Upload
willow
View
78
Download
0
Tags:
Embed Size (px)
DESCRIPTION
CARDIOVASCULAR FUNCTION . NUR-224. OBJECTIVES. Explain cardiac anatomy/physiology and the conduction system of the heart. Incorporate assessment of cardiac risk factors into the health history and physical assessment of the patient with cardiovascular disease. - PowerPoint PPT Presentation
Citation preview
CARDIOVASCULAR FUNCTION NUR-224
Explain cardiac anatomy/physiology and the conduction system of the heart.
Incorporate assessment of cardiac risk factors into the health history and physical assessment of the patient with cardiovascular disease.
Discuss clinical indications, patient preparation and other elated nursing implications fro common test and procedures used to assess and diagnose cardiovascular diseases.
OBJECTIVES
Three layers Endocardium Myocardium Epicardium
Four chambers Heart valves
THE HEART
Surrounded by pericardium Pericardial fluid 10-30 mL Divided by septum Left ventricular wall 2-3 x as thick as right
ventricle Atrial wall thinner than ventricles
HEART
Inferior and superior vena cava send deoxygenated blood to right atrium
Blood passes through tricuspid valve to right ventricle blood passes from right ventricle through pulmonic valve via pulmonary artery to lungs
Blood from lungs enters left atrium via pulmonary veins
Passes through mitral valve to left ventricle Blood ejected to body through aortic valve
aorta peripheral system
BLOOD FLOW THROUGH THE HEART
STRUCTURE OF THE HEART
CORONARY ARTERIES
Depolarization (contraction of heart) Sinoatrial node – pacemaker of heart Contraction of atria AV node Bundle of His Right and left bundle branches Purkinje fibers
CONDUCTION SYSTEM
Systole Contraction of myocardium Ejection of blood from ventricles
Diastole Relaxation of myocardium Filling of coronary arteries Atrium is emptying into the ventricles
MECHANICAL SYSTEM
Number of times the ventricles contract each minute
60-100 Regulated by: Autonomic Nervous
System Sympathetic Parasympathetic
HEART RATE
Amount of blood pumped by each ventricle during a given period
Amount of blood ejected from ventricle with each beat (stroke volume) x heart rate
CO = SV x HR 4 – 7 L/min
CARDIAC OUTPUT
Stroke volume: amount of blood ejected with each heartbeat
Cardiac output: amount of blood pumped by ventricle in liters per minute
Preload: degree of cardiac muscle fiber tension at end of diastole (prior to contraction)
Afterload: resistance that ventricles must overcome to eject the blood
Contractility: ability of cardiac muscle to shorten in response to electrical impulse
CARDIAC OUTPUT
Health history Family/genetic history
ASSESSMENT
Chest pain Dyspnea Peripheral edema, weight gain Palpitations Fatigue Dizziness, syncope, changes in level of
consciousness
COMMON SYMPTOMS
Medications Nutrition Elimination Activity, exercise Sleep, rest
Self-concept Roles,
relationships Sexuality Risk factors
ASSESSMENT
Inspection Palpation Percussion Auscultation
PHYSICAL ASSESMENT
Normal skin color Capillary refill < 3 seconds Thorax symmetrical No jugular vein distention with patient at
45° Absence of clubbing
INSPECTION
PMI palpable at 5th ICS mid-clavicular line No thrills, heaves Slight pulsation of abdominal aorta in
epigastric region Carotid and extremity pulses equal
bilaterally No pedal edema
PALPATION
Normal heart sounds S1 and S2 heart sounds heard Apical-radial rate equal and regular No murmurs or extra heart sounds No S3 or S4 Pericardial friction rub
AUSCULTATION
HEART SOUNDS
Extremities
Lungs
Abdomen
ASSESSMENT OF OTHER SYSTEMS
Laboratory test: Diagnose the cause of cardiac-related
signs/symptoms Determine baseline values before initiating
therapeutic interventions Ensure therapeutic levels of medication are
maintained Evaluate the patient’s response to the
therapeutic regimen Identify abnormalities
DIAGNOSTIC EVALUATION
Cholesterol - normal level <200mg/dL Major sources – diet, liver
Low density lipoproteins LDLs <160
High-density lipoproteins HDLs
Triglycerides <200
BLOOD CHEMISTRIES
CXR/Fluoroscopy Electrocardiography Cardiac stress testing Echocardiography
DIAGNOSTIC STUDIES
Coronary arteries dilate to 4x their normal in response to increased metabolic demands for oxygen.
Coronary arteries affected by atherosclerosis dilate less, compromising blood flow to the myocardium ischemia
Noninvasive test Abnormalities in CV function are more likely
to be detected during times of increased stress.
CARDIAC STRESS TESTING
Determine :• presence of CAD• cause of chest pain • functional capacity of the heart after MI/ heart surgery• effective of antianginal/antiarrhythmic • dysrhythmias/ physical exercise
CARDIAC STRESS TESTING
Pre-Test Physical and Baseline ECG Signed consent Patient teaching Report cardiac symptoms during test NPO 4 hours pre-test Withhold meds Emergency and resuscitation
equipment need to be at site of test at all times
CARDIAC STRESS TESTING
Testing procedure Exercise equipment Increase HR to target rate for age and
gender OR c/o chest pain or fatigue Speed or incline increased every 2-3
minutes to increase stress on patient ECG and BP monitored throughout the test Rest for 15 minutes post test while being
monitored
CARDIAC STRESS TESTING
Invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries
Requires ECG, emergency equipment must be available
Assessment prior to test: allergies, blood work
Assessment of patient postprocedure: circulation, potential for bleeding, potential for dysrhythmias
Activity restrictions Patient education pre/postprocedure
CARDIAC CATHERIZATION
Preparation √ allergies to shellfish Signed consent form D/C anticoagulants,
ASA, salicylates, herbals affecting coagulants
Contraindicated; patients with bleeding disorders Elderly, dehydrated Severe renal failure
Patient Teaching Palpitations as
catheter enters left ventricle
Heat/hot flash as contrast medium injected
Sensation of need to cough as medium injected into right side of heart
CARDIAC CATHETERIZATION
During Procedure nausea pain at insertion
siteSTAT Intervention chest pain dysrhythmias changes in
peripheral pulses neuro assessment
Post Procedure VS & Neuro checks insertion site pressure dressing bleeding/hematomaAssessment extremities - s/s
ischemia r/t clots bed rest 4-6 hrs
post procedure
CARDIAC CATHERIZATION
CVP Pulmonary artery pressure Intra-arterial BP monitoring
HEMODYNAMIC MONITORING
HEMODYNAMIC MONITORING