Session 7 Nadeeka Jayasinghe

OBJECTIVES Nursing assessment of a patient with cardiovascular problems Diagnostic tests Medical and surgical conditions related to the cardiovascular system: (Coronary Heart Disease, MI, Cardiogenic shock, endocarditis, myocarditis, pericarditis)

Assessment of Cardiovascular System

History Current and past cardiovascular systems Family history of cardiovascular problems (high blood pressure, increased cholesterol levels, stroke) Other diseases - diabetes, respiratory disorders Exercise program History of cigarette smoking Diet – salt & fat intake Symptoms – pain, shortness of breath, fatigue, palpitations, cough and fainting Medication Lifestyle – social support, stress, coping strategies

Physical Assessment Blood Pressure Pulse – strength, equality, regularity Apical pulse auscultation – rate, quality, rhythm Skin – colour, temperature, lesions, edema (ex: pitting edema in patients with congestive heart failure)

Diagnostic Studies Can help identify the presence of cardiovascular disease Can be used as a screening tool to recognise increased risk of developing cardiovascular dieasese (ex: serum lipid level)

Diagnostic studies Cardiac monitoring – continuous observation, during or after surgery, monitor responses to drug therapy ECG – 12 lead Blood tests: heamglobin, electrolytes, cardiac enzymes (CK, troponin) Hemodynamic studies – pressures involved in blood circulation (heart rate, arterial blood pressure, central venous pressure, stroke volume, cardiac output)

Coronory Artery Disease Atherosclerosis is an abnormal accumulation of lipids and fibrous tissues in the vessel wall. The atheromas (plaque) protrude into the lumen of the vessel, narrowing it and obstructing blood flow. The thrombus may obstruct blood flow leading to myocardial infarction or sudden death.

Risk Factors Modifiable risk factors: - Cholesterol levels - Cigarette smoking - Hypertension - Diabetes mellitus 2. Nonmodifiable risk factors: - Age - Gender - Family history - Race

Myocardial Infarction (MI) Myocardial cells are permanently destroyed Caused by reduced blood flow in coronary artery due to embolus or thrombus Pharmacologic Therapy: - Thrombolytic - Analgesics - ACE inhibitors Emergency percutaneous transluminal coronary angioplasty

Myocardial Infarction Signs/Symptoms: 1. Chest pain, substernally with radiation to arm, neck, jaw, or back; and unrelieved by rest or nitrates. 2. Diaphoresis and cool, clammy, pale skin. 3. Nausea and vomiting. 4. Dyspnea. 5. Palpitations or syncope. 6. Restlessness and anxiety. 7. Tachycardia or bradycardia. 8. Hypertension or hypotension

Nursing Management 1.Administer prescribed medications, morphine, nitrates, thrombolytic, anticoagulants; or stool softeners during rehabilitation. 2. Monitor ECG and cardiac enzymes( CPK,LDH) 3. Provide liquids or solid diet as tolerated (low sodium, low cholesterol, low fat) 4. Monitor and record vital signs. 5. Provide restful environment. 6. Psychological support. 7. Positioning.

Cardiogenic Shock Decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. Cardiogenic shock is the leading cause of death in acute MI, with mortality rates of up to % in the absence of aggressive, highly experienced technical care. Signs and symptoms: Hypotension Absence of hypovolemia Clinical signs of poor tissue perfusion (ie, oliguria, cyanosis, cool extremities, altered mentation)

Cardiogenic Shock - diagnosis Biochemical profile CBC Cardiac enzymes (eg, creatine kinase and CK-MB, troponins, myoglobin, LDH) Arterial blood gases Lactate Brain natriuretic peptide Echocardiography should be performed early to establish the cause of cardiogenic shock Chest radiographic findings are useful for excluding other causes of shock or chest pain (eg, aortic dissection, tension pneumothorax, pneumomediastinum) Coronary angiography is urgently indicated in patients with myocardial ischemia or MI who also develop cardiogenic shock Intensive Care management

Cardiogenic Shock - Management Fluid resuscitation to correct hypovolemia and hypotension, unless pulmonary edema is present Prompt initiation of pharmacologic therapy to maintain blood pressure and cardiac output Admission to an intensive care setting (eg, cardiac catheterization suite or ICU or critical care transport to a tertiary care center) Early and definitive restoration of coronary blood flow; at present, this represents standard therapy for patients with cardiogenic shock due to myocardial ischemia Correction of electrolyte and acid-base abnormalities (eg, hypokalemia, hypomagnesemia, acidosis)

ACTIVITY 3 groups Endocarditis, Myocarditis, Pericarditis Anatomy, Etiology, Clinical manifestations / Causes, Complications, Treatment

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