Presentation on theme: "1 NCLEX RN Preparation Program Cardiovascular Disorders Module 5, Part 2 of 3."— Presentation transcript:
1 NCLEX RN Preparation Program Cardiovascular Disorders Module 5, Part 2 of 3
2 Cardiovascular System Introduction The heart and the circulatory system comprise one of the most essential parts of the body. Failure to function results in death of the organism. Photo Source: National Heart, Lung and Blood Institute (NHLBI)
3 Gross Structure of the Heart Layers: Pericardium Fibrous Serous Pericardium Epicardium Myocardium Endocardium
4 Chambers of the Heart Heart, a muscular organ divided by a septum into two halves. Right or venous chamber and left or arterial chamber. Right Chambers Right Atrium Right Ventricle Left Chambers Left Atrium Left Ventricle
5 Coronary Blood Supply Right Coronary Artery Left Coronary Artery Left anterior descending Circumflex Photo Source: U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program
6 Valves of the Heart Valves are strong membranous openings that provide one-way flow of blood. Atrioventricular valves – prevent backflow of blood from ventricles to atria during systole. Tricuspid Mitral Semilunar valves – prevent backflow from the aorta and pulmonary arteries into the ventricles during diastole. Pulmonic Aortic
7 Valves of the Heart Photo Source: U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program
8 Conduction system Specialized tissue that allows rapid transmission of electrical impulses through the myocardium Sinoatrial node – main pacemaker of heart. Normal rhythmic, self-excitatory impulse is generated.
9 Conduction system Photo Source: St. Francis Hospitals & Health Centers, rg/DesktopDefault.aspx?tabid= 72&Class=Test&pageid=P rg/DesktopDefault.aspx?tabid= 72&Class=Test&pageid=P079 73
10 Gross Structure of Vasculature Arteries: transport blood under high pressure to body tissues Precapillary sphincters Arteriovenous shunts Capillaries – exchanging fluid and nutrients between blood and interstitial space. Veins: acts as conduits for transport of the blood from tissues back to heart
11 Physiology of the Heart Contraction – shortening or increase in muscle tension. Utilizes chemical energy to do the work of contraction Cardiac Muscle Principle: Frank Starling Law: the greater the heart is filled during diastole, within physiological limits, the greater the quantity of blood pumped into the aorta and pulmonary artery.
13 Baroreceptor Reflex (Pressoreceptors) Located in the walls of large systemic arteries Rise in pressure results in baroreceptors transmitting signals to CNS (Central Nervous System) to inhibit sympathetic action Other signals, in turn, sent to circulatory system to reduce pressure back to normal. Result: decreased heart rate, vasodilation, decreased BP.
14 Other Chemical Controls of Blood Pressure Kidney Adrenal cortex - aldosterone Renin-angiotensin system Antidiuretic hormone (vasopressin)
15 System Assessment Evaluate Patients History Pain Dyspnea Cyanosis Fatigue Palpitations Syncope Hemoptysis Edema Condition of Extremities
16 Evaluate veins and arterial pulses through inspection/palpation Veins Neck veins Arm and hand veins Leg and foot veins Arteries Central Peripheral pulses
22 Acute Coronary Syndromes Coronary Artery Disease (CAD) Narrowing or obstruction of one or more coronary arteries as a result of atherosclerosis, an accumulation of lipid-containing plaque in the arteries. Photo Source: National Heart, Lung and Blood Institute (NHLBI),
23 Pathophysiology Atherosclerosis - fat deposited in intima of arterial wall Inflammatory response begins Macrophages inflitrate area to ingest lipids, then die Smooth muscles cells within the blood vessel cover the area with fiber and plaque is formed. If the plaque is thin, the lipid center may grow, rupture, become a thrombus
24 Myocardial Ischemia / Angina Pectoris Decreased oxygen to heart Exercise-induced chest pain Unstable angina Other risk factors
25 Coronary Artery Disease Myocardial ischemia CLINICAL MANIFESTATIONS: May be asymptomatic unless ischemia occurs Chest pains or pressure, may radiate to jaw, back, shoulder Palpitations, weakness Dyspnea Syncope Nausea Excessive fatigue EKG changes (T wave inversion)
26 Coronary Ischemia/Angina Silent angina - no symptoms, but EKG changes. Often occurs in diabetic patients with CAD.
27 Teaching for Angina Rest at onset of chest pain Take one nitroglycerin, repeat 2 more prn No relief by 3rd, call 911 Previous angina with particular activity, take nitroglycerin prior to activity
34 MONA Acronym from Advanced Cardiac Life Support (ACLS) though order is ONMA. O = Oxygen 2-4 liters per nasal cannula N = Nitroglycerin (if not already tried outside hospital); relieves pain M= Morphine relieves pain, decreases anxiety, increases venous pooling (to reduce cardiac workload) A = Aspirin prevents platelet aggregation at the site of obstruction
35 Reperfusion Strategies Thrombolytics Percutaneous Transluminal Coronary Angioplasty (PTCA) Stent Procedure Photo Source: National Heart, Lung and Blood Institute (NHLBI),
36 Post-PCTA Care Monitor V/S Assess distal pulses Bed rest with limb straight for 6 – 8 hours Anticoagulants/antiplatelet agents – prevent thrombus formation Monitor IV nitroglycerin – prevent coronary artery spasms ASA once a day permanently Assist planning lifestyle modification
37 Acute Myocardial Infarction Bed rest for 24 to 36 hrs Pain control Monitor rhythm Assess for new murmurs Monitor potassium, magnesium Monitor for heart failure Gradual increase of activities
56 Patient Education Programmed rate When to notify MD: Dizziness, weakness, sudden weight gain of 3-5 pounds overnight, persistent hiccups. Check pulse daily, report sudden slowing or increasing of pulse. Signs/symptoms to report: Fever, redness, swelling, drainage from insertion site, dizziness, fatigue, shortness of breath, chest pains, swelling of ankles/legs Pacemaker identification, medic alert Measure pulse daily, keep record
57 Patient Education (continued) Wear loose-fitting clothing Avoid contact sports Inform all health care providers of pacemaker Most electrical appliances can be used without any interference with the functioning of the pacemaker. If any unusual feelings occur when near any electrical devices, move 5 to 10 feet away and check pulse.
58 Congestive Heart Failure Inability of the heart to maintain adequate circulation to meet the metabolic needs of the body because of impaired pumping actions. Cardiac output diminished and peripheral tissue not adequately perfused Congestion of the lungs and periphery may occur. Classification: Acute and Chronic Types: Right-sided/left-sided heart failures
59 Congestive Heart Failure Clinical manifestations Weight gain, I & 0, edema, if severe: ascites Crackles in lungs (especially bibasilar) Dyspnea, orthopnea, urinary frequency, murmurs (if valve problem) S3 heart sound - sign heart beginning to fail & increased blood volume remains in heart after each beat BNP lab test - the higher the number, the worse the CHF is. Can monitor severity of CHF, improvement due to treatment regimen, timely diagnosing of CHF Jugular vein distension, LOC, pulse oximetry.
61 CHF: Nursing Management Elevate head of bed Give oxygen Decrease oxygen demand Exacerbation? Identify precipitating factors Teach: low-salt diet, medications and their rationale, weigh daily, exercise but pace activities. Wait 90 min. after meals to exercise. Avoid extremes in weather when exercising.
62 Cardiac Valve Disorders Mitral stenosis Mitral prolapse Aortic stenosis Aortic regurgitation Photo Source: National Heart, Lung and Blood Institute (NHLBI),
63 Cardiac Valve Disorders Clinical Manifestations: Heart murmur Left ventricular hypertrophy seen on EKG
67 Pericarditis Inflammation of pericardial sac. Can be caused by viral infection, complicaton after cardiac surgery 10 days to 2 months, or after MI Idiopathic cause, or disorder of connective tissue (lupus), cancer, radiation therapy, etc
68 Pericarditis: Manifestations Chest pain on inspiration, worse when patient leans forward, lying down or turning Pericardial friction rub Symptoms of right-sided heart failure Mild fever, elevated WBC, ESR Atrial fibrillation common 12 lead EKG may have elevation in ALL leads Can worsen to cardiac tamponade
69 Pericarditis Collaborative Management NSAIDs or corticosteroids Pericardiocentesis or surgical pericardial window
70 Pericarditis: Nursing Mgmt Position for comfort Monitor for cardiac tamponade (fluid between heart and pericardial sac) that causes heart to be compressed inside the sac leading to decreased blood pressure and shock, distant heart sounds Teach: gradual increases of activity Teach: avoid aspirin, anticoagulants
71 Infective Endocarditis Valves infected, spreads to endothelium Leaflets deform, leak High risk: elderly, prosthetic valves, IV drug abusers, immunosuppressed
73 Management IV antimicrobials based on cultures Teach prevention Monitor: sepsis, new murmur, stroke, meningitis, CHF
74 Hypertension Pathophysiology 90-95% unknown cause 5-10% secondary causes Some genetic tendency, obesity, stress, excess sodium intake Prolonged hypertension eventually damages blood vessels, heart (LVH) and kidneys, eyes, brain.
75 Hypertension Clinical manifestations Usually asymptomatic silent killer Some report headache, especially early morning Risk factors Family history Age Diabetes Obesity Heavy alcohol High sodium intake
76 Hypertension Goals: reduce BP. Goal: 120/80 Ask for S/S indicative of HTN Obtain BP on both arms Family history, weight, dietary patterns Identify medication therapy Assess cardiac, neuro, renal, diagnostic and lab studies.
77 Hypertension Collaborative Management Medications: diuretics, beta blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, alpha blockers Monitor and routine follow-up with EKG, lipid lower agents if needed
78 Hypertension Nursing Management TEACH: weight loss, stress management, rationale for medications prescribed & their importance. Low-sodium, low-fat, low- cholesterol diet. Stop smoking. Limit caffeine, alcohol. Teach how to modify risk factors. Monitor for target-organ problems. Teach potential problems if hypertension untreated. Many people undiagnosed. Promote screening for early detection.
82 Peripheral Vascular Disease (PVD) Pathophysiology Generalized atherosclerosis (plaque development) or arteriosclerosis (hardening of the arteries) Narrowing of lumen, obstruction by thrombosis Bifurcation or branch areas higher risk of blockage. If have PVD, at risk of having CAD as well
84 PVD: Management Medications Control hypertension Angioplasty, bypasses Exercises Position Vasodilation Avoid vasoconstriction
85 Arterial Bypass Monitor for graft occlusion Promote graft patency Monitor for compartment syndrome
86 Peripheral Venous Insufficiency Stasis dermatitis lower legs Edema Ulcers over malleoli Anterior leg ulcers if arterial flow impaired
87 Peripheral Vascular Disease Compression stockings Sequential compression pump Manage ulcers Elevate legs Avoid prolonged sitting or standing No compression of legs
88 Abdominal Aortic Aneurysm Localized dilatation of the wall of the abdominal aorta caused by congenital weakness, trauma, disease, atherosclerosis Risk factors: smoking, hypertension Progressive weakening and enlarging of area of vessel If a tear develops - medical emergency (rupture)
89 Aortic Aneurysms Goal of treatment: limit progression of the condition by modifying risk factors, controlling BP, recognizing symptoms early, and preventing rupture Photo Source: National Heart, Lung and Blood Institute (NHLBI),
90 Abdominal Aortic Aneurysm Clinical Manifestations: Can palpate enlarged aorta, possible bruit ausculated If rupture, sudden pain in back or abdomen If tearing, pain in abdominal area or back; can be slowly progressive If rupture-hemorrhage, shock, death unless emergent surgical intervention
92 Thoracic Aortic Aneurysm Pain: neck, shoulders, lower back or abdomen Syncope Dyspnea Tachycardia Cyanosis Weakness
93 Manage Thoracic Aneurysm Monitor V/S Assess for pain – abdominal or back pains. Check peripheral pulses, including temperature and color Observe for signs of rupture Note tenderness/distention of abdomen
94 Photo Acknowledgement: All unmarked photos and clip art contained in this module were obtained from the 2003 Microsoft Office Clip Art Gallery.