstructive #mechanical interference ith ventricular filling or ventricular emptying$

c. distributive #vasogenic$

i. septic

ii. anaphylactic

d. hypovolemic #intravascular volume loss$

*indings: progression of shock #you ill note there are many terms used to describe the stages of shock$

a. stage - reversible! compensatory! initial! 'arm'

i. characteri>ed by decreased cardiac output and perfusion, anaerobic metabolism begins#development of lactic acidosis$

ii. compensatory mechanisms #neural! chemical! and hormonal$ act to maintain perfusion

• neural compensation

baroreceptors in carotid sinus aortic arch activate sympathetic nervous system #8&$!

hich contracts blood vessels so that skin cools

sympathetic 8& stimulates heart! so tachycardia sets in, it cuts blood flo to kidneys

and gastrointestinal system and dilates pupils

• hormonal compensation

decreased blood flo to kidneys releases angiotensin! hich constricts vessels and

increases %P

angiotensin stimulates the secretion of aldosterone, aldosterone makes kidneys

retain sodium! hich increases serum osmolality! hich in turn stimulates antidiuretichormone #A"$

A" causes ater retention

increased sodium and ater retention results in increased %P! decreased urine

volume and increased urine specific gravity

anterior pituitary is stimulated to secrete adrenocorticotropic hormone #AC/"$, AC/"

acts on adrenal corte+ to increase secretion of glucocorticoids! hich increase serumglucose

• chemical compensation

decreased pulmonary blood flo causes hypo+emia

hypo+emia is sensed by chemoreceptors that increase rate and depth of respirations!hich results in respiratory alkalosis

iii. clinical findings at this stage are vague because of compensatory mechanisms

• an+iety! restlessness

• tachypnea

• skin cool and clammy

• thirst


36/50

• pupils dilated

• slight tachycardia

• eak or normal peripheral pulses

• decreased boel sounds

• normal to decreased urine output

• concentrated urine

b. progressive stage of shock - compensatory mechanisms can no longer maintain perfusion

i. severe hypoperfusion

ii. massive cell death

iii. organs begin to fail

iv. severe lactic acidosis and metabolic acidosis

v. findings of progressive stage of shock

• consciousness - LC depressed

• lungs - tachypnea ith hypoventilation and adventitious lung sounds #crackles and hee>es$

• cardiovascular

decreased cardiac output and decreased %P ith systolic belo D@ mm "g

narroing pulse pressure

tachycardia and irregular pulse

eak and thready peripheral pulses

• elimination

urine volume belo 2@ mLhour

dilute urine osmolality

absent boel sounds

c. refractory stage - shock irreversible

i. death from multi-organ dysfunction syndrome #;&$

ii. findings of refractory stage of shock

• cardiac failure

• respiratory failure

• renal shutdon

• liver dysfunction

• loss of consciousness

d. iagnostics - bedside data collection based on etiology of shock

e. ;anagement - ob(ective is to correct underlying cause and prevent progression


37/50

i. many treatments listed are used for all shock syndromes! e.g.! vasopressors! positive inotropicsupport! o+ygen therapy #intubation$! fluid replacement

ii. cardiogenic shock

• pharmacologic treatments

positive inotropic agents: increase myocardial contractility and improve systolic

e(ection! e.g.! dobutamine #obutre+$! amrinone lactate #nocor$

vasodilators: improve heart4s pumping action by reducing its orkload,

e.g.! nitroglycerin #Corobid$! nitroprusside sodium #8ipride$, usually limited to clientsith failing ventricular function

vasopressors: increase peripheral vascular resistance and elevate blood pressure!

e.g.! norepinephrine #Levophed$! Pamine hydrochloride #ntropin$

• o+ygen therapy - titrated based on A% analysis and respiratory effort

•

supportive treatments

intra-aortic balloon pump #counterpulsation$

left and right ventricular assist pumping

iii. hypovolemic shock: rapid fluid replacement therapy to replace lost volume

• crystalloids- 2 moves out of vascular space! e.g. normal saline or ringers lactate

• colloids #not for sepsis or burn$N 1 to 12 moves out of vascular space! e.g. de+tran! blood!

hetastarch! **P! albumin

• hemoglobin based o+ygen carriers! e.g. Poly"eme! "emopure! "emolink

• blood products: hole blood #autotransfusion an option if they go to surgerychest tube$

iv. anaphylactic shock

• epinephrine #adrenalin$

• antihistamines

• aminophylline #/ruphylline$

v. neurogenic: depends on causative agent

vi. septic shock

• fluid replacement

• antiinfective agents based on culture results

• improve cardiac output ith positive inotropes and vasopressors

8ursing interventions for shock: the cardio-care si+ e*cept

a. do not elevate or loer head: maintain complete bed rest in flat position or ith legs slightly raised to

increase venous return #modified trendelenburg$

b. bed rest

c. turn patient every to hours as tolerated



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d. keep client arm

e. administer parenteral therapy! medications

f. monitor mean hemodynamic indicators as ordered

g. blood plasma e+panders or packed cells if hematocrit and hemoglobin lo

ysrhythmias and Lesser )ascular isorders

A. 'ysrhythmias

1. efinition: disturbance in heart rate or rhythm

2. /ypes of dysrhythmia

a. supraventricular: sinus! atrial! and (unctional

i. sinus tachycardia

ii. sinus bradycardia

iii. sinus arrhythmia

iv. premature atrial comple+es

v. atrial tachycardia

vi. atrial flutter

vii. atrial fibrillation

viii. premature (unctional comple+

i+. (unctional tachycardia

b. ventricular

i. premature ventricular contraction

ii. ventricular tachycardia

iii. ventricular fibrillation

iv. asystole

v. atrioventricular block

vi. first degree A-) block

vii. second degree A-) block ;obit> one #type one$

viii. second degree A-) block ;obit> to #type to$

i+. third degree A-) block

8ursing interventions - alays check your client for symptoms of an arrythmia #the number and degree of findingsill often dictate the treatment$

a. supraventricular dysrhythmias

i. asymptomatic - no nursing interventions indicated

ii. symptomatic

• vagal stimulation


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• administer medications as ordered #slo rate of administration$

adenosine #Adenocard$

calcium channel blockers

beta blockers

• procedures

cardioversion

ablation

• provide emotional support

• teach client

about medications and side effects

to decrease stimulant use! i.e.! caffeine! nicotine

to control reactions to stress

to reduce alcohol intake

about importance of sleep

b. ventricular dysrhythmias

i. administer medications as ordered

ii. monitor hemodynamic indicators as ordered

iii. administer o+ygen as ordered

iv. provide a restful environment

v. prepare the client for cardioversion

vi. initiate cardiopulmonary resuscitation as indicated

vii. provide emotional support

viii. teach client

• medications and side effects

• importance of earing ;edicAlertO identification

c. atrio-ventricular #A)$ conduction disturbances

i. asymptomatic: no nursing interventions indicated

ii. symptomatic

• administer medications as ordered

• prepare client for pacemaker insertion

• care of the client undergoing surgery

• provide emotional support

• provide a restful environment

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Aneurysms

1. efinition: dilation of an artery due to a eakness in the arterial all

2. 3tiology - atherosclerosis

. /ypes

a. four types of aneurysms

i. saccular: out-pouching of one all in a circumscribed area

ii. fusiform: involves complete circumference of artery

iii. dissecting: accumulation of blood separating the layers of the arterial all

iv. pseudoaneurysm: tear of the full thickness of the arterial all! leading to a collection of bloodcontained in the connective tissue

b. common locations

i. location one: abdominal aortic aneurysm

• findings of abdominal aortic aneurysm

usually asymptomatic

vague abdominal or back pain

tenderness on palpation

hypotension

diminished pulses in loer e+tremities

commonest site: (ust belo renal arteries and above iliac arteries

• diagnostics - arteriography

• management - surgical repair

• nursing interventions

postop care of client

after surgery! atch for back pain! a sign of retroperitoneal hemorrhage

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monitor perfusion

provide comfort measures

provide emotional support

teach client - to avoid prolonged sitting and lifting of heavy ob(ects

ii. location to: thoracic aortic aneurysm

• findings of thoracic aortic aneurysm

may be asymptomatic

vague chest pain

dyspnea

distended neck veins

• diagnostics - arteriography

• management - surgical repair

• nursing interventions

care of the client undergoing surgery

postop care of client

Arterial occlusi&e disease

1. efinition: insufficient blood supply in the arteries! usually in legs, may be acute or chronic

2. Acute arterial occlusive disease

a. etiology

i. embolism! thrombosis! and trauma

ii. femoral artery most often affected

b. findings

i. pain in affected limb

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ii. cyanosis in affected limb

iii. paresthesia in affected limb

iv. if untreated! gangrene

c. management

i. anticoagulants

ii. ) heparin

iii. surgical t reatment

• embolectomy

• bypass of affected artery

• amputation of limb

• percutaneous transluminal coronary angioplasty

Chronic arterial occlusive disease

a. etiology

i. arteriosclerosis obliterans! aneurysms! hypercoagulability states! tobacco use

ii. slo! progressive arteriosclerotic changes give collateral circulation a chance to form

iii. collateral circulation cannot give tissues enough o+ygen, result is hypoperfusion

iv. hypoperfusion leads to ischemia

v. usually affects legs

b. findings

i. intermittent claudication indicates mild to moderate obstruction

ii. pain at rest indicates severe obstruction

iii. affected limb ill sho

• edema

• paresthesia

• eak pulses

• skin: a+y! hairless! cool! pale! cyanotic

iv. in men! impotence

c. management

i. physical activity

ii. diet

iii. smoking cessation

iv. pharmacologic

• anticoagulants - to prevent blood clots


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• vasodilators

• antiplatelet drugs - to prevent platelet aggregation

• pento+ifylline #/rental$: increases blood flo by thinning blood

v. surgical treatment

• endarterectomy

• femoral-popliteal bypass

• sympathectomy

• amputation of affected limb for gangrene

• laser coronary angioplasty

• peripheral angioplasty

%oth acute and chronic arterial occlusive disease

a. nursing interventions

i. administer medications as ordered

ii. monitor peripheral pulses and blanch test

iii. provide comfort measures

iv. help client develop an e+ercise program

v. postop care of client

vi. provide foot care

b. teach client

i. to change positions fre?uently

ii. to avoid crossing legs

iii. to avoid any constrictive clothing on legs

iv. to avoid trauma to loer e+tremities

v. foot care

vi. to place legs in dependent position to increase blood flo

Raynaud+s phenomenon (arteriopastic disease)

1. efinition

a. episodic vasospasm of the small cutaneous arteries that results in intermittent pallor or cyanosis ofthe skin - usually affects the fingers bilaterally! but occasionally affects the toes! nose! or tongue thatresult in intermittent pallor or cyanosis of the skin

b. the process involves a severe constriction of cutaneous vessels folloed by vessel dilation and thena reactive hyperemia #blue! hite! red$

2. 3tiology

a. unknon

b. fre?uently occurs in omen

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c. may be triggered by stress! cold

. *indings

. iagnostics

a. clinical pattern

b. digital plethysmography

Documents

A. Cardiovascular