cardiovascular diseases modified
TRANSCRIPT
CARDIOVASCULAR DISEASES
Nelia B Perez RN MSN
PCU ndash MJCN
BSN 2013
THE CARDIOVASCULAR SYSTEM
THE CARDIOVASCULAR SYSTEM
GENERAL CARDIAC ASSESSMENT
bull Health historybull Demographic informationbull Familygenetic historybull Culturalsocial factors
bull Risk factorsbull Modifiable High blood cholesterol
obesity smoking stress hypertension diabetes mellitus
bull Nonmodifiable Family history increasing age gender race
Pathophysiology
ASSESSING CHEST PAIN
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Onset Gradual Sudden Sudden Gradual Sudden
Gradual Sudden
Abrupt Gradual Sudden
Precipitating Factors
At rest after exercise or emotional stress
Breathing deeply rotating trunk yawning
Inflammation of GI parts increased HCL medications
After exercise emotional stress eating envtrsquol changes
Hypertension Immobility Prolonged bedrest
Location Substernal anterior chest rarely back radiates to jawneck
Precordial rotates to neck left shoulder amp arm
Xiphoid to umbilicus
Substernal anterior chest poorly localized
Site of rupture anterior chest or back between scapula
Pleural area retrosternal
Quality Crushing burning stabbing squeezing vicelike
Pleuritic sharp Aching burning cramplike gnawing
Squeezing feeling of heavy pressure burning
Sharp tearing ripping
Sharp stabbing
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic
MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Intensity Asymptomatic to severe increases with time
Mild to severe Mild to severe Mild to moderate
Severe unbearable maximal from onset
Aggravated by breathing
Duration 30 min to 1-2 hours may wax and wane
Continuous Periodic 2-10 min ave 3-5 min
Continuous does not abate once started
Variable
Relief Narcotics Sitting up leaning forward
Physical emotional rest food antacid
Nitroglycerin rest
Large repeated doses of narcotics
02 sitting up morphine
Associated Symptoms
Nausea fatigue heartburn equal peripheral pulses
Fever dyspnea nausea anorexia anxiety
NV dysphagia anorexia weight loss
Belching indigestion dizziness
Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses
Dyspnea tachypnea diaphoresis hemoptysis cough apprehension
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Pathophysiology
ASSESSING CHEST PAIN
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Onset Gradual Sudden Sudden Gradual Sudden
Gradual Sudden
Abrupt Gradual Sudden
Precipitating Factors
At rest after exercise or emotional stress
Breathing deeply rotating trunk yawning
Inflammation of GI parts increased HCL medications
After exercise emotional stress eating envtrsquol changes
Hypertension Immobility Prolonged bedrest
Location Substernal anterior chest rarely back radiates to jawneck
Precordial rotates to neck left shoulder amp arm
Xiphoid to umbilicus
Substernal anterior chest poorly localized
Site of rupture anterior chest or back between scapula
Pleural area retrosternal
Quality Crushing burning stabbing squeezing vicelike
Pleuritic sharp Aching burning cramplike gnawing
Squeezing feeling of heavy pressure burning
Sharp tearing ripping
Sharp stabbing
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic
MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Intensity Asymptomatic to severe increases with time
Mild to severe Mild to severe Mild to moderate
Severe unbearable maximal from onset
Aggravated by breathing
Duration 30 min to 1-2 hours may wax and wane
Continuous Periodic 2-10 min ave 3-5 min
Continuous does not abate once started
Variable
Relief Narcotics Sitting up leaning forward
Physical emotional rest food antacid
Nitroglycerin rest
Large repeated doses of narcotics
02 sitting up morphine
Associated Symptoms
Nausea fatigue heartburn equal peripheral pulses
Fever dyspnea nausea anorexia anxiety
NV dysphagia anorexia weight loss
Belching indigestion dizziness
Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses
Dyspnea tachypnea diaphoresis hemoptysis cough apprehension
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ASSESSING CHEST PAIN
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Onset Gradual Sudden Sudden Gradual Sudden
Gradual Sudden
Abrupt Gradual Sudden
Precipitating Factors
At rest after exercise or emotional stress
Breathing deeply rotating trunk yawning
Inflammation of GI parts increased HCL medications
After exercise emotional stress eating envtrsquol changes
Hypertension Immobility Prolonged bedrest
Location Substernal anterior chest rarely back radiates to jawneck
Precordial rotates to neck left shoulder amp arm
Xiphoid to umbilicus
Substernal anterior chest poorly localized
Site of rupture anterior chest or back between scapula
Pleural area retrosternal
Quality Crushing burning stabbing squeezing vicelike
Pleuritic sharp Aching burning cramplike gnawing
Squeezing feeling of heavy pressure burning
Sharp tearing ripping
Sharp stabbing
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic
MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Intensity Asymptomatic to severe increases with time
Mild to severe Mild to severe Mild to moderate
Severe unbearable maximal from onset
Aggravated by breathing
Duration 30 min to 1-2 hours may wax and wane
Continuous Periodic 2-10 min ave 3-5 min
Continuous does not abate once started
Variable
Relief Narcotics Sitting up leaning forward
Physical emotional rest food antacid
Nitroglycerin rest
Large repeated doses of narcotics
02 sitting up morphine
Associated Symptoms
Nausea fatigue heartburn equal peripheral pulses
Fever dyspnea nausea anorexia anxiety
NV dysphagia anorexia weight loss
Belching indigestion dizziness
Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses
Dyspnea tachypnea diaphoresis hemoptysis cough apprehension
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Onset Gradual Sudden Sudden Gradual Sudden
Gradual Sudden
Abrupt Gradual Sudden
Precipitating Factors
At rest after exercise or emotional stress
Breathing deeply rotating trunk yawning
Inflammation of GI parts increased HCL medications
After exercise emotional stress eating envtrsquol changes
Hypertension Immobility Prolonged bedrest
Location Substernal anterior chest rarely back radiates to jawneck
Precordial rotates to neck left shoulder amp arm
Xiphoid to umbilicus
Substernal anterior chest poorly localized
Site of rupture anterior chest or back between scapula
Pleural area retrosternal
Quality Crushing burning stabbing squeezing vicelike
Pleuritic sharp Aching burning cramplike gnawing
Squeezing feeling of heavy pressure burning
Sharp tearing ripping
Sharp stabbing
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic
MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Intensity Asymptomatic to severe increases with time
Mild to severe Mild to severe Mild to moderate
Severe unbearable maximal from onset
Aggravated by breathing
Duration 30 min to 1-2 hours may wax and wane
Continuous Periodic 2-10 min ave 3-5 min
Continuous does not abate once started
Variable
Relief Narcotics Sitting up leaning forward
Physical emotional rest food antacid
Nitroglycerin rest
Large repeated doses of narcotics
02 sitting up morphine
Associated Symptoms
Nausea fatigue heartburn equal peripheral pulses
Fever dyspnea nausea anorexia anxiety
NV dysphagia anorexia weight loss
Belching indigestion dizziness
Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses
Dyspnea tachypnea diaphoresis hemoptysis cough apprehension
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
Characteristic
MI Pericarditis GI Prob Angina Dis Aneurysm P Embolism
Intensity Asymptomatic to severe increases with time
Mild to severe Mild to severe Mild to moderate
Severe unbearable maximal from onset
Aggravated by breathing
Duration 30 min to 1-2 hours may wax and wane
Continuous Periodic 2-10 min ave 3-5 min
Continuous does not abate once started
Variable
Relief Narcotics Sitting up leaning forward
Physical emotional rest food antacid
Nitroglycerin rest
Large repeated doses of narcotics
02 sitting up morphine
Associated Symptoms
Nausea fatigue heartburn equal peripheral pulses
Fever dyspnea nausea anorexia anxiety
NV dysphagia anorexia weight loss
Belching indigestion dizziness
Syncope loss of sensations pulses oliguria BP discrepancies decrease in pulses
Dyspnea tachypnea diaphoresis hemoptysis cough apprehension
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Angina Pectoris Myocardial IschemiaIschemia ndash suppressed blood flowAngina ndash to chokeOccurs when blood supply is
inadequate to meet the heartrsquos metabolic demands
Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Pathophysiology
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Types
AStable angina ndash the common initial manifestation of a heart diseaseCommon cause atherosclerosis
(although those with advance atherosclerosis do not develop angina)
Pain is precipitated by increased work demands of the heart (ie physical exertion exposure to cold amp emotional stress)
Pain location precordial or substernal chest area
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Pain characteristics - constricting squeezing or
suffocating sensation- Usually steady increasing in
intensity only at the onset amp end of attack
- May radiate to left shoulder arm jaw or other chest areas
- Duration lt 15mins- Relieved by rest (preferably sitting
or standing with support) or by use of NTG
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
B VariantVasospastic Angina (Prinzmetal Angina) 1st described by Prinzmetal amp
Associates in 1659 Cause spasm of coronary
arteries (vasospasm) due to coronary artery stenosisMechanism is uncertain (may
be from hyperactive sympathetic responses mishandling defects of calcium in smooth vascular muscles reduced prostaglandin I2 production)
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Pain Characteristics occurs during rest or with minimal exercise
- commonly follows a cyclic or regular pattern of occurrence (ie Same time each day usually at early hours)
If client is for cardiac cath Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack amp demonstrate the presence amp location of spasm
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Conthellip
C Nocturnal Angina - frequently occurs nocturnally (may be associated with REM stage of sleep)
D Angina Decubitus ndash paroxysmal chest pain occurs when client sits or stands up
E Post-infarction Angina ndash occurs after MI when residual ischemia may cause episodes of angina
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ConthellipDx detailed pain history ECG TST
angiogram may be used to confirm amp describe type of angina
Tx directed towards MI prevention- Lifestyle modification (individualized
regular exercise program smoking cessation)
- Stress reduction- Diet changes- Avoidance of cold- PTCA (percutaneous transluminal
coronary angioplasty) may be indicated if with severe artery occlusion
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Drug Therapy Nitroglycerin (NTGs) ndash
vasodilators patch (Deponit
Transderm-NTG) sublingual (Nitrostat) oral (Nitroglyn) IV (Nitro-Bid)
Β-adrenergic blockers Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor)
Calcium channel blockers Nifedipine (Calcibloc
Adalat) Diltiazem (Cardizem)
Lipid lowering agents ndashstatins Simvastatin
Anti-coagulants ASA (Aspirin)Heparin sodiumWarfarin (Coumadin)
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Classification
Class I ndash angina occurs with strenuous rapid or prolonged exertion at work or recreation
Class II ndash angina occurs on walking or going up the stairs rapidly or after meals walking uphill walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace under emotional stress or in cold
Class III ndash angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace
Class IV ndash angina occurs even at rest
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Nursing Management
Diet instructions (low salt low fat low cholesterol high fiber) avoid animal fats Eg White meat ndash chicken wo skin fish
Stop smoking amp avoid alcohol Activity restrictions are placed within clientrsquos
limitations NTGs ndash max of 3doses at 5-min intervals
Stinging sensation under the tongue for SL is normal
Advise clients to always carry 3 tablets Store meds in cool dry place air-tight amber
bottles amp change stocks every 6months Inform clients that headache dizziness
flushed face are common side effects
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Do not discontinue the drug For patches rotate skin sites usually on
chest wall Instrct on evaluation of effectiveness based
on pain reliefPropanolols causes bronchospasm amp
hypoglycemia do not administer to asthmatic amp diabetic clients
Heparin ndash monitor bleeding tendencies (avoid punctures use of soft-bristled toothbrush) monitor PTT levels used for 2wks max do not massage if via SC have protamine sulfate available
Coumadin ndash monitor for bleeding amp PT always have vit K readily available (avoid green leafy veggies)
Nursing Management
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Acute Coronary Syndrome
Unstable AnginaNon ST-Segment Elevation MI ndash a clinical syndrome of myocardial ischemia
Causes atherosclerotic plaque disruption or significant CHD cocaine use (risk factor)
Defining guidelines (3 presentations)1 Symptoms at rest (usually prolonged ie
gt20mins)2 New onset exertional angina (increased in
severity of at least 1 class ndash to at least class III) in lt2months
3 Recent acceleration of angina to at least class III in lt2months
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Dx based on pain severity amp presenting symptoms ECG findings amp serum cardiac markers
When chest pain has been unremitting for gt20mins possibility of ST-Segment Elevation MI is usually considered
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Conthellip
ST-Segment Elevation MI (Heart Attack)Characterized by ischemic death of
myocardial tissue associated with atherosclerotic disease of coronary arteries
Area of infarction is determined by the affected coronary artery amp its distribution of blood flow (right coronary artery left anterior descending artery left circumflex artery)
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Dx based on presenting SSx serum markers amp ECG (changes may not be present immediately after symptoms except dysrhythmias PVCspremature ventricular contractions are common after MI)Typical ECG changes ST-segment
elevation Q wave prolongation T wave inversion
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Conthellip(MI)
Manifestations chest pain ndash severe crushing
constricting ldquosomeone sitting on my chestrdquo
- substernal radiating to left arm neck or jaw
- prolonged (gt35mins) amp not relieved by rest
Shortness of breath profuse perspirationFeeling of impending doom
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Complications death (usually within 1 hr of onset)Heart failure amp cardiogenic shock ndash
profound LV failure from massive MI resulting to low cardiac output
Thromboemboli ndash leads to immobility amp impaired cardiac function contributing to blood stasis in veins
Rupture of myocardiumVentricular aneurysms ndash decreases
pumping efficiency of heart amp increases work of LV
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Pathophysiology
Causes atherosclerotic heart disease thrombosisembolism
shock ampor hemorrhage direct traumaMyocardial ischemia
uarrcellular hypoxia
darrmyocardial O2 supplydarr myocardial contractility
darrcardiac output darrarterial pressure Stimulation of sympathetic receptors
uarrperipheral vasoconstriction
uarr myocardial contractility
uarr afterload uarrmyocardial O2 demand
uarr HR uarrdiastolicfilling
darrmyocardial tissue perfusion
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Tissue Changes After MI
Time after Onset Type of Injury amp Gross Tissue Changes
0-05hrs Reversible injury
1-2hrs Onset of irreversible injury
4-12hrs Beginning of coagulation necrosis
18-24hrs Continued necrosis gross pallor of infected tissue
1-3days Total necrosis onset of acute inflammatory process
3-7days Infarcted area becomes soft with a yellow-brown center amp hyperemic edges
7-10days Minimally soft amp yellow with vascularized edges scar tissue generation begins (fibroplastic activity)
8th week Complete scar tissue replacement
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Management of MI Initial Management OMEN
- O2 therapy via nasal prongs - adequate analgesia (Morphine via IV ndash also has
vasodilator property)- ECG monitoring-sublingual NTG (unless contraindicated IV
may be given to limit infarction size amp most effective if given within 4hrs of onset)
Thrombolytic Therapy ndash best results occur if initiated within 60-90mins of onset (Streptokinase amp Urokinase ndash promote conversion of plasminogen to plasmin)
Anti-arrhythmics lidocaine atropine propanolol Anticoagulants amp antiplatelets ASA heparin Stool softeners
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Surgery 1Revascularization
bullPTCAbullCoronary stent implantation
bullCoronary Artery Bypass Graft (CABG) ndash no response to medical treatment amp PTCA
2Resection ndash aneurysm
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ASSESSMENT
bull Subjective databull PAINbull Nauseabull SOBbull Apprehension
bull Objective databull VSbull Diaphoresisbull Emotional restlessness
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to myocardial damage
bull Impaired gas exchange related to poor perfusion shock
bull Pain related to myocardial ischemia
bull Activity intolerance related to pain or inadequate oxygenation
bull Fear related to possibility of death
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLANbull Goal 1 reduce pain discomfort
bull Narcotics ndash morphine note response Avoid IM
bull Humidified oxygen 2-4 Lmin mouth care ndash O2 is drying
bull Position semi-Fowlerrsquos to improve ventilation
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLANbull Goal 2 maintain adequate circulation stabilize heart
rhythmbull Monitor VSUO observe for cardiogenic shockbull Monitor ECG for arrhythmiasbull Medications antiarrhythmics anticoagulants
thrombolyticsbull Diagnostics cardiac catheterizations CAB surgerybull Recognize heart failure edema cyanosis dyspnea
cracklesbull Check labs troponin blood gases electrolytes
clotting timebull CVP (5-15 cm H2O) increases with heart failure
bull ROM of lower extremities antiembolic stockings
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 3 decrease oxygen demandpromote oxygenation reduce cardiac workloadbull O2 as ordered
bull Activity bedrest (24-48 H) with bedside commode planned rest periods control visitors
bull Position semi-Fowlerrsquos to facilitate lung expansion and decrease venous return
bull Anticipate needs of client call light water Reassurance
bull Assist with feeding turningbull Environment quiet and comfortablebull Medications CCBs vasodilators cardiotonics
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 4 maintain fluid electrolyte nutritional statusbull IV (KVO) CVP vital signsbull UO 30 cchrbull Labs electrolytes (Na K
Mg)bull Monitor ECGbull Diet progressive low
calorie low sodium low cholesterol low fat without caffeine
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 5 facilitate fecal eliminationbull Medications stool
softeners to prevent Valsalva maneuver mouth breathing during bowel movement
bull Bedside commode
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 6 provide emotional supportbull Recognize fear of dying
denial anger withdrawalbull Encourage expression of
feelings fears concernsbull Discuss rehabilitation lifestyle
changes prevent cardiac-invalid syndrome by promoting self-care activities independence
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 7 promote sexual functioningbull Encourage verbalization of concerns regarding
activity inadequacy limitations expectations ndash include partner (usually resume activity 5-8 wks after uncomplicated MI or when client can climb 2 flights of stairs
bull Identify need for referral for sexual counselling
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 8 health teachingbull Diagnosis and treatment regimenbull Caution when to avoid sexual activity after heavy
meal alcohol ingestion when fatigued stressed with unfamiliar partners in extreme temperatures
bull Information about sexual activity less fatiguing positions
bull Support groups Follow-up carebull Medications administration importance untoward
effects pulse takingbull Control risk factors rest diet exercise no smoking
weight control stress reduction
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
EVALUATION
bull No complications stable vital signs relief of painbull Adheres to medication regimenbull Activity tolerance is increasedbull Reduction or modification of risk factors
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CONGESTIVE HEART FAILURE
bull inability of the heart to pump sufficient blood to meet the needs of the tissue for oxygen and nutrient
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
PATHOPHYSIOLOGY
Increased cardiac workload
decreased effective myocardial contractility
Decreased cardiac output
LV failure Pulmonary congestion
RA RV failure
Systemic congestion
Peripheral edema
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ASSESSMENTbull Subjective data
bull Shortness of breathbull Orthopnea (sleeps on two
or more pillows)bull Paroxysmal nocturnal
dyspnea (sudden breathlessness during sleep)
bull Dyspnea on exertion (climbing stairs)
bull Apprehension anxiety irritability
bull Fatigue weaknessbull Reported weight gain
feeling of puffiness
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ASSESSMENTbull Objective data
bull VSbull BP decreasing systolic
narrowing pulse pressurebull Pulse pulsus alternans
(alternating strong-weak-strong cardiac contraction) increased
bull Respirations crackles Cheyne-Stokes
bull Edema dependent pitting (1+ to 4+ mm)
bull Liver enlarged tenderbull Distended neck veinsbull Chest X-ray enlarged heart
dilated pulmonary vessels lung edema
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Left Ventricular Compared with Right Ventricular Heart Failure
LEFT VENTRICULAR
FAILURE
RIGHT VENTRICULAR
FAILURE
Pulmonary crackles Jugular venous distention
Tachypnea Peripheral edema
S3 gallop Perioral and peripheral cyanosis
Cardiac murmurs Congestive hepatomegaly
Paradoxical splitting of S2
Ascites
Hepatojugular reflux
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
ANALYSIS NURSING DIAGNOSES
bull Decreased cardiac output related to decreased myocardial contractility
bull Activity intolerance related to generalized body weakness and inadequate oxygenation
bull Fatigue related to edema and poor oxygenation
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Fluid volume excess related to compensatory mechanisms
bull Impaired gas exchange related to pulmonary congestion
bull Anxiety related to shortness of breath
bull Sleep pattern disturbance related to paroxysmal nocturnal disturbance
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 1 provide physical rest reduce emotional stimulibull Position sitting or semi-Fowlerrsquos until
tachycardia dyspnea edema resolved change position frequently pillows for support
bull Rest planned periods limit visitors activity noise Chair and commode privileges
bull Support stay with client who is anxious have family member who is supportive present administer sedativestranquilizers as ordered
bull Warm fluids if appropriate
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 2 provide for relief of respiratory distress reduce cardiac workloadbull Oxygen low flow rate encourage
deep breathing (5-10 min q 2H) auscultate breath sounds for congestion pulmonary edema
bull Position elevating head of bed 20-25 cm (8-10 in) alleviates pulmonary congestion
bull Medications ndash digitalis ACE inhibitors inotropic agents diuretics tranquilizers vasodilators
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLANbull Goal 3 provide for special safety
needsbull Skin care
bull Inspect massage lubricate bony prominences
bull Use foot cradle heel protectors sheepskin
bull Side rails up if hypoxic (disoriented)
bull Vital signs monitor for signs of fatigue pulmonary emboli
bull ROM active passive elastic stockings
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 4 maintain fluid and electrolyte balance nutritional statusbull Urine output 30 cchr minimum estimate insensible
loss in client who s diaphoretic Monitor BUN serum creatinine and electrolytes
bull Daily weight same time clothes scalebull IV IV infusion pump to avoid circulatory overload
strict IObull Diet
bull Low sodiumbull Small frequent feedingsbull Discuss food preferences with client
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
NURSING CARE PLAN
bull Goal 5 health teachingbull Diet restrictions meal preparationbull Activity restrictions planned rest periodsbull Medications schedule (eg diuretics in early
morning) purpose dosage side effects (pulse taking daily weights intake of potassium-containing foods)
bull Refer to available community resources for dietary assistance weight reduction exercise program
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
EVALUATION
bull Increase in activity level tolerance ndash fatigue decreasedbull No complications ndash pulmonary edema respiratory
distressbull Reduction in dependent edema
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
DAY 3 OF
CARDIOVASCULARDISEASES
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull hyperlipidemia means high lipid levels
bull High lipid levels can speed up a process called atherosclerosis or hardening of the arteries
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions Lifestyle contributors include obesity not exercising and smoking Conditions that cause hyperlipidemia include diabetes kidney disease pregnancy and an underactive thyroid gland
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull You can also inherit hyperlipidemia The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55 If a close relative had early heart disease (father or brother affected before age 55 mother or sister affected before age 65) you also have an increased risk
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Treatment of Hyperlipidemia
bull It is necessary to first identify and treat any potential underlying medical problems such as diabetes or hypothyroidism that may contribute to hyperlipidemia Treatment of hyperlipidemia itself includes dietary changes weight reduction and exercise If lifestyle modifications cannot bring about optimal lipid levels then medications may be necessary
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Medications most commonly used to treat high LDL cholesterol levels are statins such as atorvastatin (Lipitor) or simvastatin (Mevacor) These medications work by reducing the production of cholesterol within the body
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIESHeart muscle disease associated with cardiac dysfunction
CARDIOMYOPATHIESbull 1 Dilated Cardiomyopathybull 2 Hypertrophic Cardiomyopathybull 3 Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
bull 1 Heavy alcohol intakebull 2 Pregnancybull 3 Viral infectionbull 4 Idiopathic
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
DILATED CARDIOMYOPATHYPATHOPHYSIOLOGY
bull Diminished contractile proteins - poor contraction -decreased blood ejection -increased blood remaining in the ventricle -ventricular stretching and dilatation-
bull SYSTOLIC DYSFUNCTION
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
HYPERTROPHIC CARDIOMYOPATHY
bull Associated factorsbull 1 Geneticbull 2 Idiopathic
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
HYPERTROPHIC CARDIOMYOPATHY
bull Pathophysiologybull Increased size of
myocardium - reduced ventricular volume - increased resistance to ventricular filling - diastolic dysfunction
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
RESTRICTIVE CARDIOMYOPATHY
Associated factors
1 Infiltrative diseases like AMYLOIDOSIS
2 Idiopathic
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
RESTRICTIVE CARDIOMYOPATHYPathophysiology
bull Rigid ventricular wall -impaired stretch and diastolic filling -decreased output - Diastolic dysfunction
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
bull Assessment findingsbull 1 PNDbull 2 Orthopneabull 3 Edemabull 4 Chest painbull 5 Palpitationsbull 6 dizzinessbull 7 Syncope with exertion
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
bull Laboratory Findingsbull 1 CXR- may reveal cardiomegalybull 2 ECHOCARDIOGRAMbull 3 ECGbull 4 Myocardial Biopsy
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
bull Medical Managementbull 1 Surgerybull 2 pacemaker insertionbull 3 Pharmacological drugs for symptom
relief
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
bull Nursing Managementbull 1Improve cardiac outputbull Adequate restbull Oxygen therapybull Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
Nursing Management
2 Increase patient tolerance
Schedule activities with rest periods in between
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOMYOPATHIES
Nursing Management
3 Reduce patient anxiety
Support
Offer information about transplantations
Support family in anticipatory grieving
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Infection of the heart valves and the endothelial surface of the heart
bull Can be acute or chronic
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
Etiologic factors
1 Bacteria- Organism depends on several factors
2 Fungi
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
Risk factors
1 Prosthetic valves
2 Congenital malformation
3 Cardiomyopathy
4 IV drug users
5 Valvular dysfunctions
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Pathophysiologybull Direct invasion of microbes microbes
adhere to damaged valve surface and proliferate damage attracts platelets causing clot formation erosion of valvular leaflets and vegetation can embolize
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Assessment findingsbull 1 Intermittent HIGH feverbull 2 anorexia weight lossbull 3 cough back pain and joint painbull 4 splinter hemorrhages under nails
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Assessment findingsbull 5 Oslerrsquos nodes- painful nodules on
fingerpadsbull 6 Rothrsquos spots- pale hemorrhages in the
retina
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Assessment findingsbull 7 Heart murmursbull 8 Heart failure
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Preventionbull Antibiotic prophylaxis if patient is
undergoing procedures like dental extractions bronchoscopy surgery etc
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull LABORATORY EXAMbull Blood Cultures to determine the exact
organism
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Nursing managementbull 1 regular monitoring of temperature heart
soundsbull 2 manage infectionbull 3 long-term antibiotic therapy
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Medical managementbull 1 Pharmacotherapybull IV antibiotic for 2-6 weeksbull Antifungal agents are given ndash amphotericin
B
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Infective endocarditis
bull Medical managementbull 2 Surgerybull Valvular replacement
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOGENIC SHOCK
bull Heartfails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
bull ETIOLOGYbull 1 Massive MIbull 2 Severe CHFbull 3 Cardiomyopathybull 4 Cardiac traumabull 5 Cardiac tamponade
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOGENIC SHOCK
bull ASSESSMENT FINDINGSbull 1 HYPOTENSIONbull 2 oliguria (less than 30 mlhour)bull 3 tachycardiabull 4 narrow pulse pressurebull 5 weak peripheral pulsesbull 6 cold clammy skinbull 7 changes in sensoriumLOCbull 8 pulmonary congestion
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOGENIC SHOCK
bull LABORATORY FINDINGSIncreased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOGENIC SHOCK
bull NURSING INTERVENTIONSbull 1 Place patient in a modified
Trendelenburg (shock ) positionbull 2 Administer IVF vasopressors and
inotropics such as DOPAMINE and DOBUTAMINE
bull 3 Administer O2bull 4 Morphine is administered to
decreased pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIOGENIC SHOCK
bull 5 Assist in intubation mechanical ventilation PTCA CABG insertion of Swan-Ganz cath and IABP
bull 6 Monitor urinary output BP and pulses
bull 7 cautiously administer diuretics and nitrates
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull This condition restricts ventricular filling resulting to decreased cardiac output
bull Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull Causative factorsbull 1 Cardiac traumabull 2 Complication of Myocardial
infarctionbull 3 Pericarditisbull 4 Cancer metastasis
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 1 BECKrsquos Triad- Jugular vein
distention hypotension and distantmuffled heart sound
bull 2 Pulsus paradoxusbull 3 Increased CVPbull 4 decreased cardiac output
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull ASSESSMENT FINDINGSbull 5 Syncopebull 6 anxietybull 7 dyspneabull 8 Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull Laboratory FINDINGSbull 1 Echocardiogrambull 2 Chest X-ray
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
CARDIAC TAMPONADE
bull NURSING INTERVENTIONSbull 1 Assist in PERICARDIOCENTESISbull 2 Administer IVFbull 3 Monitor ECG urine output and BPbull 4 Monitor for recurrence of
tamponade
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Pericardiocentesisbull Patient is monitored by ECGbull Maintain emergency equipmentsbull Elevate head of bed 45-60 degreesbull Monitor for complications- coronary
artery rupture dysrhythmias pleural laceration and myocardial trauma
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
HYPERTENSION
bull A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period based on two or more BP measurements
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
HYPERTENSION
bull Types of Hypertensionbull 1 Primary or ESSENTIAL
bull Most common typebull 2 Secondary
bull Due to other conditions like Pheochromocytoma renovascular hypertension Cushingrsquos Connrsquos SIADH
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Alterations in Blood Flow in the Systemic Circulation
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Buergerrsquos Disease
bull Also known as Thromboangiitis obliterans
bull Usually a disease of heavy cigarette smokertobacco user men 25-40yo
bull Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins amp nerves
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Affects medium-sized arteries (usually plantar amp digital vessels in the foot or lower legs)
bull unknown pathogenesis but it had been suggested thatbull tobacco may trigger an immune
response or bull unmask a clotting defect rarr these 2 can incite an inflammatory
reaction of the vessel wall
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Manifestations
Pain ndash predominant symptom RT distal arterial ischemia Intermittent claudication in the arch of foot amp digits
Increased sensitivity to cold (due to impaired circulation
Absentdiminished peripheral pulses
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Color changes in extremity (cyanotic on dependent position digits may turn reddish blue)
Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues amp
gangrenous changes may arise may necessitate amputation
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Diagnosis amp Treatment
bull Diagnostic methods ndash those that assess blood flow (Doppler ultrasound amp MRI)
bull Tx mandatory to stop smoking or using tobaccobull Meds to increase blood flow to extremitiesbull Surgery (surgical sympathectomy)bull amputation
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Rynaudrsquos DiseaseMechanism intensive vasospasm of arteries amp
arterioles in the fingersCause unknownUsually affects young womenPrecipitated by exposure to cold amp strong
emotionsRaynaudrsquos phenomenon ndash associated with
previous injury (ie Frostbite occupational trauma associated with use of heavy vibrating tools collagen diseases neuro do chronic arterial occlusive do)
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Manifestations bull Period of ischemia (ischemia due to vasospasm)
bull change in skin color = pallor to cyanoticbull 1st noticed at the fingertips later moving to distal phalangesbull Cold sensationbull Sensory perception changes (numbness amp tingling)
bull Period of hyperemia ndash intense rednessbull Throbbingbull Paresthesia
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
bull Return to normal colorbull Note although all of the fingers are
affected symmetrically only 1-2digits may be involved
bull Severe cases arthritis may arise (due to nutritional impairment)bull Brittle nailsbull Thickening of the skin of fingertipsbull Ulceration amp superficial gangrene of fingers
(rare occasions)
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Diagnosis amp Treatment Dx initial = based on Hx of vasospastic attacks
Immersion of hand in cold water to initiate attack aids in the Dx
Doppler flow velocimetry ndash used to quantify blood flow during temperature changes
Serial Computed thermography (finger skin temp) ndash for diagnosing the extent of disease
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Tx directed towards eliminating factors causing vasospasm amp protecting fingers from injury during ischemic attacks PRIORITIES Abstinence in smoking amp
protection from cold Avoidance of emotional stress (anxiety amp
stress may precipitate vascular spasm) Meds avoid vasoconstrictors (ie
Decongestants)-Calcium channel blockers (Diltiazem Nifedipine Nicardipine) ndash decrease episodes of attacks
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
Care Plan for Clients with Altered Cardiovascular Oxygenation
A Assessment
1 Hx of symptoms (pain esp chest pain palpitations dyspnea)
2 vsB Nursing Dx
1 ineffective tissue perfusion (cardiopulmonary)
2 Impaired gas exchange
3 Anxiety due to fear of death (clients with MI or Angina)
C Goals
1 Relief of pain amp symptoms
2 Prevention of further cardiac damage
D Nursing Interventions
1 Pain control
2 Proper medications
3 Decrease clientrsquos anxiety
4 Health teachings (meds activities diet exercise etc)
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
-
- CARDIOVASCULAR DISEASES
- Slide 2
- GENERAL CARDIAC ASSESSMENT
- Pathophysiology
- Slide 5
- ASSESSING CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN
- COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN (2)
- Angina Pectoris Myocardial Ischemia
- Pathophysiology
- Types
- Slide 12
- Slide 13
- Slide 14
- Conthellip
- Conthellip (2)
- Drug Therapy
- Classification
- Nursing Management
- Nursing Management (2)
- Acute Coronary Syndrome
- Slide 22
- Conthellip (3)
- Slide 24
- Conthellip(MI)
- Slide 26
- Pathophysiology (2)
- Tissue Changes After MI
- Management of MI
- Slide 30
- Slide 31
- ASSESSMENT
- ANALYSIS NURSING DIAGNOSES
- NURSING CARE PLAN
- NURSING CARE PLAN (2)
- NURSING CARE PLAN (3)
- NURSING CARE PLAN (4)
- NURSING CARE PLAN (5)
- NURSING CARE PLAN (6)
- NURSING CARE PLAN (7)
- NURSING CARE PLAN (8)
- EVALUATION
- CONGESTIVE HEART FAILURE
- PATHOPHYSIOLOGY
- ASSESSMENT (2)
- ASSESSMENT (3)
- Left Ventricular Compared with Right Ventricular Heart Failure
- ANALYSIS NURSING DIAGNOSES (2)
- Slide 49
- NURSING CARE PLAN (9)
- NURSING CARE PLAN (10)
- NURSING CARE PLAN (11)
- NURSING CARE PLAN (12)
- NURSING CARE PLAN (13)
- EVALUATION
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Treatment of Hyperlipidemia
- Slide 62
- CARDIOMYOPATHIES Heart muscle disease associated with cardiac d
- DILATED CARDIOMYOPATHY ASSOCIATED FACTORS
- DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY
- HYPERTROPHIC CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY (2)
- RESTRICTIVE CARDIOMYOPATHY
- RESTRICTIVE CARDIOMYOPATHY Pathophysiology
- CARDIOMYOPATHIES
- CARDIOMYOPATHIES (2)
- CARDIOMYOPATHIES (3)
- CARDIOMYOPATHIES (4)
- CARDIOMYOPATHIES (5)
- CARDIOMYOPATHIES (6)
- Infective endocarditis
- Infective endocarditis (2)
- Infective endocarditis (3)
- Infective endocarditis (4)
- Infective endocarditis (5)
- Infective endocarditis (6)
- Infective endocarditis (7)
- Infective endocarditis (8)
- Infective endocarditis (9)
- Infective endocarditis (10)
- Infective endocarditis (11)
- Infective endocarditis (12)
- CARDIOGENIC SHOCK
- CARDIOGENIC SHOCK (2)
- CARDIOGENIC SHOCK (3)
- CARDIOGENIC SHOCK (4)
- CARDIOGENIC SHOCK (5)
- CARDIAC TAMPONADE
- CARDIAC TAMPONADE (2)
- CARDIAC TAMPONADE (3)
- CARDIAC TAMPONADE (4)
- CARDIAC TAMPONADE (5)
- CARDIAC TAMPONADE (6)
- CARDIAC TAMPONADE (7)
- Slide 100
- HYPERTENSION
- HYPERTENSION (2)
- Slide 103
- Slide 104
- Slide 105
- Alterations in Blood Flow in the Systemic Circulation
- Buergerrsquos Disease
- Slide 108
- Manifestations
- Slide 110
- Diagnosis amp Treatment
- Rynaudrsquos Disease
- Manifestations (2)
- Slide 114
- Diagnosis amp Treatment (2)
- Slide 116
- Care Plan for Clients with Altered Cardiovascular Oxygenation
- Slide 118
- Slide 119
- Slide 120
- Slide 121
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