Care of Patient with Cardiovascular Disorder
( NUR 240) DR. Samah Mohammed Outlines overview of cardiovascular system. Atherosclerosis. Angina.
Management of dysrhythmia. Congestive heart failure. Definition Causes and pathophysiology Clinical manifestation Types Diagnostic evaluation Management Nursing process Introduction The cardiovascular/circulatory system transports food, hormones, metabolic wastes, and gases (oxygen, carbon dioxide) to and from cells. Anatomy and physiology
Hearts job is to pump blood to supply oxygen-enriched red blood cells to tissues. Divided into left and right sides Contain of 4 champers (two) Atria receives incoming blood, and ( two) ventricles pump outgoing blood. One-way valves keep blood flowing in the proper direction. Aorta, bodys main artery, receives blood ejected from left ventricle. Anatomy and physiology
Hearts electrical system controls blood pressure and heart rate and coordinates atria and ventricles. The cardiac muscle is the (myocardium). The heart membrane is the (pericardium). Autonomic nervous system (ANS) controls involuntary activities. The ANS has two parts: Sympathetic nervous system Fight-or-flight system as ( Anxiety, Stress,..) Parasympathetic nervous system Slows various bodily functions as ( Defecation, Rest,) Anatomy and physiology
Arterioles and capillaries are smaller. Capillaries connect arterioles to venules. Venules are the smallest branches of the veins. Vena cava return blood to the heart. Superior vena cava: from the head and arms Inferior vena cava: from the abdomen, kidneys, and legs Coronary arteries are blood vessels that supply blood to heart muscle. Anatomy and physiology
Blood pressure: is the pressure of circulating blood against artery walls. Systolic blood pressure The max pressure generated by left ventricle. Top number in the reading. Diastolic blood pressure The pressure while the left ventricle is at rest. A pulse: is felt when blood passes through an artery during systole. Peripheral pulses felt in the extremities. Functions of the heart pump blood to all parts of the
body Anatomy and physiology
Blood consists of: Red blood cells, which carry oxygen. White blood cells, which fight infection. Platelets, which help blood to clot. Plasma, which is the fluid cells float in. Cardio vascular Diseases
Acute Rheumatic Fever. Chronic Rheumatic Heart Diseases. Hypertensive Diseases. Ischemic Heart Diseases. Pulmonary Heart Diseases & Diseases of Pulmonary Circulation. Other forms of Heart Disease. Cerebrovascular Diseases. Diseases of Arteries, Arterioles and Capillaries. Diseases of Veins, Lymphatic Vessels & Lymph Nodes. Other and Unspecified Disorders of the Circulatory System Hypertension Commonly called high blood pressure
Systolic and diastolic measurements Normal systolic mmHg Normal diastolic mm 160/95 mm Hg? 140/90 mm Hg? Common symptoms Sudden, severe headache. Strong, bounding pulse, Ringing in the ears. Nausea and vomiting, Dizziness. Warm skin (dry or moist), Nosebleed. Coronary Atherosclerosis
Diseases of the coronary arteries is almost always due to plaque. Atherosclerosis: defined as the buildup of calcium and cholesterol in the arteries can cause occlusion of arteries. Fatty material accumulates with age. Atherosclerosis Signs & symptoms Causes Tachycardia Family history
Smoking Hypertension Diabetes (DM Physical activity Obesity Alcohol High Cholesterol Signs & symptoms Tachycardia Bradycardia Palpitations Weakness nausea sweating Shortness of breath fainting Chest pain Sudden death Prevention of atherosclerosis
Control of risk factors as ( dont smoking). Take regular exercise (20 min 3 times a week) Maintain ideal body weight Eat a mixed diet rich in fresh fruit and vegetables Change diet to reduce the amount of sodium, fats and cholesterol. Reduce the amount of stress in your everyday life Regular Medical checkups Medication Angina Angina defined as: It is a clinical syndrome, characterized of chest pain, occurs when the hearts need for oxygen exceeds supply. Causes caused by atherosclerotic plaque. Cigarette smoking, high blood pressure, high cholesterol, high blood glucose level (diabetes), lack of exercise, and stress. Angina Signs & symptoms :- Weakness, nausea, sweating.
Shortness of breath, fainting. Chest pain that does not change. Irregular heartbeat. Lower jaw, arm, back, abdomen, neck pain and Sudden death. Numbness of arms and hands. Types of angina Stable angina (classic angina)
Stable angina is characterized by central chest pain, discomfort or breathlessness, and is relieved by rest or nitroglycerin Unstable angina (Acute coronary syndrome) Unstable angina is characterized by rapidly worsening angina. It is most dangerous and does not follow a pattern, do not relieved with rest or medicine. the common signs of unstable angina are breathlessness, nausea & vomiting. Management of angina Advice to patients with stable angina:-
control of risk factors such as smoking, hypertension. Aim for ideal body weight. Take regular exercise. The use of measures to control symptoms. Give Medication Anti-anginal drug treatment Five groups of drug are used to help relieve or prevent the symptoms of angina: nitrates, -blockers, calcium antagonists and potassium channel activators. Management of angina Percutaneous transluminal coronary angioplasty (PTCA): is a surgical procedure in which tiny a balloon catheter is inserted into a blocked blood vessel to increase the blood flow of that vessel. Narrowed artery with balloon catheter positioned. Inflated balloon presses against arterial wall. Management of angina 2. Cardiac pacemakers:-
This technology is very reliable. Pacemaker malfunction can cause dizziness, or weakness due to an excessively slow heart rate. Transport patients promptly and safely. Function of Cardiac Pacemakers:- Maintain regular cardiac rhythm and rate. Deliver electrical impulse through wires in direct contact with the myocardium. Implanted under a heavy muscle or fold of skin in the upper left portion of the chest. Angioplasty Pacemakers Congestive heart failure
(CHF): It is defined as the condition in which heart is unable to pump an adequate amount of blood required for normal body functions. Heart failure is a serious condition and needs immediate medical care. Causes of Heart Failure
Coronary artery disease. Uncontrolled Hypertension. Other factors that contribute to weakness of the heart muscle are toxins, Infections, myocarditis, valves Diseases and damage from myocardial infarction (MI) Classification of Heart Failure
Left-sided heart failure It occurs primarily in the lungs from backup of blood into pulmonary veins and capillaries because of left ventricular pump failure. As blood backs up into the pulmonary bed, increased hydrostatic pressure causes fluid accumulation in the lungs. Blood flow is consequently decreased to the brain, kidneys, and other tissues Classification of Heart Failure
2. Right-sided heart failure (or left ventricular) It systemic circulation results from right ventricular pump failure. As blood backs up into the pulmonary bed, increased hydrostatic pressure produces peripheral and dependent pitting edema. Venous congestion in the kidneys, liver, and GI tract also develops. Signs and Symptoms Management of Heart Failure
1. Non-Pharmacologic lifestyle modification Healthy Diet: Salt restriction Fluid restriction Weightloss Lipid control Stop Smoking Activity is restricted to decrease cardiac workload Reduce stress Social Support Loose weight Follow up Pharmacologic Medication Surgical Arrhythmias Arrhythmia defined as: is failure of conduction of impulses through the A. V. Node. Causes: drugs, ischemia, and failure of S.A node. Signs & symptoms: tachycardia, palpation, fatigue, and sudden death. Management of Arrhythmias
Record BP, HR and rhythm, rate and depth of respirations, and breath sounds to determine the dysrhythmias hemodynamic effect. Ask patients about, dizziness, or fainting. Make ECGfor the patient. Administer anti arrhythmic medications. Assess for factors that contribute to the dysrhythmia (e.g, caffeine, stress, and medication ) and assist the patient in making lifestyle changes as diet and exercise. Nursing process 1. Assessment
The nurse should observe & ask the patient about: When do attack tend to occur? How does the patient describe the pain? Is the onset of pain gradual or sudden How long does it last? Is the pain is steady? Is the discomfort accompanied by other symptoms? How many minutes after taking the nitroglycerin does the pain last? Full history Physical examination & clinical manifestation Interpretation of the finding of the diagnostic tests Nursing process 2. Nursing diagnosis:
Nursing diagnosis may include the following: Chest: pain related to decreased O2 supply to the heart muscle secondary to arterial stenosis. Anxiety: related to fear of death. Health: maintenance altered related to knowledge deficit about nature of the diseases and ways to avoid. High: risk for complications ( myocardial infarction) related to non adherence to the therapeutic regimen & non acceptance of necessary life- style changes. Nursing process Patient's goals: ( patient will) Nursing intervention
Report pain free or pain is decreased Report anxiety level is decreased Understand nature of the disease & capable to avoid complications Accept the necessary of life-style changes. Nursing intervention Prevention of pain Control of pain Reduction of anxiety Understanding of illness & ways to avoid complications Adherence to the self care program