1. Cardiovascular System
Chapter 36
Cardiovascular System

2. 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

3. Anatomy and Physiology Review

4. Anatomy and Physiology Review

5. Anatomy and Physiology Review

6. Anatomy and Physiology Review

7. 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)

8. Health History Onset of symptoms Predisposing factors
Treatment of symptoms
Activity level or limitations
Appetite
Ability to sleep
Cardiovascular risk factors

9. Assessment Subjective data:
Chest pain, dyspnea, edema, fainting, palpitations, diaphoresis, fatigue, and orthopnea
(continued)

10. 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

11. Assessment

12. Assessment

13. Assessment

14. Assessment

15. Echocardiography

16. Electrocardiography

17. Normal Sinus Rhythm Sinoatrial (SA) node Atrioventricular (AV) node
Natural pacemaker
Wave causes atria to contract
Atrioventricular (AV) node
Impulse pauses
(continued)

18. Normal Sinus Rhythm AV bundle
Divides into right and left bundle branches
Divides into Purkinje fibers
Causes ventricles to contract

19. Normal Sinus Rhythm

20. 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)

21. Dysrhythmias Symptoms vary from none to cardiac arrest:
Fainting, seizures, fatigue, decreased energy level, exertional dyspnea, chest pain, and palpitations

22. Types of Dysrhythmias Bradycardia Tachycardia
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

23. Bradycardia

24. Tachycardia

25. Atrial Dysrhythmias
Occur from electrical conduction disturbances in atria:
Premature atrial contractions
Atrial tachycardia
Paroxysmal supraventricular tachycardia
Atrial flutter
Atrial fibrillation
(continued)

26. Atrial Flutter

27. Atrial Flutter

28. Atrial Fibrillation

29. Atrial Dysrhythmias Treatment depends on cause:
Pacemaker, vagal stimulation, antidysrhythmic medication, and cardioversion

30. Ventricular Dysrhythmias
Originate in ventricles
More life-threatening
Include:
Premature ventricular contractions
Ventricular tachycardia
Ventricular fibrillation
Ventricular asystole
(continued)

31. Premature Ventricular Contraction

32. Ventricular Fibrillation

33. Ventricular Fibrillation

34. Asystole

35. Ventricular Dysrhythmias
Treatment depends on cause:
Oxygen, amiodarone (Cordarone), magnesium sulfate, lidocaine, cardioversion or defibrillation, CPR, and advanced cardiac life support (ACLS) protocol

36. AV Blocks
Electrical conduction interrupted to some degree between atria and ventricles at AV node
Degrees:
First
Second
Third
(continued)

37. AV Blocks Treatment: First degree Second and third degree None
Pacemaker

38. 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)

39. Rheumatic Heart Disease
Clients require prophylactic antibiotic therapy before dental procedures or invasive surgery

40. Infective Endocarditis
Inflammation or infection of inside lining of heart
Including valves
Acute symptoms:
Tachycardia, pallor, diaphoresis, and symptoms of infection
(continued)

41. 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

42. Myocarditis Inflammation of myocardium Symptoms: Treatment:
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

43. Pericarditis Inflammation of membranous sac surrounding heart
Symptoms:
Severe chest pain and pericardial friction rub
Complication:
Cardiac tamponade
(continued)

44. Pericarditis

45. Pericarditis
Treatment:
Pericardiocentesis, surgery, and medications

46. 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

47. Valvular Heart Diseases

48. 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

49. Atherosclerosis

50. 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)

51. Angina Pectoris

52. Angina Pectoris

53. 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)

54. Angina Pectoris

55. Angina Pectoris

56. Angina Pectoris

57. Angina Pectoris

58. Angina Pectoris

59. Angina Pectoris

60. Angina Pectoris

61. Angina Pectoris

62. Angina Pectoris

63. Angina Pectoris

64. Angina Pectoris

65. It’s time for report…

66. 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.

67. 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)

68. Myocardial Infarction

69. Myocardial Infarction

70. 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

71. Myocardial Infarction

72. Myocardial Infarction

73. 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)

74. Right-Sided Heart Failure
Symptoms:
Edema (may be pitting) in extremities and trunk, anorexia, hepatomegaly, splenomegaly, distended jugular veins, and oliguria

75. 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)

76. 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

77. 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

78. Pitting edema in the lower extremities.
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?
Pulse 89, irregular.
Urine output 60mL.
Pulse oximetry 94%.
Pitting edema in the lower extremities.

79. 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.

80. The home health nurse visits 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?
“Do you get light-headed when you get out of bed?”
“Do you need to sleep with more than one pillow?”
“Do you have to get up to urinate more frequently?”
“Have you had a nausea, vomiting or diarrhea?”

81. 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.

82. Assess capillary refill. Take the pulse oximetry.
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?
Assess capillary refill.
Take the pulse oximetry.
Limit client activity.
Assess fluid intake.

83. 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.

84. It’s time for report…

85. 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.

86. Cardiac Transplantation
Done for cardiomyopathy, end-stage coronary artery disease, and valvular disease
Recipient must remain on immunosuppressant medication for remainder of life

87. Cardiac Transplantation

88. Infants with Special Needs: Birth to 12 Months
Chapter 60
Infants with Special Needs: Birth to 12 Months 88

89. 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)

90. Congenital Cardiovascular Defects
Symptoms vary with type of disease
Treatment:
Medications and surgery

91. Common Problems: 1–18 Years
Chapter 61
Common Problems: 1–18 Years

92. Cardiovascular, Hematologic, and Lymphatic Systems
Rheumatic fever
Leukemia
Idiopathic thrombocytopenic purpura
Hemophilia