Chapter 36
Cardiovascular System
Anatomy and Physiology Review
• Heart, its vasculature, and peripheral vascular system
• Functions:– Provides oxygen, nutrients, and hormones to
cells– Removes carbon dioxide and waste products
from cells– Maintains body temperature by distributing
heat produced by metabolic activity
Anatomy and Physiology Review
Anatomy and Physiology Review
Anatomy and Physiology Review
Anatomy and Physiology Review
Health History
• Goals:– Identify present and potential health problems– Identify possible familial and lifestyle risk
factors– Involve client in planning long-term health
care
(continued)
Health History
• Onset of symptoms
• Predisposing factors
• Treatment of symptoms
• Activity level or limitations
• Appetite
• Ability to sleep
• Cardiovascular risk factors
Assessment
• Subjective data:– Chest pain, dyspnea, edema, fainting,
palpitations, diaphoresis, fatigue, and orthopnea
(continued)
Assessment
• Objective data:– Cyanosis, poor skin turgor, distended neck
veins, poor quality of respirations, coughing, heart sounds, ascites, edema, skin temperature, pulses, capillary refill, and Homan’s sign
Assessment
Assessment
Assessment
Assessment
Echocardiography
Electrocardiography
Normal Sinus Rhythm
• Sinoatrial (SA) node– Natural pacemaker– Wave causes atria to contract
• Atrioventricular (AV) node– Impulse pauses
(continued)
Normal Sinus Rhythm
• AV bundle– Divides into right and left bundle branches– Divides into Purkinje fibers
• Causes ventricles to contract
Normal Sinus Rhythm
Dysrhythmias
• Irregularity in rate, rhythm, or conduction of electrical system of heart
• Most common causes:– Coronary artery disease, congestive heart
failure, and myocardial infarction
(continued)
Dysrhythmias
• Symptoms vary from none to cardiac arrest:– Fainting, seizures, fatigue, decreased energy
level, exertional dyspnea, chest pain, and palpitations
Types of Dysrhythmias
• Bradycardia– Heart rate of 60 beats per minute or less– Treatment:
• Atropine or pacemaker
• Tachycardia– Heart rate of 100 to 150 beats per minute– Treatment depends on cause
Bradycardia
Tachycardia
Atrial Dysrhythmias
• Occur from electrical conduction disturbances in atria:– Premature atrial contractions– Atrial tachycardia– Paroxysmal supraventricular tachycardia– Atrial flutter– Atrial fibrillation
(continued)
Atrial Flutter
Atrial Flutter
Atrial Fibrillation
Atrial Dysrhythmias
• Treatment depends on cause:– Pacemaker, vagal stimulation,
antidysrhythmic medication, and cardioversion
Ventricular Dysrhythmias
• Originate in ventricles
• More life-threatening
• Include:– Premature ventricular contractions– Ventricular tachycardia– Ventricular fibrillation– Ventricular asystole
(continued)
Premature Ventricular Contraction
Ventricular Fibrillation
Ventricular Fibrillation
Asystole
Ventricular Dysrhythmias
• Treatment depends on cause:– Oxygen, amiodarone (Cordarone),
magnesium sulfate, lidocaine, cardioversion or defibrillation, CPR, and advanced cardiac life support (ACLS) protocol
AV Blocks
• Electrical conduction interrupted to some degree between atria and ventricles at AV node
• Degrees:– First– Second– Third
(continued)
AV Blocks
• Treatment:– First degree
• None
– Second and third degree• Pacemaker
Rheumatic Heart Disease
• Complication of rheumatic fever
• Linked to group A streptococcus following upper respiratory infection
• Treat inflammation, prevent cardiac complications, and prevent recurrence
(continued)
Rheumatic Heart Disease
• Clients require prophylactic antibiotic therapy before dental procedures or invasive surgery
Infective Endocarditis
• Inflammation or infection of inside lining of heart– Including valves
• Acute symptoms:– Tachycardia, pallor, diaphoresis, and
symptoms of infection
(continued)
Infective Endocarditis
• Subacute symptoms:– Low-grade fever, malaise, weight loss, and
anemia
• Clients may develop murmurs, dyspnea, peripheral edema, or pulmonary congestion
• Treatment:– Surgery and antibiotics
Myocarditis
• Inflammation of myocardium
• Symptoms:– Flu-like symptoms of fever, pharyngitis,
myalgias, GI complications, chest pain, and pericardial friction rub
• Treatment:– Digoxin, antibiotics, anti-inflammatories,
oxygen, and bed rest to prevent congestive heart failure
Pericarditis
• Inflammation of membranous sac surrounding heart
• Symptoms:– Severe chest pain and pericardial friction rub
• Complication:– Cardiac tamponade
(continued)
Pericarditis
Pericarditis
• Treatment:– Pericardiocentesis, surgery, and medications
Valvular Heart Diseases
• Occurs when valves do not open and close properly
• Stenosis and insufficiency
• Mitral valve prolapse
• Treatment:– Prophylactic antibiotics before dental
procedures, surgery, medications, and valve replacement
Valvular Heart Diseases
Arteriosclerosis
• Narrowing and hardening of arteries
• Causes decreased perfusion to cells beyond narrowed or hardened area
• Vessels lose elasticity– Results in arteriosclerotic heart disease,
angina, myocardial infarction, stroke, and peripheral vascular disease
Atherosclerosis
Angina Pectoris
• Caused by myocardial ischemia
• Squeezing pain under sternum radiating to left or right shoulder, jaw, or ear
• Pain may be mild or immobilizing
(continued)
Angina Pectoris
Angina Pectoris
Angina Pectoris
• Treat to increase blood supply to affected area via medication or surgical procedures– E.g., percutaneous transluminal coronary
angioplasty (PTCA), stent, coronary artery bypass graft (CABG)
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
Angina Pectoris
It’s time for report…
Prioritize the five nursing interventions as you would do them
initially:
A – Take the vital signs.
B – Assist to commode.
C – Perform a body systems assessment.
D – Check oxygen saturation level.
E – Talk with Mrs. T.
Myocardial Infarction
• Obstruction in coronary artery resulting in necrosis to tissues supplied by artery
• Symptoms:– Chest heaviness, lower sternal pain, dyspnea,
diaphoresis, nausea, anxiety, vomiting, change in pulse and blood pressure, pallor, and cyanosis
• Women may have different symptoms
(continued)
Myocardial Infarction
Myocardial Infarction
Myocardial Infarction
• Treat to reduce oxygen demands, increase oxygen supply, relieve pain, improve tissue perfusion, and prevent complications and further tissue damage
• Treatment:– Medications, surgery, diet, and bed rest
Myocardial Infarction
Myocardial Infarction
Right-Sided Heart Failure
• Develops when heart no longer capable of meeting body’s oxygen needs
• Causes:– Untreated left ventricular failure, right
ventricular myocardial infarction, chronic obstructive coronary disease, cor pulmonale, and pulmonic valve stenosis
(continued)
Right-Sided Heart Failure
• Symptoms:– Edema (may be pitting) in extremities and
trunk, anorexia, hepatomegaly, splenomegaly, distended jugular veins, and oliguria
Left-Sided Heart Failure
• Causes:– Left ventricular myocardial infarction, aortic
valve stenosis, prolapsed valve complications, and hypertension
• Symptoms:– Lung congestion, cyanosis, dyspnea,
restlessness, and blood-tinged sputum (hemoptysis)
Treatment of Heart Failure
• Treat to improve circulation to coronary arteries and decrease workload of left ventricle
• Treatment:– Medication, diet changes, fluid restriction,
oxygen, and surgery• E.g., ventricular assist device (VAD), intra-aortic
balloon pump
Cor Pulmonale
• Heart affected because of lung condition that interferes with exchange of carbon dioxide and oxygen in alveoli
• Symptoms and medical and nursing care same as right-sided heart failure
The nurse admits a 69-year-old male with HF. The physician orders furosemide 60mg IV stat,
digoxin 0.25mg po and KCl 20mEq po now. Which assessment finding is most indicative of
an ineffective response 2 hours after the administration of all the medications?
A. Pulse 89, irregular.
B. Urine output 60mL.
C. Pulse oximetry 94%.
D. Pitting edema in the lower extremities.
B is the answer
Although output falls within the parameters of renal function, the client received furosemide IV and diuresis is the desired effect.
Options A, C and D are expected findings in a client with HF.
The home health nurse visits a client with HF. In reviewing the client’s medications, the nurse
notes that the client takes the following daily oral medications: digoxin 0.25mg, furosemide
10mg and captopril 0.625mg. After speaking to the client and wife, the nurse suspects digitalis toxicity. Which question helps the nurse gather
more information specific to digitalis toxicity?
A. “Do you get light-headed when you get out of bed?”B. “Do you need to sleep with more than one pillow?”C. “Do you have to get up to urinate more frequently?”D. “Have you had a nausea, vomiting or diarrhea?”
D is the answer
Although these signs and symptoms are frequently seen with all drug therapy, they are frequently early side effects of digitalis toxicity.
Options A, B and C relate to the action of the other drugs.
The nurse is assigned to a client with HF. The nurse’s morning lung assessment indicates
crackles and wheezes in the mid to lower lung bases, R 32, client restless. Which nursing
intervention is of priority initially?
A. Assess capillary refill.
B. Take the pulse oximetry.
C. Limit client activity.
D. Assess fluid intake.
B is the answer
Client assessment indicates rapid breathing and possible hypoxia. To fully assess the respiratory status of the client, it is important to take the pulse oximetry.
Options A, C and D are important – but not priority – interventions.
It’s time for report…
Prioritize the five nursing interventions as you would do them
initially:
A – Assess respiratory rate.
B – Obtain urinary output data.
C – Assess rate/rhythm and quality of pulse.
D – Assess complaints of visual disturbances.
E – Check current lab data.
Cardiac Transplantation
• Done for cardiomyopathy, end-stage coronary artery disease, and valvular disease
• Recipient must remain on immunosuppressant medication for remainder of life
Cardiac Transplantation
Chapter 60
Infants with Special Needs:Birth to 12 Months
Congenital Cardiovascular Defects
• Categorized according to blood flow:– Increased pulmonary blood flow– Decreased pulmonary blood flow– Obstructed blood flow out of heart– Mixed blood flow
(continued)
Congenital Cardiovascular Defects
• Symptoms vary with type of disease
• Treatment:– Medications and surgery
Chapter 61
Common Problems: 1–18 Years
Cardiovascular, Hematologic, and Lymphatic Systems
• Rheumatic fever
• Leukemia
• Idiopathic thrombocytopenic purpura
• Hemophilia