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Nursing CareNursing Care
ManagementManagementPatients with Cardiovascular CarePatients with Cardiovascular Care
NeedsNeeds
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The CARDIOVASCULARThe CARDIOVASCULAR
SYSTE
MSYSTE
M
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Importance of Studying the CVS forImportance of Studying the CVS for
NursesNurses1._________________________________1._________________________________
2._________________________________2._________________________________
3._________________________________3._________________________________
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Cardiac assessmentCardiac assessment InspectionInspection
Palpation of the apical pulse and PMI atPalpation of the apical pulse and PMI atthe 5the 5thth ICS LMCLICS LMCL
Auscultation for the heart soundsAuscultation for the heart sounds S1 and S2S1 and S2
Auscultation for the heart valvesAuscultation for the heart valves
TVTVMVMV
PVPV
AVAV
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Anatomy & PhysiologyAnatomy & Physiology
The Valves of the HeartThe Valves of the Heart
Valve TypeValve Type
AtrioventricularAtrioventricular
(AV)(AV)
SemilunarSemilunar
NameName
TricuspidTricuspid
MitralMitral(Bicuspid)(Bicuspid)
PulmonicPulmonic
AorticAortic
LocationLocation
Separates right atrium andSeparates right atrium and
right ventricleright ventricle
Separates left atrium andSeparates left atrium andleft ventricleleft ventricle
Between right ventricleBetween right ventricle
and pulmonary arteryand pulmonary arteryBetween left ventricle andBetween left ventricle and
aortaaorta
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The Heart: PhysiologyThe Heart: Physiology
Heart sounds can be auscultatedHeart sounds can be auscultated
S1, S2, S3, and S4S1, S2, S3, and S4
S1 is due to the closure of the AV valvesS1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valvesS2 is due to the closure of the semilunar valves
S3 is due to the rushing of blood through theS3 is due to the rushing of blood through the
AV openingAV opening S4 is due to contraction of the atriumS4 is due to contraction of the atrium
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Surface AnatomySurface Anatomy AuscultationAuscultation
TricuspidTricuspid ValveValve lieslies behindbehind rightright halfhalf of of thethesternumsternum;; oppositeopposite thethe 44thth ICSICS
LEFTLEFT halfhalf of of thethe lowerlower endend ofofthethe bodybody of of thethe sternumsternum ((44thth
ICS)ICS)
MitralMitral ValveValve lieslies behindbehind thethe leftleft halfhalf of of thethe
sternumsternum;; oppositeopposite thethe 44thth costalcostal
cartilagecartilage
apexapex beatbeat ((55thth ICSICS LMCL)LMCL)
PulmonaryPulmonary ValveValve LiesLies behindbehind thethe medialmedial endend ofof thethe
33rdrd leftleft costalcostal cartilagecartilage && thetheadjoiningadjoining partpart ofof thethe sternumsternum
MedialMedial endend ofof thethe 22ndnd leftleft ICSICS
AorticAortic ValveValve BehindBehind leftleft halfhalf of of sternumsternum;;
oppositeopposite 33rdrd ICSICS
MedialMedial endend ofof thethe 22ndnd rightright ICSICS
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The CARDIOVASCULARThe CARDIOVASCULAR
SYSTEMSYSTEM
This system is composed of the heart and theThis system is composed of the heart and the
blood vesselsblood vessels The main functions of this system are:The main functions of this system are:
to transport oxygen, hormones andto transport oxygen, hormones and
nutrients to the tissuesnutrients to the tissuesand to transport waste products to theand to transport waste products to the
lungs and kidneys for excretionlungs and kidneys for excretion
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The Gross Anatomy of the HeartThe Gross Anatomy of the Heart
The heart is located within theThe heart is located within the
thorax behind the sternum in thethorax behind the sternum in the
compartment calledcompartment calledMEDIASTINUMMEDIASTINUM
Th
eh
eart is commonly describedTh
eh
eart is commonly describedas the size of a clenched fistas the size of a clenched fist
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The Gross Anatomy of the HeartThe Gross Anatomy of the Heart
The shape is conical, with a baseThe shape is conical, with a base
and an apexand an apex
The base is directed upwardThe base is directed upward
The apex is directed downward toThe apex is directed downward to
th
e left at th
e level of th
e 5th
e left at th
e level of th
e 5thth
ICSICSLMCLLMCL
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Heart SurfaceHeart Surface
ANTERIOR SURFACEANTERIOR SURFACE
Right ventricleRight ventricle
POSTERIOR SURFACEPOSTERIOR SURFACE
Left ventricleLeft ventricle
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Fig. 12.4Fig. 12.4
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The Heart: AnatomyThe Heart: Anatomy
The heart has four chambersThe heart has four chambers
The right atriumThe right atrium
The right ventricleThe right ventricle The left atriumThe left atrium
The left ventricleThe left ventricle
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The Heart: AnatomyThe Heart: Anatomy
The blood supply of the heart:The blood supply of the heart:
The coronary arteries are the blood supplyThe coronary arteries are the blood supply
There are two main coronary arteriesThere are two main coronary arteries-- thetheright coronary artery and the left coronaryright coronary artery and the left coronaryarteryartery
The venous drainage of the heart is theThe venous drainage of the heart is thecoronary sinus; the anterior cardiac vein andcoronary sinus; the anterior cardiac vein andthe smallest cardiac veinthe smallest cardiac vein
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Blood SupplyBlood Supply
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Venous DrainageVenous Drainage
Coronary sinus will collect all the venousCoronary sinus will collect all the venous
blood from the heart into the RIGHT atriumblood from the heart into the RIGHT atrium
The anterior cardiac vein drains NOT intoThe anterior cardiac vein drains NOT into
the coronary sinus but DIRECTLY into thethe coronary sinus but DIRECTLY into the
right atriumright atrium
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CirculationCirculation
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Fig. 12.11Fig. 12.11
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Cardiovascular AssessmentCardiovascular Assessment
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The Cardiovascular SystemThe Cardiovascular System
Cardiac HistoryCardiac History
InterviewInterview
Focused assessment
Focused assessment
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CARDIAC ASSESSMENTCARDIAC ASSESSMENT
Health HistoryHealth History
During the healthhistory, theDuring the healthhistory, the
nurse should assess fornurse should assess forsignificant past diseases andsignificant past diseases andrecent illnessrecent illness
Family history may highlightFamily history may highlightrisk factorsrisk factors
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CARDIAC ASSESSMENTCARDIAC ASSESSMENT
Health HistoryHealth History
Obtain description of presentObtain description of present
illness and the chief complaintillness and the chief complaintChest pain, Edema, etc.Chest pain, Edema, etc.
Assess risk factorsAssess risk factors
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CARDIAC ASSESSMENTCARDIAC ASSESSMENT
Physical examinationPhysical examination
Vital signsVital signs-- BP, PPBP, PP
Inspection of the skinInspection of the skin Inspection of the thoraxInspection of the thorax
Palpation of the PMI, pulsesPalpation of the PMI, pulses
Auscultation of the heart soundsAuscultation of the heart sounds
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Cardiac assessmentCardiac assessment InspectionInspection Palpation of the apical pulse and PMI atPalpation of the apical pulse and PMI at
the 5the 5thth ICS LMCLICS LMCL
Auscultation for the heart soundsAuscultation for the heart sounds S1 and S2S1 and S2
Auscultation for the heart valvesAuscultation for the heart valves
TVTVMVMV
PVPV
AVAV
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Surface AnatomySurface Anatomy AuscultationAuscultation
TricuspidTricuspid ValveValve lieslies behindbehind rightright halfhalf of of thethesternumsternum;; oppositeopposite thethe 44thth ICSICS
LEFTLEFT halfhalf of of thethe lowerlower endend ofofthethe bodybody of of thethe sternumsternum ((44thth
ICS)ICS)
MitralMitral ValveValve lieslies behindbehind thethe leftleft halfhalf of of thethe
sternumsternum;; oppositeopposite thethe 44thth costalcostal
cartilagecartilage
apexapex beatbeat ((55thth ICSICS LMCL)LMCL)
PulmonaryPulmonary ValveValve LiesLies behindbehind thethe medialmedial endend ofof thethe
33rdrd leftleft costalcostal cartilagecartilage && thetheadjoiningadjoining partpart ofof thethe sternumsternum
MedialMedial endend ofof thethe 22ndnd leftleft ICSICS
AorticAortic ValveValve BehindBehind leftleft halfhalf of of sternumsternum;;
oppositeopposite 33rdrd ICSICS
MedialMedial endend ofof thethe 22ndnd rightright ICSICS
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Determining the pulsesDetermining the pulses
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CARDIAC ASSESSMENTCARDIAC ASSESSMENT
3. Laboratory and diagnostic studies3. Laboratory and diagnostic studies CBCCBC
Lipid profileLipid profile
arteriographyarteriography
Cardiac enzymesCardiac enzymes
CXRCXR
ECGECG
HolterHolter monitoringmonitoring Exercise ECGExercise ECG
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The Normal CardiovascularThe Normal Cardiovascular
PatternPatternFactors that identify the normal function of theFactors that identify the normal function of the
heartheart
1.1. T
he heart rateT
he heart rate2.2. Blood pressureBlood pressure
3.3. Skin temperature and skin colorSkin temperature and skin color
4.4. Urine outputUrine output5.5. Sensorium or Level of consciousnessSensorium or Level of consciousness
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The Normal CardiovascularThe Normal Cardiovascular
PatternPattern Heart rateHeart rate-- the normal heart rate variesthe normal heart rate varieson the average of 60 to 100 beats peron the average of 60 to 100 beats per
minute.minute.
This is reflected by the pulses determinedThis is reflected by the pulses determined
by palpating them in areas of the body.by palpating them in areas of the body.
The heart rate is highest in the newbornThe heart rate is highest in the newborn
and decreases with age.and decreases with age.
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The Normal CardiovascularThe Normal Cardiovascular
PatternPattern Blood pressureBlood pressure-- the force with which thethe force with which theblood is pushed through the arterial system.blood is pushed through the arterial system.
Normal BP also varies with age. The adultNormal BP also varies with age. The adult
average is 120/80 mmHgaverage is 120/80 mmHg
It varies during the day,It varies during the day, being highest during latebeing highest during late
afternoon.afternoon.
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The Normal CardiovascularThe Normal Cardiovascular
PatternPattern Skin temperature and colorSkin temperature and color-- the personthe person
with good circulatory status is warm,with good circulatory status is warm,
with
fairly uniform skin temperaturewith
fairly uniform skin temperature Skin color can reflect the level of bloodSkin color can reflect the level of blood
oxygenation and adequacy of bloodoxygenation and adequacy of blood
flow.flow.
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The Normal CardiovascularThe Normal Cardiovascular
PatternPatternOther indicators:Other indicators:
Absence of pain in the chestAbsence of pain in the chest
Normal urine output of more than 30Normal urine output of more than 30ml/hourml/hour
Normal cognitive functionNormal cognitive function
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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function
AGEAGE-- the rapid metabolic rate of thethe rapid metabolic rate of thenewborns demands tremendous bloodnewborns demands tremendous blood
flow to the developing tissues.flow to the developing tissues. Heart rate is considerably faster in theHeart rate is considerably faster in theyoung.young.
In old age, the vascular system hasIn old age, the vascular system hasnaturally narrowed and stiffened, thusnaturally narrowed and stiffened, thusBP somewhat increases.BP somewhat increases.
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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function
ACTIVITY and EXERCISEACTIVITY and EXERCISE--
Increased metabolic demands from theIncreased metabolic demands from theexercising muscles will force the heart toexercising muscles will force the heart to
beat faster.beat faster.
The increased temperature causes
The increased temperature causesvasodilatation increasing local blood flow.vasodilatation increasing local blood flow.
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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function
GENDERGENDER-- heart rate and BP varyheart rate and BP vary
slightly among men and women.slightly among men and women. Menopause women however haveMenopause women however have
comparable increase in BPcomparable increase in BP
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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function
TEMPERATURETEMPERATURE--
When body temperature begins to rise, theWhen body temperature begins to rise, the
autonomic system signals th
e periph
eralautonomic system signals th
e periph
eralarterioles to open wide (dilate) to allowarterioles to open wide (dilate) to allow
heat loss.heat loss.
The opposite occurs when the body isThe opposite occurs when the body is
exposed to coldexposed to coldVASOCONSTRICTIONVASOCONSTRICTION
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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function
LIFE STYLE AND HABITSLIFE STYLE AND HABITS--
smoking increases heart rate and BPsmoking increases heart rate and BP
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Common Altered CardiacCommon Altered Cardiac
FunctionsFunctions
Decreased Pumping ability of the heartDecreased Pumping ability of the heart(decreased cardiac output)(decreased cardiac output)
Altered blood flow (Impaired tissueAltered blood flow (Impaired tissueperfusion)perfusion)
Altered blood composition (BloodAltered blood composition (Bloodalterations)alterations)
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Altered Cardiac FunctionsAltered Cardiac Functions
Decreased Pumping ability of the heart (decreasedDecreased Pumping ability of the heart (decreasedcardiac output)cardiac output) -- a healthy heart is able to createa healthy heart is able to createtremendous pressure and eject blood through thetremendous pressure and eject blood through thearteries to the lungs and body tissues.arteries to the lungs and body tissues.
Decreased pumping action can be the result ofDecreased pumping action can be the result ofconduction problems termed asconduction problems termed as cardiaccardiacarrhythmias.arrhythmias.
Another cause of pump failure isAnother cause of pump failure isvalvularvalvulardysfunctiondysfunction. The valves which guard the chambers. The valves which guard the chambersmay be damaged by infection, trauma ormay be damaged by infection, trauma orinflammation.inflammation.
Muscle damageMuscle damage such as in myocardial infarctionsuch as in myocardial infarctioncan weaken the pump action of the heart.can weaken the pump action of the heart.
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Altered Cardiac FunctionsAltered Cardiac Functions Altered blood flow (Impaired tissue perfusion)Altered blood flow (Impaired tissue perfusion)--blood vessels control the amount of blood enteringblood vessels control the amount of blood entering
the heart and tissues.the heart and tissues.
Obstruction and narrowing can greatly affectObstruction and narrowing can greatly affecttissue oxygenation.tissue oxygenation.
Capillary dysfunction (when subjected toCapillary dysfunction (when subjected toinflammatory mediators)inflammatory mediators)
Venous pooling ( collection of blood in the venousVenous pooling ( collection of blood in the venoussystem caused commonly be venous valvesystem caused commonly be venous valve
incompetence).incompetence). Signs of impaired peripheral circulation can be:Signs of impaired peripheral circulation can be:
decreased peripheral pulses, pale skin color, cooldecreased peripheral pulses, pale skin color, coolextremities and decreased hair distributionextremities and decreased hair distribution..
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Altered Cardiac FunctionsAltered Cardiac Functions
Altered blood composition (Blood alterations)Altered blood composition (Blood alterations)--alteration in RBC, plasma or circulating volumealteration in RBC, plasma or circulating volume
can affect the tissue oxygenation.can affect the tissue oxygenation.
Anemia can lead to inadequate oxygenation ofAnemia can lead to inadequate oxygenation ofbody tissues leading to hypoxia.body tissues leading to hypoxia.
Signs of anemia may include chronic fatigue,Signs of anemia may include chronic fatigue,
pallor, shortness of breath and hypotension.pallor, shortness of breath and hypotension.
Bleeding, burns, dehydration can all lead to deficitBleeding, burns, dehydration can all lead to deficitin blood volumein blood volume
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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function
AA
DD
PP II
EE
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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function
ASSESSMENTASSESSMENT
To formulate accurate nursing care plan, theTo formulate accurate nursing care plan, thenurse must conduct an assessment of the CVSnurse must conduct an assessment of the CVS
status.status.
This may include gathering of subjective data,This may include gathering of subjective data,
objective data (through physical examination)objective data (through physical examination)
and laboratory data.and laboratory data.
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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function
Nursing HistoryNursing History
Information obtained by the nurse oftenInformation obtained by the nurse oftenprovides the basis for interventions.provides the basis for interventions.
The nurse must elicit from the history the riskThe nurse must elicit from the history the riskfactors present, the functional pattern of thefactors present, the functional pattern of the
patient before consultation, the events thatpatient before consultation, the events that
lead to th
e occurrence of th
e manifestationslead to th
e occurrence of th
e manifestationsand the abnormal pattern of cardiovascularand the abnormal pattern of cardiovascularfunctions.functions.
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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function
Physical ExaminationPhysical Examination
During inspection, the nurse observes the generalDuring inspection, the nurse observes the generalbehavior, sensorium, and appearance.behavior, sensorium, and appearance.
The nurse must inspect the skin for color changes,The nurse must inspect the skin for color changes,edema, abnormal pulsations, varicosities and nailedema, abnormal pulsations, varicosities and nailclubbingclubbing
Palpation involves checking for skin temperature,Palpation involves checking for skin temperature,capillary refill time (normally is less than 3capillary refill time (normally is less than 3seconds), pulses (either apical or peripheral).seconds), pulses (either apical or peripheral).
Auscultation involves the use of a stethoscope toAuscultation involves the use of a stethoscope tohear for the different heart sounds. Blood pressurehear for the different heart sounds. Blood pressureis also taken with the aid of the apparatus andis also taken with the aid of the apparatus and
stethoscope.stethoscope.
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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function
Diagnostic TestsDiagnostic Tests CBC can determine the information about the bloodCBC can determine the information about the blood
components.The hemoglobin reflects the oxygencomponents.The hemoglobin reflects the oxygencarrying capacity of the bloodcarrying capacity of the blood
Cardiac Enzymes are released by DAMAGED cardiacCardiac Enzymes are released by DAMAGED cardiaccells and may indicate tissue damage as in myocardialcells and may indicate tissue damage as in myocardialinfarction.infarction.
Serum electrolytes can directly affect the heart functions.Serum electrolytes can directly affect the heart functions.Imbalances may cause arrhythmias.Imbalances may cause arrhythmias.
ECG records the electrical impulse conduction of theECG records the electrical impulse conduction of theheart in the resting patient.The treadmill test involvesheart in the resting patient.The treadmill test involveschecking the ECG of a patient subjected to exercise.checking the ECG of a patient subjected to exercise.
Echocardiogram is simply the ultrasound of the heartEchocardiogram is simply the ultrasound of the heart
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The Nursing Process in CardiacThe Nursing Process in Cardiac
CareCareNURSING DIAGNOSISNURSING DIAGNOSIS
Altered tissue perfusion (renal, Cerebral,Altered tissue perfusion (renal, Cerebral,
Cardiopulmonary, GI and Peripheral)Cardiopulmonary, GI and Peripheral)
Decreased Cardiac OutputDecreased Cardiac Output
Activity IntoleranceActivity Intolerance
Fluid volume excess
Fluid volume excess
Fluid volume deficitFluid volume deficit
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CARDIACCARDIAC
IMPLEMENTATIONIMPLEMENTATION
1. Assess the cardio1. Assess the cardio--pulmonary statuspulmonary status
VS, BP, Cardiac assessmentVS, BP, Cardiac assessment
2. Enhance cardiac output2. Enhance cardiac output
Establish IV line to administerEstablish IV line to administer
fluidsfluids
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The Nursing Process in CardiacThe Nursing Process in Cardiac
CareCareIMPLEMENTATIONIMPLEMENTATION3. Promote CARDIOVASCULARhealth and function3. Promote CARDIOVASCULARhealth and function
The nurse can employ health teaching strategies byThe nurse can employ health teaching strategies bypresenting information concerning risk factors,presenting information concerning risk factors,
availability ofhealthy lifestyle programs like fitnessavailability ofhealthy lifestyle programs like fitnessclubs.clubs.
The nurse can employ various therapeuticThe nurse can employ various therapeuticinterventions that will address specific problemsinterventions that will address specific problems
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ActivityActivityintoleranceintolerance
Monitor TPR and BPMonitor TPR and BPSpace activities in the daySpace activities in the dayPermit rest periods before activityPermit rest periods before activityLimit activity 1 hour before mealsLimit activity 1 hour before meals
Teach energy conservationTeach energy conservationmeasures like bed restmeasures like bed rest
Examples of Nursing measuresExamples of Nursing measures
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EdemaEdema Instruct patient to avoid constrictingInstruct patient to avoid constrictinggarmentsgarmentsInstruct to elevate edematous areasInstruct to elevate edematous areas
Instruct patient to avoid dependentInstruct patient to avoid dependentpositionspositions
Teach patient to prepare low sodiumTeach patient to prepare low sodiummealsmealsApply antiApply anti--embolic stockingsembolic stockings
Examples of Nursing measuresExamples of Nursing measures
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PainPain Instruct patient to stop activityInstruct patient to stop activitywhen pain occurswhen pain occurs
Administer nitroglycerin forAdminister nitroglycerin foranginaanginaPace activities within patientsPace activities within patientslimitslimits
Instruct patient to avoid coldInstruct patient to avoid coldtemperatures and smokingtemperatures and smoking
Instruct to report unrelievedInstruct to report unrelievedpain immediatelypain immediately
Examples of Nursing measuresExamples of Nursing measures
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Nursing Process for CARDIACNursing Process for CARDIAC
CARECARE4. Energy Conservation4. Energy Conservation
The patient should be warned against ValsalvaThe patient should be warned against Valsalvamaneuver which can cause sudden increase in bloodmaneuver which can cause sudden increase in blood
pressure but simultaneously preventing venouspressure but simultaneously preventing venousreturn.return.
The most important energy conserving activity isThe most important energy conserving activity isRESTREST
Regular rest periods should be provided. ActivitiesRegular rest periods should be provided. Activitiesshould be spaced to avoid fatigue.should be spaced to avoid fatigue.
i f CA D ACi f CA D AC
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Nursing Process for CARDIACNursing Process for CARDIAC
CARECARE5. Administer medications as ordered5. Administer medications as ordered
Administration of meds is an importantAdministration of meds is an importantnursing functionnursing function
The nurse is also responsible for assessing theThe nurse is also responsible for assessing the
effects of medications and for potentialeffects of medications and for potential
complicationscomplications
N i P f CARDIACN i P f CARDIAC
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Nursing Process for CARDIACNursing Process for CARDIAC
CARECARE6. Perform CPR as needed.6. Perform CPR as needed. CPR is a combination of oral resuscitationCPR is a combination of oral resuscitation
which supplies oxygen to the lungs andwhich supplies oxygen to the lungs andexternal cardiac massage which is intended toexternal cardiac massage which is intended to
rere--establish cardiac functions.establish cardiac functions.
The three cardinal signs of cardiac arrest thatThe three cardinal signs of cardiac arrest thatthe nurse must assess are Apnea, Absence ofthe nurse must assess are Apnea, Absence of
carotid or femoral pulses and dilated pupils.carotid or femoral pulses and dilated pupils.
Respiratory Arrest is the cessation ofRespiratory Arrest is the cessation ofbreathing. It often occurs because of blockedbreathing. It often occurs because of blocked
airway.airway.
CARDIACCARDIAC
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CARDIACCARDIAC
IMPLEMENTATIONIMPLEMENTATION
7. Promote gas exchange7. Promote gas exchange
Administer O2Administer O2
Position client inPosition client in SEMISEMI--FowlersFowlers
Encourage coughing and deepEncourage coughing and deep
breath
ing exercisesbreath
ing exercises
CARDIACCARDIAC
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CARDIACCARDIAC
IMPLEMENTATIONIMPLEMENTATION
8. Promote client comfort8. Promote client comfort
Assess the clients description ofAssess the clients description of
pain and ch
est discomfortpain and ch
est discomfortAdminister medication asAdminister medication asprescribedprescribed
Morphine for MIMorphine for MINitroglycerine for AnginaNitroglycerine for Angina
Diuretics to relieve congestion (CHF)Diuretics to relieve congestion (CHF)
CARDIACCARDIAC
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CARDIACCARDIAC
IMPLEMENTATIONIMPLEMENTATION
9. Prevent infection9. Prevent infection
Monitor skin integrity of lowerMonitor skin integrity of lower
extremitiesextremitiesAssess skin site for edema, redness andAssess skin site for edema, redness and
warmthwarmth
Monitor for feverMonitor for feverChange position frequentlyChange position frequently
CARDIACCARDIAC
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CARDIACCARDIAC
IMPLEMENTATIONIMPLEMENTATION
10. Minimize patient anxiety10. Minimize patient anxiety
Encourage verbalization of
Encourage verbalization offeelings, fears and concernsfeelings, fears and concerns
Answer client questions. ProvideAnswer client questions. Provide
information about procedures andinformation about procedures andmedicationsmedications
VA UAT ONVA UAT ON
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EVALUATIONEVALUATION
Patients with cardiovascularPatients with cardiovascular
dysfunction show widely variable ratesdysfunction show widely variable rates
of progress.of progress. Specific goals for these patients mustSpecific goals for these patients must
be individualized.be individualized.
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In SummaryIn Summary
The cardiovascular system transports gases inThe cardiovascular system transports gases inthe blood to and from the tissues and facilitatesthe blood to and from the tissues and facilitatesthe diffusion of gases between the capillariesthe diffusion of gases between the capillaries
and body tissuesand body tissues
The heart and blood vessels make up theThe heart and blood vessels make up the
cardiovascular system that together with blood iscardiovascular system that together with blood isthe major system for transporting oxygen andthe major system for transporting oxygen andnutrients to the tissues and wastes productsnutrients to the tissues and wastes products
away from the tissues for eliminationaway from the tissues for elimination
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In SummaryIn Summary
The right side of the heart receives theThe right side of the heart receives the
unoxygenated blood while the left side of theunoxygenated blood while the left side of theheart receives oxygenated bloodheart receives oxygenated blood
The coronary arteries supply the oxygen andThe coronary arteries supply the oxygen and
nutrients to the heart musclesnutrients to the heart muscles
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In SummaryIn Summary
The systemic vessels carry blood to the tissuesThe systemic vessels carry blood to the tissues
through the system of arteries, and return it tothrough the system of arteries, and return it tothe heart via a system of veinsthe heart via a system of veins
The blood pressure is determined by the cardiacThe blood pressure is determined by the cardiac
output and the peripheral vascular resistance. Itoutput and the peripheral vascular resistance. It
rises gradually from birth to adult range in therises gradually from birth to adult range in theadolescent periodadolescent period
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In SummaryIn Summary
There are many factors that affect cardiovascularThere are many factors that affect cardiovascularfunctions; atherosclerosis causes fatty deposition withinfunctions; atherosclerosis causes fatty deposition withinthe arterioles/arteriesthe arterioles/arteries
Decreased cardiac output, impaired tissue perfusion,Decreased cardiac output, impaired tissue perfusion,and disorders affecting the blood are the majorand disorders affecting the blood are the majorcardiovascular problems that may affect oxygenation.cardiovascular problems that may affect oxygenation.
The most common cause of impaired blood flow isThe most common cause of impaired blood flow is
atherosclerosis.atherosclerosis.
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In SummaryIn Summary
Nursing interventions to promote circulationNursing interventions to promote circulation
include using antiinclude using anti--embolic stockings, sequentialembolic stockings, sequentialcompression devices and administration ofcompression devices and administration of
cardiac medicationscardiac medications
Cardiopulmonary resuscitation (CPR) is usedCardiopulmonary resuscitation (CPR) is used
during cardiopulmonary arrest.during cardiopulmonary arrest.
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. . . End. . . End
Thank you very much goodluckThank you very much goodluck
Have a nice day!Have a nice day!
The Heart : MicroscopicThe Heart : Microscopic
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The Heart : MicroscopicThe Heart : Microscopic
AnatomyAnatomy The heart has three layersThe heart has three layers
The epicardiumThe epicardium
The myocardiumThe myocardium
The endocardiumThe endocardium
The heart is covered by the pericardium with aThe heart is covered by the pericardium with aparietal and visceral layersparietal and visceral layers
The pericardial sac is a potential space in betweenThe pericardial sac is a potential space in betweenthe two pericardial layers with a minimal (15 cc)the two pericardial layers with a minimal (15 cc)fluidfluid
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Anatomy & PhysiologyAnatomy & PhysiologyThe Layers of the Heart WallThe Layers of the Heart WallEpicardium (visceral
Epicardium (visceralpericardium)pericardium)
MyocardiumMyocardium
EndocardiumEndocardium
Essential layer of t
he
heart
Essential layer of t
he
heartCoronary arteries are found inCoronary arteries are found in
this layerthis layer
Middle and thickest layer of the heartMiddle and thickest layer of the heartResponsible for contraction ofResponsible for contraction of
the heartthe heart
Innermost layer of the heartInnermost layer of the heart
Lines the inside of theLines the inside of themyocardiummyocardium
Covers the heart valvesCovers the heart valves
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Myocardial Cells are ofTwo typesMyocardial Cells are ofTwo types
Myocardial Cell TypesMyocardial Cell TypesKinds ofKinds of
Cardiac CellsCardiac Cells
Myocardial cellsMyocardial cells
Specialized cellsSpecialized cells
of the electricalof the electrical
conductionconduction
systemsystem
WhereWhereFoundFound
MyocardiumMyocardium
ElectricalElectrical
conductionconduction
systemsystem
PrimaryPrimaryFunctionFunction
Contraction andContraction andRelaxationRelaxation
Generation andGeneration and
conduction ofconduction of
electricalelectrical
impulsesimpulses
PrimaryPrimaryPropertyProperty
ContractilityContractility
AutomaticityAutomaticity
ConductivityConductivity
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Anatomy & PhysiologyAnatomy & PhysiologyCharacteristics of cardiac cells: PhysiologyCharacteristics of cardiac cells: PhysiologyAutomaticityAutomaticity
ExcitabilityExcitability
ConductivityConductivity
ContractilityContractility
Ability to INITIATE an electrical impulseAbility to INITIATE an electrical impulse
Ability to RESPOND to the electric impulseAbility to RESPOND to the electric impulse
Ability of the cardiac cells to TRANSMIT theAbility of the cardiac cells to TRANSMIT theimpulse to other cellsimpulse to other cells
Ability of the cardiac cells to CONTRACT orAbility of the cardiac cells to CONTRACT or
shorten in response to electric stimulusshorten in response to electric stimulus
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The Heart : PhysiologyThe Heart : Physiology
This consists ofThis consists of
The conducting systemThe conducting system
The cardiac cycleThe cardiac cycle The cardiac output and Blood pressureThe cardiac output and Blood pressure
The preload and afterloadThe preload and afterload
The Starlings law of the heartThe Starlings law of the heart
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The Heart: PhysiologyThe Heart: Physiology
The conducting system of theThe conducting system of theheart is a group of specializedheart is a group of specialized
heart cells that functions toheart cells that functions toconduct electrical impulsesconduct electrical impulsesindependent of any nerveindependent of any nerve
supplysupply
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The Heart: PhysiologyThe Heart: Physiology
The parts of the conducting systemThe parts of the conducting systemof the heart are:of the heart are:
The SA (sinoThe SA (sino--atrial) nodeatrial) nodeThe AV (atrioThe AV (atrio--ventricular) nodeventricular) node
The Bundle of His with its rightThe Bundle of His with its rightand left bundleand left bundle
The Purkinje fibersThe Purkinje fibers
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The Heart: PhysiologyThe Heart: Physiology
Cardiac CycleCardiac Cycle-- Refers to the repetitive pumping process thatRefers to the repetitive pumping process that
begins with the onset of cardiac musclebegins with the onset of cardiac musclecontractions and ends with the beginning ofcontractions and ends with the beginning ofthe next contractions.the next contractions.
The cardiac cycle consists of the contractionThe cardiac cycle consists of the contractionphase and the relaxation phase in eachphase and the relaxation phase in each
heartbeatheartbeat The SYSTOLE is the contraction phaseThe SYSTOLE is the contraction phase
The DIASTOLE is the relaxation phaseThe DIASTOLE is the relaxation phase
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The Heart: PhysiologyThe Heart: Physiology
Heart sounds can be auscultatedHeart sounds can be auscultated
S1, S2, S3, and S4S1, S2, S3, and S4
S1 is due to the closure of the AV valvesS1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valvesS2 is due to the closure of the semilunar valves
S3 is due to the rushing of blood through theS3 is due to the rushing of blood through the
AV openingAV opening S4 is due to contraction of the atriumS4 is due to contraction of the atrium
The Heart: REGULATION OFThe Heart: REGULATION OF
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The Heart: REGULATION OFThe Heart: REGULATION OF
HEARTFUNCTIONHEARTFUNCTION The amount of blood the heart pumps out inThe amount of blood the heart pumps out in
each beat is called theeach beat is called the STROKE VOLUMESTROKE VOLUME
CARDIAC OUTPUT(CO)CARDIAC OUTPUT(CO) Vol. of bloodVol. of blood
pumped by either ventricle of the heart eachpumped by either ventricle of the heart eachminuteminute
CO = SV x HR (the number of timesCO = SV x HR (the number of timescontracts each minutecontracts each minute
CO at rest = 70ml/beat x 72bpmCO at rest = 70ml/beat x 72bpm
= 5040 ml/min or 5L/min= 5040 ml/min or 5L/min
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The Heart: Intrinsic RegulationThe Heart: Intrinsic Regulation
**the force of contraction producedby cardiac muscle isthe force of contraction producedby cardiac muscle isrelated to the degree of stretch of cardiac muscle fibersrelated to the degree of stretch of cardiac muscle fibers
VENOUS RETURNVENOUS RETURN IS THE AMOUNTIS THE AMOUNT
OF BLOOD THAT RETURNS TO THEOF BLOOD THAT RETURNS TO THE
HEARTHEART
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The PRELOAD is the degree of stretchingThe PRELOAD is the degree of stretchingof the ventricular walls when it is filledof the ventricular walls when it is filled--upupwith bloodwith blood
The AFTERLOAD is the resistance toThe AFTERLOAD is the resistance towhich the heart must pump to eject thewhich the heart must pump to eject the
bloodblood
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INCREASED VENOUSE RETURNINCREASED VENOUSE RE
TURN
-- heart fills to a greater volume and stretch = incheart fills to a greater volume and stretch = incpreloadpreload
-- Cardiac muscle fibers contract with greater forceCardiac muscle fibers contract with greater force= inc vol of blood to be ejected from the heart= inc vol of blood to be ejected from the heart
-- = inc stroke volume= inc stroke volume
Inc venous returnInc venous return inc preloadinc preload inc COinc CO
Starlings Law of the HeartStarlings Law of the Heart -- relationshiprelationshipbetween preload and stroke volumebetween preload and stroke volume
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EXTRINSIC REGULATIONEXTRINSIC REGULATION
Nervous ControlNervous Control
Reflex ControlReflex Control
Hormonal ControlHormonal Control
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BP regulationBP regulation
CentralCentral
Pons and medullaPons and medulla
Sympathetic nervous systemSympathetic nervous system Increases heartIncreases heartraterate
Parasympathetic nervous system (vagus)Parasympathetic nervous system (vagus)
decreases heart ratedecreases heart rate
l il i
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BP regulationBP regulation
BaroreceptorsBaroreceptors
Receptors sensitive to stretch located in theReceptors sensitive to stretch located in the
carotid sinuses and aortic archcarotid sinuses and aortic arch stretch stretch reflex increase in heart ratereflex increase in heart rate
BPBP
stretch stretch reflex decrease in heart ratereflex decrease in heart rateBPBP
BP l iBP l i
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BP regulationBP regulation
HormonalHormonal
EpinephrineEpinephrine vasoconstriction(skinvasoconstriction(skinand viscera)and viscera) increased resistanceincreased resistance
increased BPincreased BP--epinephrine causes vasodilation ofepinephrine causes vasodilation of
blood vessels in skeletal muscles &blood vessels in skeletal muscles &cardiac musclescardiac muscles
ADHADH water reabsorptionwater reabsorption BloodBloodvolumevolume increased BPincreased BP
H l R l iH l R l i
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Hormonal RegulationHormonal Regulation
Angiotensinogen A1Angiotensinogen A1Angiotensin 2Angiotensin 2
ANFANF increase sodium excretionincrease sodium excretion
increased urineincreased urine decreased blooddecreased bloodvolumevolume decreased BPdecreased BP
bloodLung
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Th Bl d l ATh Bl d l A
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The Blood vessel: AnatomyThe Blood vessel: Anatomy
This consists of the artery, vein and capillaryThis consists of the artery, vein and capillary
together with the lymphatic vesselstogether with the lymphatic vessels
The ARTERY has thicker wall, deeplyThe ARTERY has thicker wall, deeply
located, pulsating, reddish, with abundantlocated, pulsating, reddish, with abundantsmooth muscles and elastic tissues that carriessmooth muscles and elastic tissues that carries
oxygenated blood away from the heartoxygenated blood away from the heart
towards the body tissuestowards the body tissues
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Th Bl d l Ph i lTh Bl d l Ph i l
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The Blood vessel: PhysiologyThe Blood vessel: Physiology
The diameter of the arterioles is the mainThe diameter of the arterioles is the maincontributor of the peripheral resistancecontributor of the peripheral resistance
In the presence of epinephrine, coldIn the presence of epinephrine, cold
temperature and irritation, the smooth musclestemperature and irritation, the smooth musclesof the blood vessels will contract making theof the blood vessels will contract making thelumen smallerlumen smaller resistanceresistance
In the presence of histamineIn the presence of histamine,,warmwarmtemperature, the vessels will dilatetemperature, the vessels will dilate
resistanceresistance
A t & Ph i lA t & Ph i l
TerminologyTerminology
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Anatomy & PhysiologyAnatomy & PhysiologyTerminologyTerminologyChronotropicChronotropic
effecteffect
DromotropicDromotropic
effecteffect
Inotropic effectInotropic effect
Refers to a change in heart rateRefers to a change in heart rate
A positive chronotropic effect refers to an increaseA positive chronotropic effect refers to an increasein heart ratein heart rate
A negative chronotropic effect refers to a decreaseA negative chronotropic effect refers to a decrease
in heart ratein heart rate
Refers to a change in the speed of conductionRefers to a change in the speed of conduction
through the AV junctionthrough the AV junctionA positive dromotropic effect results in an increaseA positive dromotropic effect results in an increase
in AV conduction velocityin AV conduction velocity
A negative dromotropic effect results in a decreaseA negative dromotropic effect results in a decrease
in AV conduction velocityin AV conduction velocity
Refers to a change in myocardial contractilityRefers to a change in myocardial contractility
A postive inotropic effect results in an increase inA postive inotropic effect results in an increase in
myocardial contractilitymyocardial contractility
A negative inotropic effect results in a decrease inA negative inotropic effect results in a decrease in
myocardial contractilitymyocardial contractility
S t i i l tiS t i i l ti
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Systemic circulationSystemic circulation
The aortaThe aorta-- leaves the left ventricle to formleaves the left ventricle to formthe ascending aorta, aortic arch, descendingthe ascending aorta, aortic arch, descendingaorta, thoracic aorta and abdominal aortaaorta, thoracic aorta and abdominal aorta
The Vena cava ( superior and inferior)The Vena cava ( superior and inferior)drains the whole body and returns the blooddrains the whole body and returns the bloodto the right atriumto the right atrium
Ph i l f i l tiPh i l f i l ti
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Physiology of circulationPhysiology of circulation
Blood pressure is the measure of force exertedBlood pressure is the measure of force exertedby blood against the blood vessel wallby blood against the blood vessel wall
Measured by sphygmomanometerMeasured by sphygmomanometer
NormallyBP is measured as systolic pressureNormallyBP is measured as systolic pressureand diastolic pressureand diastolic pressure
PULSE PRESSURE = SPPULSE PRESSURE = SP--DPDP
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