Unit 4 Problems of Cardiac Output and Tissue Perfusion Lemone and Burke Ch 30-32 Objectives Review the anatomy and physiology of the cardiovascular system. Identify normal heart sounds and relate them to the corresponding events in the cardiac cycle. Explain cardiac output and explain the influence of various factors in its regulation. 2 More Objectives Describe normal variations in assessment findings for the older adult. Identify manifestations of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock. Compare and contrast the pathophysiology and manifestations of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock. 3 1
The rest of the objectives Relate the outcomes of diagnostic tests and procedures to the pathophysiology of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock and implications of client responses to the disorder and associated nursing care for each. Discuss nursing implications for medications and treatments used in the prevention, treatment and management of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock. Explain risk factors and preventive measures for Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock. 4 Cardiovascular A & P 5 Right vs Left heart Right side- Low oxygenation Low pressure Light workload Goes toward the lungs Left side High oxygenation Thick walled high pressure Heavier workload Carries oxygenation blood to organs 6 2
Heart Sounds http://www.youtub e.com/watch?v=2a O0HKIP3vI 7 What is Cardiac Output? CO = HR x SV CO=cardiac output HR= heart rate SV= stroke volume Factors that affect SV: HR Preload Afterload Contractility 8 Assessing CV status Other than physical assessment History Family History Genetic Risk Personal History Diet History Socioeconomic Status 9 3
Risk Factors Modifiable HTN Diabetes Hyperlipidemia Cigarette smoking Obesity Physical inactivity Diet Nonmodifiable Age Gender Genetic Factors The text also discusses Metabolic Syndrome and Risk factors unique to women on page 964 10 Risk Factors and Preventive Measures for Cardiac Disorders Heart Failure Risk factors Coronary artery disease Cardiomyopathies Hypertension Congenital and valvular heart disease prevention Education regarding coronary artery disease and diabetes 11 CV Assessment Focused physical assessment General appearance Integumentary system Color Temperature Extremeties Blood pressure Edema Venous flow and arterial pulses 12 4
CV Diagnostic exams Lab tests: CBC Serum electrolytes Mark cardiac damage Troponin CK-MB Myoglobin 13 Cardiac lab tests 14 Diagnostic exams Chest x-ray Angiography Cardiac Catheterization ECG Nursing interventions??? 15 5
Diversity concerns CV client Clients often fear diseases r/t cardiovascular system Require good education, opportunity for client and family to voice concerns/fears Support groups Cardiac rehab referral 16 Chapter 32 Nursing Care of Clients with Cardiac Disorders Pathophysiology of Common Cardiac Disorders Heart Failure Pulmonary Edema Rheumatic Fever/Rheumatic Heart Disease Infective Endocarditis Myocarditis Pericarditis 18 6
Pathophysiology of Common Cardiac Disorders 19 Pathophysiology of Common Cardiac Disorders 20 Right vs Left heart failure Right Peripheral edema Weight gain anorexia Left SOB Fatigue Crackles on auscultation of breath sounds 21 7
Clinical manifestations of Inflammatory Heart Disease Types of inflammatory diseases: Myocarditis Infective endocarditis Pericarditis Rheumatic Carditis 22 Risk Factors and Preventive Measures for Cardiac Disorders Myocarditis Risk factors are any thing that alters immune response Advanced age Malnutrition Alcohol use Immunosuppression Exposure to radiation Stress 23 Anatomy, Physiology, and Functions of the Heart The Pericardium Double-layered fibroserous membrane surrounding the heart Anchors the heart to surrounding structures Space between layers is filled with pericardial fluid Lubricates heart muscle Helps to cushion the heart 24 8
Anatomy, Physiology, and Functions of the Heart 25 Infective endocarditis An infection of the endocardium Common in clients who abuse drugs, had valve replacements, systemic infections or structural cardiac defects 26 Risk Factors and Preventive Measures for Cardiac Disorders Infective Endocarditis Risk factors Congenital deformities Tissue damage due to ischemic disease Valve prosthesis Intravenous drug use Invasive catheters Dental procedures or poor dental health Recent heart surgery Prevention Education is key Prophylactic antibiotics 27 9
Infective endocarditis Most common complication is heart failure 50% have embolic complications due to vegetation Common to have clients with petechia and splinter hemorrhages Diagnosed with positive blood culture or echocardiogram Treat with antibiotics Often need antibiotics before dental procedures 28 Petechiae and splinter hemorrhage 29 Pericarditis vs endocarditis 30 10
Pericarditis Often follows a respiratory infection Often presents with pain in supine position releived by sitting or leaning forward May hear friction rub with stethoscope Treated with NSAIDS relieved within 48 hrs. depends on cause for further treatment Short term course of illness (2-6 weeks) for acute Chronic may require surgery 31 Pericardiocentesis 32 Risk Factors and Preventive Measures for Cardiac Disorders Rheumatic Fever and Rheumatic Heart Disease Risk factors Crowded living conditions Malnutrition Immunodeficiency Poor access to health care Genetic factor may be present Prevention Prompt identification, treatment Importance of finishing medications 33 11
When the heart can t keep up, we may need to pace it Pacemakers Clients who experience life threatening dysrhythmias may require surgical treatment for short or long-term management Small device with a long battery life (20 years or longer) 35 Coronary Circulation and Electrical Properties of the Heart 36 12
Coronary Circulation and Electrical Properties of the Heart 37 Care of the client with a pacemaker 1012 has a great table for teaching the client with a pacemaker. 38 Ultimately when the heart fails, the patient will have shock Chapter 11 Lemone and Burke 13
Cellular Homoeostasis and Basic Hemodynamics Homeostatic regulation maintained primarily by cardiovascular system Four physiologic components Sufficient cardiac output Uncompromised vascular system Sufficient blood volume and blood pressure Tissues that are able to extract and use oxygen 40 Types of Shock Hypovolemic Shock Affects all body systems Most common type of shock Cardiogenic Shock Loss of pumping action of the heart Obstructive Shock Impaired diastolic filling (pericardial tamponade, pneumothorax) Distributive Shock Also known as vasogenic shock 41 Shock Hypovolemic Too little circulating blood causes decrease in MAP thus not meeting the body s total need for oxygen Internal hemorrhage GI bleed External hemorrhage trauma Dehydration 42 14
Shock Cardiogenic Heart muscle is unhealthy or pumping is impaired Causes a decrease CO, afterload and reduces MAP This is seen with an MI 43 Shock Obstructive Affects the heart muscles ability to pump effectively The heart itself is normal however manifestations outside the heart affect filling or contraction Cardiac tamponade Tension pneumothorax Pulmonary embolism 44 Shock Distributive Loss of sympathetic tone Vasodilation Leaky capillaries Spinal cord injury Sepsis Anaphylaxis 45 15
Interventions for Clients Shock Medications Inotropic: increases cardiac contractility Vasopressors: used to treat neurogenic, septic, or anaphylactic shock Opioids: used to treat pain Immunizations: tetanus prophylaxis 46 Shock Look at the patient Compensated vs uncompensated Blood pressure Urine output HR RR Mental status 47 Questions?? Mid Term Exam Next Week. Cumulative to include everything to now. You will have the whole class time to take the exam. 16