Chapter 81 Cardiovascular Disorders

1. Chapter 81Cardiovascular Disorders

2. Cardiovascular Disorders • Cardiovascular disorders may • Interfere with the heart’s ability to pump • Disrupt blood flow within the coronary or cerebral vessels • Disrupt blood flow to a localized area • Cardiac nurses • Coronary care unit (CCU) • Coronary intensive care unit (CICU)

3. Laboratory Tests • Serum enzymes • Creatinine kinase, isoenzyme, lactic dehydrogenase, aspartate aminotransferase, troponin, and myoglobin • Blood lipid (fat) studies • Serum electrolytes • Potassium, sodium, and magnesium

4. X-ray Evaluations • Angiocardiogram (angiogram) • Arteriogram • Test using radiopaque dye • Ask clients if they are allergic to shellfish or iodine. • This dye could cause a severe anaphylactic reaction. • Study in which the femoral site is used • Client should lie flat for up to 8 hours to prevent swelling, bruising, and bleeding at the puncture site.

5. Other Diagnostic Tests • Electrocardiogram • Stress test • Echocardiogram • Nuclear scan • Electrophysiology study • Cardiac catheterization • Immediately report a client’s rapid or irregular pulse after cardiac catheterization.

6. Common Medical Treatments • Pharmacologic therapy: Thrombolytics or fibrinolytics • Clients for thrombolytic therapy • History of chest pain within the past 6 hours • Ischemia of the heart that persists even after the administration of sublingual nitroglycerin • No recent history of surgery, organ biopsy, cardiopulmonary resuscitation, hemorrhagic CVA, bleeding abnormalities, intracranial neoplasm, recent head injury, pregnancy, or allergy to streptokinase

7. Common Surgical Treatments • Percutaneous transluminal coronary angioplasty • Atherectomy • Laser angioplasty • Cardiac surgery • Coronary artery bypass grafting • Heart valve repair and replacement • Heart transplantation

8. Nursing Considerations Before Surgery • Preoperative teaching • Discharge planning, plans for cardiac rehabilitation. • Client’s nutrition and capacity for healing • Supplemental oxygenation needs before and after surgery • Vitamin and mineral therapy • Routine tests and procedures

9. Nursing Considerations After Surgery • Maintaining airway and ventilation • Providing adequate tissue oxygenation • Monitoring and maintaining cardiac function • Maintaining fluid and electrolyte balance • Controlling chest drainage with suction • Monitoring body temperature • Identifying signs and symptoms of complications • Relieving pain

10. Question Which of the following is an indication for heart valve surgery? a. Chest pain, dyspnea, syncope b. Headaches and migraines c. Chest congestion d. Heartburn and intense discomfort e. Rapid heart rate

11. Answer a. Chest pain, dyspnea, syncope Other indications for heart valve surgery are: • Angina, heart failure • Mitral or aortic valvular insufficiency • Damage to valves • Pulmonary valve stenosis • Tricuspid regurgitation

12. Nursing Process • Data collection • Planning and implementation • Teaching about prevention • Evaluation

13. Abnormal Conditions That May Cause Cardiovascular Disease • Arteriosclerosis: Hardening of the arteries • Atherosclerosis: Fatty deterioration of the arterial smooth muscle walls • Hypertension • Leading cause of MI, cardiac damage, kidney damage, congestive heart failure, and CVA • Hypotension • Heart rate problem, a heart muscle or pump problem, or a volume problem

14. Conditions Affecting the Heart’s Rhythm • Cardiac dysrhythmias • Sinus tachycardia • Sinus bradycardia • Premature ventricular contraction (PVC) • Atrioventricular heart block • Electronic pacemaker • Fibrillation • Defibrillation • Implantable cardioverter–defibrillator

15. Question Is the following statement true or false? During electrical defibrillation, ensure that those present in the room do not touch the client or bed.

16. Answer True During electrical defibrillation, everyone present must be careful not to touch the client or the bed; doing so will lead to shock and, possibly, injury.

17. Conditions Affecting the Heart’s Pumping Function • Congestive heart failure • Hemodynamic monitoring • Measure intake and output (I&O) and weigh the client daily. • Cardiomyopathy • Dilated or congestive cardiomyopathy • Hypertropic cardiomyopathy • Restrictive cardiomyopathy

18. Infectious and Inflammatory Heart Disorders • Chronic rheumatic heart disease • Bacterial endocarditis • Make the person as comfortable as possible. • Instruct client to conserve energy. • Frequently note the pulse rate and quality. • Observe closely for fluctuation in body temperature and for any symptoms of complications. • Pericarditis

19. Coronary Artery Disease • Angina pectoris • Temporary loss of oxygen to the heart muscle • Ischemia—if loss of oxygen supply continues • Myocardial necrosis—death of heart tissue • Myocardial infarction • Acute coronary syndrome (ACS) • Acute myocardial infarction (AMI)

20. Question Is the following statement true or false? Thrombolytic therapy must be started as soon as possible after the client develops symptoms.

21. Answer True Thrombolytic therapy must be started as soon as possible after the client develops symptoms. The sooner thepharmacologic agent is administered, the less heart muscle damage results.

22. Inflammatory Disorders • Thrombophlebitis • Embolism • Pulmonary embolism • Coronary embolus • Cerebral embolism

23. Peripheral Vascular Disorders • Symptoms • Intermittent claudication • Tingling and numbness • Coldness and difference in size • Lack of new tissue growth • Buerger disease • Raynaud phenomenon • Varicose veins • Telangiectasia (spider veins)

24. Question Is the following statement true or false? For a client with peripheral vascular disorder, the bath water should be hot—as hot the client can take.

25. Answer False It is true that warm baths to help increase the circulation, but the bath water should not be hot, as heat helps dilate blood vessels. This client is very susceptible to burns. Use a bath thermometer; the maximum temperature is 100°F or 37.8°C.

26. Aneurysms • An aneurysm is an outpouching of a blood vessel. • Forms of aneurysms • Berry aneurysm in the circle of Willis • Fusiform-type aneurysm of the abdominal aorta • Dissecting aortic aneurysm

27. Types of Cerebrovascular Accident • Transient ischemic attack (TIA) • Cerebral thrombosis • Cerebral embolism • Cerebral hemorrhage or aneurysm (hemorrhagic CVA)

28. Results of Cerebrovascular Accident • Hemiplegia • Flaccid stage, spastic stage, recovery stage • Aphasia and dysphasia • Brain damage • Hemianopsia (hemianopia) • Pain • Autonomic disturbances • Personality changes

29. Rehabilitation • If contractures are prevented, the client can learn to walk again much sooner. • If the skin is kept intact, the client will not have to contend with ulcers and infections. • If bowel and bladder training have begun, the client will be well on the way to independence. • Teach adaptive ADL. • Begin speech, physical, or occupational therapy as soon as possible.

30. End of Presentation