Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 18 NURSING CARE OF THE CLIENT: CARDIOVASCULAR SYSTEM

Heart Disease Since 1900, the leading cause of death in the United States every year except in Approximately 1.1. Million Americans experience myocardial infarction each year, with 367,000 ending in death. Congestive heart failure a factor in approximately 250,000 deaths each year.

Structure of the Heart Consists of three layers: Endocardium (inner lining of heart chambers and valves). Myocardium (thickest part of the heart; consists of cardiac muscle). Epicardium (inner layer of a double walled sac called the pericardium that surrounds the heart).

Structure of the Heart: Chambers The heart is a hollow muscular organ containing four chambers: Atria (upper chambers). Ventricles (lower chambers).

Structure of the Heart: Valves There are four valves in the heart: Tricuspid. Bicuspid (mitral). Pulmonic. Aortic.

Circulation of Blood Blood enters the heart through veins and leaves the heart through arteries. Blood is distributed throughout the body and returns to the right atrium of the heart through the inferior and superior vena cava.

Coronary Arteries Supply nutrients and oxygen to the muscle tissue of the heart. The two coronary arteries are the right coronary artery and the left coronary artery, which branch off the aorta.

Conduction System For the heart to beat regularly in a rhythmic sequence, electrical impulses follow a set pattern through the conduction system of the heart. The conduction system consists of the sinoatrial node, atrioventricular node, bundle of His, bundle branches and Purkinje fibers.

Arterioles and Arteries Arteries are thick-walled tubes that vasoconstrict (decrease in diameter) or vasodilate (increase in diameter). The arteries divide and branch into smaller vessels called arterioles, or smaller arteries.

Capillaries Very thin vessels that connect the smallest arterioles with the smallest venules.

Venules and Veins Venules are small vessels that emerge from the capillaries and gradually increase in size. As venules increase in size, they eventually form veins.

Health History Nurse has three goals when obtaining health history: Identify present and potential health problems. Identify possible familial and lifestyle risk factors. Involve the client in planning long-term health care.

Health History Nurse has three goals when obtaining health history: Identify present and potential health problems. Identify possible familial and lifestyle risk factors. Involve the client in planning long-term health care.

Assessment: Subjective Data Typical concerns expressed by client with cardiac disorder are chest pain, dyspnea (difficulty in breathing), edema, fainting, palpitations, diaphoresis, and fatigue.

Types of Dyspnea Exertional (when client participates in activity and becomes short of breath). Orthopnea (difficulty breathing when lying down). Paroxysmal nocturnal dyspnea (person suddenly awakes, is sweating, and is having difficulty breathing).

Assessment: Objective Data Skin. Neck veins. Respirations. Heart sounds. Abdomen. Extremities. A head-to-toe assessment of a cardiac client should include assessments of:

Homan’s sign Indicator of deep vein thrombosis (DVT). To test, nurse dorsiflexes the client’s foot. If there is pain in the calf or the leg or behind the knee, the Homan’s sign is positive and may indicate the presence of a venous clot.

Common Diagnostic Tests

Dysrhythmia: Defined as: An irregularity in the rate, rhythm, or conduction of the electrical system of the heart. Symptoms include fainting, seizures, fatigue, decreased energy level, exertional dyspnea, chest pain, and palpitations.

Bradycardia: Defined as: Sinus bradycardia is a heart rate of 60 beats/minute or less. Causes include myocardial infarction, electrolyte imbalances, vagal stimulation, heart block, drug toxicity, intracranial tumors, sleep, and vomiting.

Tachycardia A sinus rhythm with a heart beat ranging from 100 to 150 beats/minute. Causes are exercise, emotional stress, fever, medications, pain, anemia, thyrotoxicosis, pericarditis, heart failure, excessive caffeine intake, and tobacco use.

Atrial Dysrythmias Premature Atrial Contractions. Atrial Tachycardia. Paroxysmal Supraventricular Tachycardia. Atrial Flutter. Atrial Fibrillation.

Ventricular Dysrythmias Premature Ventrical Contractions. Ventricular Tachycardia. Ventricular Fibrillation. Ventricular Asytole.

Atrioventricular Blocks In atrioventricular blocks, the electrical conduction is interrupted to some degree between the atria and ventricles at the AV node. The extent of interruption is classified as First degree, Second Degree or Third Degree AV Blocks.

Inflammatory Disorders Inflammatory or infectious conditions of the heart include: Rheumatic Heart Disease. Endocarditis. Myocarditis. Pericarditis.

Rheumatic Heart Disease A complication of rheumatic fever that is linked to group A streptococcus following an upper respiratory infection. Rheumatic fever and rheumatic heart disease affect about 1.8 million persons in the United States.

Endocarditis May cause valvular heart disease with the possibility of the valve needing to be surgically replaced (valvuloplasty) or replaced with a mechanical (caged-ball valve or tilting-disk valve) or biological valve from a calf, pig, or human.

Pericarditis An inflammation of the membranous sac surrounding the heart. Causative organisms are viral, bacterial, fungal, or parasitic.

Valvular Heart Disease Occurs when the valves do not open and close properly. A thickening of the valve tissue, causing the valve opening to be narrow, is called valvular stenosis.

Mitral Valve Prolapse Mitral insufficiency can cause mitral valve prolapse, in which the valve leaflets, chordae tendineae, and papillary muscles become damaged.

Occlusive Disorders Arteriosclerosis. Angina Pectoris. Myocardial Infarction.

Arteriosclerois Narrowing and hardening of the arteries. Three types: Atherosclerosis (fatty deposits called plaque on inner lining of vessel walls). Calcific sclerosis (calcium deposits on the middle layer of the wall of the arteries). Arteriolar sclerosis (a thickening of the arterioles caused by hypertension).

Angina Pectoris Chest pain caused by temporary inadequate blood and oxygen supply to the myocardial tissues. Surgical treatment for angina includes a PTCA, intracoronary stent, transcatheter ablation, or a coronary artery bypass graft.

Myocardial Infarction (MI) Caused by an obstruction in a coronary artery resulting in necrosis (death of the tissues supplied by the artery. Obstruction is usually due to atherosclerotic plaque, a thrombus, or an ambolism.

Congestive Heart Failure (CHF) Often the final stage of many other heart conditions. Develops when the heart is no longer capable of meeting the oxygen needs of the body. The heart is literally failing.

Peripheral Vascular Disorders Venous thrombosis. Venous thrombophlebitis. Varicose veins. Raynaud’s disease. Aneurysm. Hypertension.

Venous Thrombosis/ Thrombophlebitis Phlebitis (inflammation in the wall of a vein without clot formation) Thrombosis (formation of a clot in a vessel). Phlebothrombosis (formation of a clot because of blood pooling in the vessel) Thrombophlebitis (formation of a clot due to an inflammation in the wall of the vessel)

Virchow’s Triad Three factors leading to the formation of a clot—pooling of blood, vessel trauma, and a coagulation problem—are called Virchow’s Triad.

Varicose Veins Also known as varicosities, they are visibly prominent, dilated, and twisted veins.

Buerger’s Disease (Thromboangiitis Obliterans) An inflammatory disease of the small and medium arteries and veins that leads to vascular obstruction.

Raynaud’s Disease/Phenomenon An intermittent spasm of the digital arteries and arterioles resulting in decreased circulation to the fingers and toes.

Aneurysm A localized dilation occurring in a weakened section of an artery’s medial layer. Symptoms of an aneurysm depend upon the location of the aneurysm in the body and are often asymptomatic until they start leaking or pressing on other structures.

Hypertension (HTN) Also known as high blood pressure, it is defined as an elevated arterial blood pressure. Often the hypertensive client may not be experiencing any symptoms and does not see the importance of caring effectively for this condition.