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Chapter 81 Cardiovascular Disorders. 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) - PowerPoint PPT Presentation
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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 81
Cardiovascular Disorders
Chapter 81
Cardiovascular Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiovascular DisordersCardiovascular 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)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Laboratory TestsLaboratory Tests
• Serum enzymes
– Creatinine kinase, isoenzyme, lactic dehydrogenase, aspartate aminotransferase, troponin, and myoglobin
• Blood lipid (fat) studies
• Serum electrolytes
– Potassium, sodium, and magnesium
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
X-ray EvaluationsX-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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Other Diagnostic TestsOther Diagnostic Tests
• Electrocardiogram
• Stress test
• Echocardiogram
• Nuclear scan
• Electrophysiology study
• Cardiac catheterization
– Immediately report a client’s rapid or irregular pulse after cardiac catheterization.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Medical TreatmentsCommon 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Surgical TreatmentsCommon Surgical Treatments
• Percutaneous transluminal coronary angioplasty
– Atherectomy
– Laser angioplasty
• Cardiac surgery
– Coronary artery bypass grafting
– Heart valve repair and replacement
– Heart transplantation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations Before SurgeryNursing 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations After SurgeryNursing 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing ProcessNursing Process
• Data collection
• Planning and implementation
– Teaching about prevention
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormal Conditions That May Cause Cardiovascular DiseaseAbnormal 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Conditions Affecting the Heart’s RhythmConditions 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Is the following statement true or false?
During electrical defibrillation, ensure that those present in the room do not touch the client or bed.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Conditions Affecting the Heart’s Pumping FunctionConditions 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infectious and Inflammatory Heart DisordersInfectious 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Coronary Artery DiseaseCoronary 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)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Is the following statement true or false?
Thrombolytic therapy must be started as soon as possible after the client develops symptoms.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True
Thrombolytic therapy must be started as soon as possible after the client develops symptoms. The sooner the pharmacologic agent is administered, the less heart muscle damage results.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Inflammatory DisordersInflammatory Disorders
• Thrombophlebitis
• Embolism
– Pulmonary embolism
– Coronary embolus
– Cerebral embolism
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Peripheral Vascular DisordersPeripheral 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)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AneurysmsAneurysms
• 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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Cerebrovascular AccidentTypes of Cerebrovascular Accident
• Transient ischemic attack (TIA)
• Cerebral thrombosis
• Cerebral embolism
• Cerebral hemorrhage or aneurysm (hemorrhagic CVA)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Results of Cerebrovascular AccidentResults of Cerebrovascular Accident
• Hemiplegia– Flaccid stage, spastic stage, recovery stage
• Aphasia and dysphasia• Brain damage• Hemianopsia (hemianopia)• Pain• Autonomic disturbances• Personality changes
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
RehabilitationRehabilitation
• 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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of Presentation