Unit 4 Problems of Cardiac Output and Tissue Perfusion

Lemone and Burke Ch 30-32

ECG brief intro

P wave QRS T U http://www.youtube.com/watch?

v=rguztY8aqpk&feature=related

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Heart Sounds http://www.youtub

e.com/watch?v=ax9B6g6gEOc

http://www.youtube.com/watch?v=Ge12P7u0aQo&feature=related

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What is Cardiac Output? CO = HR x SV

CO=cardiac output HR= heart rate SV= stroke volume

Factors that affect SV: HR Preload Afterload Contractility

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Assessing CV status

Other than physical assessment History Family History Genetic Risk Personal History Diet History Socioeconomic Status

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Risk Factors Modifiable

HTN Diabetes Hyperlipidemia Cigarette smoking Obesity Physical inactivity Diet

Nonmodifiable Age Gender Genetic Factors

The text also discusses Metabolic Syndrome and Risk factors unique to women on page 964

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CV Assessment

Focused physical assessment General appearance Integumentary system

Color Temperature

Extremeties Blood pressure Edema

Venous flow and arterial pulses

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CV Diagnostic exams

Lab tests: CBC Serum electrolytes BNP

Mark cardiac damage Troponin CK-MB Myoglobin

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Cardiac lab tests

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Diagnostic exams

Chest x-ray Angiography Cardiac Catheterization ECG Nursing interventions???

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Diversity concerns CV client

Clients often fear diseases r/t cardiovascular system

Require good education, opportunity for client and family to voice concerns/fears

Support groups Cardiac rehab referral

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Pathophysiology of Common Cardiac Disorders

Heart Failure Infective Endocarditis Myocarditis Pericarditis

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Risk Factors and Preventive Measures for Cardiac Disorders

Heart Failure Risk factors

Coronary artery disease Cardiomyopathies Hypertension Congenital and valvular heart disease

prevention Education regarding coronary artery

disease and diabetes

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Pathophysiology of Common Cardiac Disorders

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Pathophysiology of Common Cardiac Disorders

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Right vs Left heart failure

Right Peripheral edema Weight gain anorexia

Left SOB Fatigue Crackles on

auscultation of breath sounds

Heart Failure

Right vs Left Systolic vs

Diastolic High and low

output

Chronic vs Acute

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Risk Factors and Preventive Measures for Cardiac Disorders

Heart Failure Risk factors

Coronary artery disease Cardiomyopathies Hypertension Congenital and valvular heart disease

prevention Education regarding coronary artery

disease and diabetes

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Pulmonary edema

Classic symptoms of Pulmonary Edema Rapid onset• Extreme shortness of breath or difficulty breathing• A feeling of suffocating or drowning• Wheezing or gasping for breath• Anxiety, restlessness or a sense of apprehension• A cough that produces frothy sputum that may be tinged

with blood• Excessive sweating• Pale skin• Chest pain, if pulmonary edema is caused by heart

disease• A rapid, irregular heartbeat (palpitations)

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Slow onset symptoms of CHF

• Increased shortness of breath when physically active.

• Difficulty breathing with exertion, often when lying flat as opposed to sitting up.

• Awakening at night with a breathless feeling that may be relieved by sitting up.

• Rapid weight gain when pulmonary edema develops as a result of congestive heart failure.

• Loss of appetite.• Fatigue

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Clinical manifestations of Inflammatory Heart Disease

Types of inflammatory diseases: Myocarditis Infective endocarditis Pericarditis Rheumatic Carditis

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Risk Factors and Preventive Measures for Cardiac Disorders

Myocarditis Risk factors are any thing that alters

immune response Advanced age Malnutrition Alcohol use Immunosuppression Exposure to radiation Stress

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Anatomy, Physiology, and Functions of the Heart

The Pericardium Double-layered fibroserous membrane

surrounding the heart Anchors the heart to surrounding structures

Space between layers is filled with pericardial fluid Lubricates heart muscle Helps to cushion the heart

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Anatomy, Physiology, and Functions of the Heart

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Infective endocarditis

An infection of the endocardium Common in clients who abuse drugs,

had valve replacements, systemic infections or structural cardiac defects

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Risk Factors and Preventive Measures for Cardiac Disorders

Infective Endocarditis Risk factors

Congenital deformities Tissue damage due to ischemic disease Valve prosthesis Intravenous drug use Invasive catheters Dental procedures or poor dental health Recent heart surgery

Prevention Education is key Prophylactic antibiotics

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Infective endocarditis Most common complication is heart failure 50% have embolic complications due to

vegetation Common to have clients with petechia and

splinter hemorrhages Diagnosed with positive blood culture or

echocardiogram Treat with antibiotics Often need antibiotics before dental

procedures

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Petechiae and splinter hemorrhage

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Pericarditis vs endocarditis

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Pericarditis Often follows a respiratory infection Often presents with pain in supine position

releived by sitting or leaning forward May hear friction rub with stethoscope Treated with NSAIDS relieved within 48 hrs.

depends on cause for further treatment Short term course of illness (2-6 weeks) for

acute Chronic may require surgery

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Pericardiocentesis

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Risk Factors and Preventive Measures for Cardiac Disorders

Rheumatic Fever and Rheumatic Heart Disease Risk factors

Crowded living conditions Malnutrition Immunodeficiency Poor access to health care Genetic factor may be present

Prevention Prompt identification, treatment Importance of finishing medications

Ultimately when the heart fails, the patient will have shock

Chapter 11 Lemone and Burke

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Cellular Homeostasis and Basic Hemodynamics

Homeostatic regulation maintained primarily by cardiovascular system

Four physiologic components Sufficient cardiac output Uncompromised vascular system Sufficient blood volume and blood

pressure Tissues that are able to extract and use

oxygen

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Types of Shock Hypovolemic Shock

Affects all body systems Most common type of shock

Cardiogenic Shock Loss of pumping action of the heart

Obstructive Shock Impaired diastolic filling (pericardial tamponade,

pneumothorax)

Distributive Shock Also known as vasogenic shock

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Shock

Hypovolemic Too little circulating blood causes

decrease in MAP thus not meeting the body’s total need for oxygen

Internal hemorrhage GI bleed

External hemorrhage trauma

Dehydration

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Shock

Cardiogenic Heart muscle is unhealthy or pumping is

impaired Causes a decrease CO, afterload and

reduces MAP

This is seen with an MI

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Shock Obstructive Affects the heart muscles ability to

pump effectively The heart itself is normal however

manifestations outside the heart affect filling or contraction Cardiac tamponade Tension pneumothorax Pulmonary embolism

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Shock

Distributive Loss of sympathetic tone Vasodilation

Leaky capillaries Spinal cord injury Sepsis Anaphylaxis

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Interventions for Clients Shock

Medications Inotropic: increases cardiac contractility Vasopressors: used to treat neurogenic,

septic, or anaphylactic shock Opioids: used to treat pain Immunizations: tetanus prophylaxis

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Shock

Look at the patient Compensated vs uncompensated

Blood pressure Urine output HR RR

Mental status

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Emergency

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Cardiac Emergency

Crash cart BLS Systematic Approach Code Team

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Rapid Response Team

ABC Act Before Code

Early intervention Early recognintion = increased survival

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What if it happens to me?

Don’t panic Activate the code Blue

Call for help if no button exists

BLS (you know this) Get in there!

Record your findings

Review your ABG’s

Questions??

Mid Term Exam Next Week.Cumulative to include everything to now. You will have the whole class time to take the exam.