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Cardiovascular System

Cardiovascular System. Nursing 1120 By: Diana Blum RN MSN Metropolitan Community College. Coronary Arteries. Two major coronary arteries arise from the aorta beyond the aortic valve. Blood flows to the coronary arteries during diastole

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Cardiovascular System

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  1. Cardiovascular System Nursing 1120 By: Diana Blum RN MSN Metropolitan Community College

  2. Coronary Arteries • Two major coronary arteries • arise from the aorta beyond the aortic valve. • Blood flows to the coronary arteries during diastole • Left main, LAD, Circumflex feeds most of Left side of the heart • Right feeds SA node, AV node, RA, RL

  3. Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge and become active. This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury.

  4. Conduction Continued

  5. Cardiac Cycle • Contraction and relaxation of the heart: • Diastole: • Systole:

  6. Video Mysterious Heart Volume 2 chapter 3

  7. Cardiac Output • the volume of blood ejected by the heart each minute and is determined by stroke volume and the heart rate. • Normal stroke volume is 60-100 ml • Normal cardiac output is 4 to 8 L / min • (CO = HR X SV)

  8. Factors affecting Stroke Volume • Preload: the amount of blood remaining in the ventricles at the end of diastole or the pressure generated at the end of diastole • Contractility: is the ability of the cardiac muscle fibers to shorten and produce a muscle contraction. (Inotropic, + or -) • Afterload: amount of pressure the Ventricle must overcome to eject blood volume out

  9. Heart Rate • SA node : pacemaker of heart 60-100 bpm • AV node : 40 -60 bpm • Heart is innervated by sympathetic and parasympathetic nervous system • Sympathetic: speeds HR, and increases force of contraction • Parasympathetic: slows HR and force

  10. Heart Tones • Murmur: Produced by turbulent sounds across valves • Rub: inflamed pericardium-best heard along left sternal border • S3 murmur: sounds like “Kentucky” • S4 murmur: sounds like “Mississippi” http://www.blaufuss.org/ http://www.med.ucla.edu/wilkes/Rubintro.htm

  11. Health History

  12. Present Illness

  13. Past Medical History

  14. Family History:

  15. Review of systems • weight gain • fatigue • dyspnea • cough • orthopnea • palpitations • chest pain • fainting • concentrated urine • edema

  16. Functional assessment • effects of illness on ADLs and rest patterns • smoker • diet • stress • coping

  17. Physical Assessment • General: • VS: orthostatic bp in both arms, apical rate and rhythm, respiratory rate and effort • peripheral pulses: • Skin: color hair distribution, cap refill, temp • Thorax: heart sounds, lung sounds, sputum • Extremities: pulses, color, temp, edema

  18. Age Related Changes • Heart less able to adapt to changing needs related to activity • Valves thicken and stiffen • # of pacemaker cells decrease • Nerve fibers decrease • Frequent dysrhythmias

  19. Diagnostic Tests • EKG: rate, rhythm, ischemia (T-inverted), injury (ST segment elevation), arrhythmias, strain, infarction (q wave) • Echocardiogram: (TEE) sound wave test detects size of chambers, valve integrity, flow, wall motion, Cardiac Output

  20. Diagnostic Tests Continued Biomarkers: Troponin will show elevation 3-4 hr after injury <0.10 is negative 0.10-0.60 is intermediate and may indicate injury >0.60 is positive evidence of MI Myoglobin increases 1-4 hours after MI CPK-MB will show increase 4 hrs after MI BNP can be elevated 48 hrs after MI which indicates heart failure

  21. Diagnostic Tests Continued • CBC: anemia • CMP: screening K+, etc • PT, INR • PTT • Lipid profile: see next 2 slides

  22. Diagnostic Tests Continued • ABG: assess acid/base levels • Pulse Oximetry: generally >92% • Holter monitoring: 24+ hr of EKG + events • Stress test: treadmill or pharmacological • Cardiac Catheterization: invasive, NPO 6-8h, consent. Visualizes chambers, valves, arteries, pressures, CO • Heart-CT scan: assesses CAD, MRI • Nuclear scans: assess heart muscle viability • EPS: NPO, consent, IV, assess electrical activity

  23. http://preop.medselfed.com/asp/center.asp?centerId=heart&partnerId=preop&id=&cachedate=&emailId=&affId=&campId=&hideNav=

  24. CAD Video-mysterious heart volume 3 chapter 2

  25. Etiology of CAD • CAD occurs when the intimal lining of the coronaries begin to plaque resulting in jagged edges and narrowed passageway for blood flow • Atherosclerosis results in impaired blood flow to the heart muscle

  26. Risk Factors for CAD • Non-controllable- • Controllable-

  27. s/s of CAD • Angina which results from a lack of 0xygen to the heart muscle • 4Es= • Weakness, diaphoresis, SOB • N/V

  28. MI: Myocardial Infarction • Occlusion of a coronary artery resulting in necrosis of the heart muscle. • Risk factors: same as for CAD • Pathophysiology: AMI-over 4-6 hrs ischemia injury and infarction develop. Ischemia=lack of 02 to heart muscle, if not relieved=injury. After 20 min of ischemia=infarction • Main S/S: chest pain and accompanying S/S

  29. Within 24 hours after infarction, healing begins, collateral circulation begins. • 10-14 days after MI=extension of MI may occur due to myocardial tissue vulnerability to stress • Complete scar formation and healing takes about 6 weeks • Video- mysterious heart volume 1 chapter 2

  30. Data Collection • Same as for CAD but will assess symptom of chest pain with accompanying s/s • May have EKG changes with or with-out ST-T wave changes or Q wave changes • Cardiac Bio-markers (Troponin, Myoglobin, CPK, CKMB) • May proceed with Echocardiogram to assess if wall motion sluggish • May go to cath lab

  31. Angina or MI • Angina without MI} often relieved with rest and NTG • Angina with MI } may be relieved with rest, NTG, 02, MS, rescue angioplasty, etc. • Think MONA • Morphine • Oxygen • Nitroglycerin • Aspirin http://www.youtube.com/watch?v=4GlQmTlP2jE&feature=related http://www.youtube.com/watch?v=rEqw3AK-M_g

  32. Treatment continued…video mysterious heart volume 3 chapter 3-7 • ASA: • MS: • Beta-blocker • ACE inhibitor:

  33. Treatment continued • May need antiarrhythmic meds • like what??? • Stool softeners to reduce valsalva maneuver and prevent constipation r/t narcotic use and bed rest • Treat: HTN, DM other co-morbid illnesses • Cardiac Rehab to follow

  34. Treatments • Low fat low cholesterol diet • Prescribed exercise program 5-7 days a week • Knows correct use of NTG for angina • Management of DM, HTN • Stop smoking • Medications to reduce work load or dilate

  35. Low salt diet (<2000mg) does not include: • Soups: • Snacks:

  36. Low fat <30% Low cholesterol <200mg • Lean meat: skinless • Dairy limited: egg beaters, skim milk • Olive oil, canola oil • Avoid: fried, fatty or heavily marbled meats, sausage, lunch meat, spareribs, frankfurters, salt pork, canned fish in oil, yolks, duck. Cream sauces, gravy, buttered vegetables, sweet rolls, other processed foods

  37. Exercise • 5-7 X week is goal to include stretches with warm-up, progressive walking program, light weights, stretches with cool down. • Strengthens heart muscle, reduces BP, BS, weight, stress, tension, appetite, LDLs. • Increases HDLs, energy and self esteem and improves immune system

  38. Principles of Exercise • Practice on regular basis • Know how to do own pulse • Strive for target heart rate • Stop if chest pain occurs • Complications: CHF & Dysrhythmias

  39. Nursing interventions for MI • Comfort measures • Freq VS, cardiac monitoring, I&O, CMS checks, spacing activities • Heart & lung sounds, assess fluid volume status, IV responsibilities, note BP & Pulse prior to heart meds!! • Client education r/t diet, meds, pulse taking activity, elimination, reporting chest pain and correct use of nitro products for angina

  40. Medications for Heart Disease • Anti-Anginal: • Anti-Hypertensive: • Anti-Arrhythmic: l • Cardiac glycoside:

  41. Medication continued • Thrombolytic: • Anti-coagulant: • Anti-platelet aggregate: • Lipid-Lowering agents: • Diuretics: • Electrolyte replacement:

  42. Medication continued • 02 to maintain 02 sat > 92% to reduce chance of angina/ischemia • If Angina the nurse needs to have the client lie down, take VS then report to charge nurse ,met team, call md. • Instruct client: If develops chest pain, sit down take 1 nitro every 3- 5 min x 3. If chest pain not relieved call 911

  43. POST MI Complications

  44. 90% will develop complication and 80% will demonstrate arrhythmia which is the most common cause of death in clients in the pre-hospital period. (VT>>>VF) • CHF and severe Left ventricular failure • Papillary muscle dysfunction • Pericarditis • Thromboembolism • Ventricle rupture

  45. Nursing Diagnosis • Decreased cardiac output r/t Dysrhythmias • Acute Pain r/t lack of 02 to myocardium • Anxiety r/t to feeling of doom, lack of understanding of medical diagnosis

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