30
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 81 Cardiovascular Disorders

Chapter 81 Cardiovascular Disorders

  • Upload
    renate

  • View
    204

  • Download
    2

Embed Size (px)

DESCRIPTION

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

Citation preview

Page 1: Chapter 81 Cardiovascular Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 81

Cardiovascular Disorders

Chapter 81

Cardiovascular Disorders

Page 2: 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)

Page 3: Chapter 81 Cardiovascular Disorders

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

Page 4: Chapter 81 Cardiovascular Disorders

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.

Page 5: Chapter 81 Cardiovascular Disorders

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.

Page 6: Chapter 81 Cardiovascular Disorders

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

Page 7: Chapter 81 Cardiovascular Disorders

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

Page 8: Chapter 81 Cardiovascular Disorders

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

Page 9: Chapter 81 Cardiovascular Disorders

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

Page 10: Chapter 81 Cardiovascular Disorders

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

Page 11: Chapter 81 Cardiovascular Disorders

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

Page 12: Chapter 81 Cardiovascular Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing ProcessNursing Process

• Data collection

• Planning and implementation

– Teaching about prevention

• Evaluation

Page 13: Chapter 81 Cardiovascular Disorders

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

Page 14: Chapter 81 Cardiovascular Disorders

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

Page 15: Chapter 81 Cardiovascular Disorders

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.

Page 16: Chapter 81 Cardiovascular Disorders

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.

Page 17: Chapter 81 Cardiovascular Disorders

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

Page 18: Chapter 81 Cardiovascular Disorders

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

Page 19: Chapter 81 Cardiovascular Disorders

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)

Page 20: Chapter 81 Cardiovascular Disorders

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.

Page 21: Chapter 81 Cardiovascular Disorders

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.

Page 22: Chapter 81 Cardiovascular Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Inflammatory DisordersInflammatory Disorders

• Thrombophlebitis

• Embolism

– Pulmonary embolism

– Coronary embolus

– Cerebral embolism

Page 23: Chapter 81 Cardiovascular Disorders

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)

Page 24: Chapter 81 Cardiovascular Disorders

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.

Page 25: Chapter 81 Cardiovascular Disorders

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.

Page 26: Chapter 81 Cardiovascular Disorders

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

Page 27: Chapter 81 Cardiovascular Disorders

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)

Page 28: Chapter 81 Cardiovascular Disorders

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

Page 29: Chapter 81 Cardiovascular Disorders

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.

Page 30: Chapter 81 Cardiovascular Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation