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Nursing of Adult Patients with Medical & Surgical Conditions Cardiovascular Disorders.

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Presentation on theme: "Nursing of Adult Patients with Medical & Surgical Conditions Cardiovascular Disorders."— Presentation transcript:

1 Nursing of Adult Patients with Medical & Surgical Conditions Cardiovascular Disorders

2 Diagnostic Tests n Diagnostic Imaging –Radiographic exam to assess heart size, shape and position and outline of shadows.

3 Diagnostic Tests –Computed Axial Tomography (CT/CAT Scan) Three dimensional view of the structure

4 Diagnostic Tests –Angiogram radiographs are taken after injection of dye into an artery –Aortogram visualizes the abdominal aorta and the major leg arteries with injection of dye into the femoral artery Iliac Artery

5 Diagnostic Tests Fluoroscopy Demo –Fluoroscopy action-picture

6 Diagnostic Tests n Cardiac Catherterization and Angiography –Visualizes the heart’s chambers, valves, great vessels, and coronary arteries –Catheter is inserted into the heart chambers to measure pressure, and blood-volume. –Contrast dye may be used for better visualization –Post-procedure: supine, with sandbag over pressure dressing at insertion site

7 Cardiac Catheterization

8 Cardiac Catheterization Lab

9 Cardiac Catheterization with Contrast

10 Diagnostic Tests n Electrocardiogram –Graphic study of the electrical activities of the myocardium

11 Review of Cardiac Electrical Activity

12 Diagnostic Tests n Electrocardiogram –P-wave contraction (depolarization) of the atria –QRS complex contraction (depolarization) of the ventricles relaxation (repolarization) of the atria is covered by the QRS complex –T-wave relaxation (repolarization) of the ventricles

13 Relationship of EKG to cardiac muscle activity (SA Node fires) (Impulse to AV node) (Impulse moves through Bundle of His & Perkinje fibers) Ventricular Depolarization Atrial Depolarization Ventricular Repolarization

14 Electrocardiogram

15 Diagnostic Tests n Cardiac Monitors –Continual monitoring of the cardiac electrical activity on a video monitor –Telemetry electronic transmission of data to a distant location

16 Diagnostic Tests n Thallium Scanning –Thallium 201 is injected and the patient exercises on a treadmill –Thallium is transported into normal cells, but not ischemic or infarcted cells

17 Thallium Scanning

18 Diagnostic Tests n Echocardiography –Ultrasound is used to record size, shape, and position of cardiac structures –Detects: pericardial effusion ventricular function cardiac chamber size and contents ventricular muscle and septal motion and thickness cardiac output cardiac tumors valvular function congenital heart disorders.

19 Echocardiography Echocardiogram Demo

20 Echocardiography

21 Diagnostic Tests n Positron Emission Tomography (PET) –Computerized radiographic technique that uses radioactive substances to examine the metabolic activity of various body structures –Used to study dementia, stroke, epilepsy, tumors, and cardiac tissue PET Demonstration

22 Diagnostic Tests n Laboratory Exams –Blood cultures Culture and sensitivity –Compete Blood Count (CBC) RBC (erythrocytes) 4-6 million/cu.mm Hemoglobin gm/100ml Hematocrit percent WBC 5,000-10,000/mm Platelets 150, ,000/mm –Coagulation Studies Prothrombin Time (PT) seconds Partial thromboplastin time (PTT) seconds –Erythrocyte sedimentation rate (ESR) Up to 20mm/minute

23 –Serum electrolyte tests sodium - maintains fluid balance ( mEq/L) potassium - relaxes heart muscle (3-5 mEq/L) calcium - contraction of cardiac muscle (9-11mg/dl) magnesium - maintain level of electrical excitability in the nerves and muscles (1-2 mEq/L) –Serum lipids Total Cholesterol ( mg/dl) High Density Lipoprotein (HDL) (35-85 mg/dl) Low Density Lipoprotein (LDL) (below 100mg/dl) Triglycerides ( mg/dl) –Arterial blood gases pH PaCO mm Hg PaO mm Hg HCO mEq/L SaO %

24 Diagnostic Tests n Cardiac Enzyme Studies –CPK isoemzyme II (MB) enzyme is released when the heart muscle is damaged or necrosis occurs levels rise in 3-6 hours, peak in hours, and may remain elevated for 3-4 days Normal Value U/L –LDH Rises within the first hours, peaks in 3-4 days, and returns to normal in approx 14 days Normal Value U/L

25 Risk Factors for Cardiovascular Disorders n Nonmodifiable Factors –Family History Parent or sibling who has CV disorder before 50 yrs –Age Normal physiological changes Approx 50% of all MI occur after 65 yrs –Sex (Gender) Men are at greater risk than women –Race African Amer. males are at higher risk of hypertension

26 Risk Factors for Cardiovascular Disorders n Modifiable Factors –Smoking 2-3 times greater risk –Hyperlipidemia Diet high in saturated fat, cholesterol, and calories Cholesterol levels above 200 mg/dl –Hypertension B/P higher than 140/90

27 Risk Factors for Cardiovascular Disorders –Diabetes Mellitus Damage to vessels due to high glucose levels High cholesterol levels (abnorm. lipid metabolism) –Obesity Increases workload of the heart –Sedentary Lifestyle Exercise improves the heart’s efficiency, lowers glucose & cholesterol levels, lowers B/P, reduces weight, and reduces stress levels

28 Risk Factors for Cardiovascular Disorders –Stress Catecholamines are released which cause increased heart rate and damage to myocardial cells –Oral Contraceptives Not clearly defined –Older high dose contraceptives made women at higher risk for cardiovascular disorders – esp. smokers –Newer low dose contraceptives don’t seem to cause that risk –Psychosocial Factors Type A personality –aggressiveness, competitiveness, perfectionism, & compulsiveness

29 Cardiac Dysrhythmias n Normal Sinus Rhythm –Originates in the SA node –Rate: beats/min –Rhythm: regular

30 n Sinus Tachycardia –Originates in the SA node –Rate: –Rhythm: regular –Causes: exercise, anxiety, fever, shock, medications, hypothermia, heart failure, excessive caffeine, and tobacco Not usually caused by cardiac problems –Treatment: Directed at cause

31 n Sinus Bradycardia –Originates: SA node –Rate: less than beats per min –Rhythm: regular –Cause: sleep, vomiting, intracranial tumors, MI, drugs, vagal stimulation, endocrine disturbances, and hypothermia –Treatment: Directed toward cause Atropine to increase heart rate Temporary or permanent pacemaker

32 n Supraventricular Tachycardia (SVT) n Premature Atrial Contraction (PAC) –Originates: atria –Rate: beats/min –Rhythm: regular –Causes: drugs, alcohol, mitral valve prolapse, emotional stress, smoking, and hormone imbalance usually not caused by heart disease –Treatment: Eliminate underlying cause Decrease heart rate –carotid sinus pressure, ocular pressure, digitalis, calcium channel blockers, propranolol, quinidine, and cardioversion

33 n Atrial Fibrillation –Originates: atria –Rate: –Rhythm: irregular; may be unable to count –Causes: atherosclerosis, mitral valve disease, CHF, cardiomyopathy, congenital abnormalities, COPD, and thyrotoxicosis –Treatment: digitalis, calcium channel blockers (verapamil), antidysrhythmics (procainamide), quinidine, anticoagulants (heparin, coumadin) and cardioversion

34 n Atrioventricular Block (1st, 2nd, & 3rd degree) –Originates: SA node; impulse is slowed at the AV junction due to a defect –Rate: 1st degree beats/min 2nd degree beats/min 3rd degree - may be no heart beat –Cause: atherosclerotic heart disease, MI, CHF, digitalis toxicity, congenital abnormality, drugs, and hypokalemia –Treatment: directed at cause atropine and isoproterenol pacemaker for 3rd degree

35 n Premature Ventricular Contractions (PVC) –Originates: ventricles –Rate: beats/min –Rhythm: regular with an occasional extra beat may occur as a single event or may occur several times in a minute, or in pairs or strings –Cause: irritability of the ventricules, exercise, stress, electrolyte imbalance, digitalis toxicity, hypoxia, and MI –Treatment: Treat the cause antidysrhythmics (lidocaine, procainamide, or bretylium

36 n Ventricular Tachycardia –Originates: ventricles; 3 or more successive PVC’s –Rate: beats/min –Rhythm: regular to slightly irregular –Cause: hypoxemia, drug toxicity, electrolyte imbalance, and bradycardia –Treatment IV procainamide (decrease excitability of cardiac muscle) Lidocaine with MI Cardioversion

37 n Ventricular Fibrillation –Originates: ventricles –Rate: none –Rhythm: none –Cause: untreated ventricular tachycardia, electrolyte imbalances, digitalis or quinidine toxicity, and hypothermia –Treatment: Emergency care –CPR –defibrillation (15-20 seconds of the onset) –medications »lidocaine, bretylium, or procainamide

38 Artificial Cardiac Pacemakers n Pacemaker –Battery-operated generators that initiate and control the heart rate by delivering an electrical impulse to the myocardium –Temporary Used for cardiac support following some MI’s or open-heart surg. –Permanent Used when other measures have failed to convert the dysrhythmia or conduction problem 2nd & 3rd degree AV block, bradydysrhythmias, & tachydysrhythmias

39 Internal Pacemaker Catheter-like electrode is placed in the area to be paced and generator is embedded under the skin

40 External Pacemaker Electrode pad is placed on the chest wall and is attached to a generator place in a pocket or pouch

41 Artificial Cardiac Pacemakers n Nursing Interventions –Post-op monitor heart rate and heart monitor assess vital signs and level of consciousness assess insertion site for erythema, edema, and tenderness bed rest with arm immobilized for first few hours –Patient Teaching continued medical care is very important medical-alert ID report signs & symptoms of pacemaker failure –weakness, vertigo, chest pain, pulse changes avoid electrical equipment –hairdryers, battery-operated toothbrushes, etc. avoid high-output electrical genterators and large magnets (MRI) teach patient or family member to check pulse rate notify physician if heart rate drops below 70


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