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Chapter 36 Cardiovascular System. Anatomy and Physiology Review Heart, its vasculature, and peripheral vascular system Functions: –Provides oxygen, nutrients,

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Presentation on theme: "Chapter 36 Cardiovascular System. Anatomy and Physiology Review Heart, its vasculature, and peripheral vascular system Functions: –Provides oxygen, nutrients,"— Presentation transcript:

1 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




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 Homans sign

11 Assessment




15 Echocardiography

16 Electrocardiography

17 Normal Sinus Rhythm Sinoatrial (SA) 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 –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


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


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 None –Second and third degree 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: –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 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


53 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











65 Its 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


70 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


73 Right-Sided Heart Failure Develops when heart no longer capable of meeting bodys 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 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.

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. In reviewing the clients 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?

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 The nurse is assigned to a client with HF. The nurses 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.

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 Its 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 Chapter 60 Infants with Special Needs: Birth to 12 Months

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 Chapter 61 Common Problems: 1–18 Years

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

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