NUR-224

 Explain cardiac anatomy/physiology and the conduction system of the heart.  Incorporate assessment of cardiac risk factors into the health history and physical assessment of the patient with cardiovascular disease.  Discuss clinical indications, patient preparation and other elated nursing implications fro common test and procedures used to assess and diagnose cardiovascular diseases.

Three layers  Endocardium  Myocardium  Epicardium  Four chambers  Heart valves

 Surrounded by pericardium  Pericardial fluid mL  Divided by septum  Left ventricular wall 2-3 x as thick as right ventricle  Atrial wall thinner than ventricles

 Inferior and superior vena cava send deoxygenated blood to right atrium  Blood passes through tricuspid valve to right ventricle  blood passes from right ventricle through pulmonic valve via pulmonary artery to lungs  Blood from lungs enters left atrium via pulmonary veins  Passes through mitral valve to left ventricle  Blood ejected to body through aortic valve  aorta  peripheral system

 Depolarization (contraction of heart)  Sinoatrial node – pacemaker of heart  Contraction of atria  AV node  Bundle of His  Right and left bundle branches  Purkinje fibers

Systole  Contraction of myocardium  Ejection of blood from ventricles Diastole  Relaxation of myocardium  Filling of coronary arteries  Atrium is emptying into the ventricles

 Number of times the ventricles contract each minute   Regulated by: Autonomic Nervous System Sympathetic Parasympathetic

 Amount of blood pumped by each ventricle during a given period  Amount of blood ejected from ventricle with each beat (stroke volume) x heart rate CO = SV x HR 4 – 7 L/min

 Stroke volume: amount of blood ejected with each heartbeat  Cardiac output: amount of blood pumped by ventricle in liters per minute  Preload: degree of cardiac muscle fiber tension at end of diastole (prior to contraction)  Afterload: resistance that ventricles must overcome to eject the blood  Contractility: ability of cardiac muscle to shorten in response to electrical impulse

 Health history  Family/genetic history

 Chest pain  Dyspnea  Peripheral edema, weight gain  Palpitations  Fatigue  Dizziness, syncope, changes in level of consciousness

 Medications  Nutrition  Elimination  Activity, exercise  Sleep, rest  Self-concept  Roles, relationships  Sexuality  Risk factors

 Inspection  Palpation  Percussion  Auscultation

 Normal skin color  Capillary refill < 3 seconds  Thorax symmetrical  No jugular vein distention with patient at 45°  Absence of clubbing

 PMI palpable at 5th ICS mid-clavicular line  No thrills, heaves  Slight pulsation of abdominal aorta in epigastric region  Carotid and extremity pulses  equal bilaterally  No pedal edema

 Normal heart sounds  S1 and S2 heart sounds heard  Apical-radial rate equal and regular  No murmurs or extra heart sounds  No S3 or S4  Pericardial friction rub

 Extremities  Lungs  Abdomen

Laboratory test:  Diagnose the cause of cardiac-related signs/symptoms  Determine baseline values before initiating therapeutic interventions  Ensure therapeutic levels of medication are maintained  Evaluate the patient’s response to the therapeutic regimen  Identify abnormalities

 Cholesterol - normal level <200mg/dL  Major sources – diet, liver  Low density lipoproteins LDLs <160  High-density lipoproteins HDLs  Triglycerides <200

 CXR/Fluoroscopy  Electrocardiography  Cardiac stress testing  Echocardiography

 Coronary arteries dilate to 4x their normal in response to increased metabolic demands for oxygen.  Coronary arteries affected by atherosclerosis dilate less, compromising blood flow to the myocardium  ischemia  Noninvasive test  Abnormalities in CV function are more likely to be detected during times of increased stress.

 Determine : presence of CAD cause of chest pain functional capacity of the heart after MI/ heart surgery effective of antianginal/antiarrhythmic dysrhythmias/ physical exercise

Pre-Test  Physical and Baseline ECG  Signed consent  Patient teaching  Report cardiac symptoms during test  NPO 4 hours pre-test  Withhold meds  Emergency and resuscitation equipment need to be at site of test at all times

Testing procedure  Exercise equipment  Increase HR to target rate for age and gender OR c/o chest pain or fatigue  Speed or incline increased every 2-3 minutes to increase stress on patient  ECG and BP monitored throughout the test  Rest for 15 minutes post test while being monitored

 Invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries  Requires ECG, emergency equipment must be available  Assessment prior to test: allergies, blood work  Assessment of patient postprocedure: circulation, potential for bleeding, potential for dysrhythmias  Activity restrictions  Patient education pre/postprocedure

Preparation  √ allergies to shellfish  Signed consent form  D/C anticoagulants, ASA, salicylates, herbals affecting coagulants  Contraindicated; patients with bleeding disorders Elderly, dehydrated  Severe renal failure Patient Teaching  Palpitations as catheter enters left ventricle  Heat/hot flash as contrast medium injected  Sensation of need to cough as medium injected into right side of heart

During Procedure  nausea  pain at insertion site STAT Intervention  chest pain  dysrhythmias  changes in peripheral pulses  neuro assessment Post Procedure  VS & Neuro checks  insertion site  pressure dressing  bleeding/hematoma Assessment  extremities - s/s ischemia r/t clots  bed rest 4-6 hrs post procedure

 CVP  Pulmonary artery pressure  Intra-arterial BP monitoring