LeMone & Burke Ch 30-32 2 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 3
CO = HR x SV CO=cardiac output HR= heart rate SV= stroke volume Factors that affect SV: HR Preload Afterload Contractility 4 Other than physical assessment History Family History Genetic Risk Personal History Diet History Socioeconomic Status 5 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
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 Focused physical assessment General appearance Integumentary system Color Temperature Extremities Blood pressure Edema Venous and arterial pulses 8 Lab tests: CBC Serum electrolytes Mark cardiac damage Troponin CK-MB Myoglobin 9
10 Chest x-ray Angiography Cardiac Catheterization ECG Nursing interventions??? 11 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 12
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 Pathophysiology of Common Cardiac Disorders
Pathophysiology of Common Cardiac Disorders Right Peripheral edema Weight gain anorexia Left SOB Fatigue Crackles on auscultation of breath sounds 17 Types of inflammatory diseases: Myocarditis Infective endocarditis Pericarditis Rheumatic Carditis 18
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 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 Anatomy, Physiology, and Functions of the Heart
And infection of the endocardium Common in clients who abuse drugs, had valve replacements, systemic infections or structural cardiac defects 22 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 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 24
25 26 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 27
Pericardiocentesis 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
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) 31 Coronary Circulation and Electrical Properties of the Heart Coronary Circulation and Electrical Properties of the Heart
34 Education Function Activity Failure Interference Site care LeMone Page 1012 35 Ultimately when the heart fails, the patient will have shock Chapter 11 LeMone and Burke
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 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 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
Cardiogenic Shock Heart muscle is unhealthy or pumping is impaired Causes a decrease CO, afterload and reduces MAP This is seen with an MI Obstructive Shock 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 Distributive Shock Loss of sympathetic tone Vasodilation Leaky capillaries Spinal cord injury Sepsis Anaphylaxis
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 Shock Look at the patient Compensated vs uncompensated Blood pressure Urine output HR RR Mental status