Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder 1 Slide 1 human heart Slide 2 MECHANICAL: PUSHES BLOOD FROM HEAD TO TOES AND BACK Slide 3 1
ELECTRICAL SYSTEM: TRIGGERS THE MECHANICAL PHASE Slide 4 Slide 5 Overview of Anatomy and Physiology Cardiac cycle A complete heartbeat Atria contract while ventricles relax Ventricles contract while atria relax Systole Phase of contraction (picture next slide) Diastole Phase of relaxation Period between contraction of the atria or ventricles during which the blood enters the relaxed chambers Slide 6 2
IF THE PLUMBING IS PLUGGED OR DISEASED Blood vessels Capillaries Tiny blood vessels joining arterioles and veins Arteries Large vessels carrying blood away from the heart Carry enriched oxygen or arterial blood Veins Vessels that convey blood from the capillaries to the heart carrying venous blood, de-saturated of oxygen Slide 7 Circulation Coronary blood supply Right and left coronary arteries Branch off of the aorta Encircle the heart like a crown Supply the myocardium with blood Coronary veins Return the venous blood to the coronary sinus, then to the right atrium Slide 8 (From Canobbio, M. [1990]. Cardiovascular disorders, Mosby s clinical nursing series. St. Louis: Mosby.) Arterial coronary circulation (anterior). Slide 9 3
How many people need and receive heart transplants? There were 2,210 heart transplants performed in the United States in 2007 and 2,192 in 2006. Each year thousands more adults would benefit from a heart transplant if more donated hearts were available. As of May 30, 2008, the one-year survival rate was 87.5 percent for males and 85.5 percent for females; the three-year survival rate was about 78.8 percent for males and 76.0 percent for females. The five-year survival rate was 72.3 percent for males and 67.4 percent for females. Slide 10 Heart and Lung Transplants Heart-and-lung transplant operations have been performed since 1980 in the United States. Since 1995, between 30 and 70 heart-lung transplants are performed each year, according to the United Network for Organ Sharing (UNOS). Slide 11 Risk factors for MI Slide 12 4
Diagnostic Examinations Diagnostic imaging Fluoroscopy Angiogram Aortogram Cardiac catheterization and angiography Electrocardiography Slide 13 Disorders of the Cardiovascular System Modifiable risk factors Smoking Hyperlipidemia Hypertension Diabetes mellitus Obesity Sedentary lifestyle Stress Psychosocial factors Slide 14 Disorders of the Cardiovascular System Cardiac Arrest No cardiac output Signs and symptoms: abrupt loss of consciousness with no response to stimuli; absence of pulse and blood pressure Treatment: cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) Slide 15 5
Disorders of the Heart Coronary atherosclerotic heart disease Coronary artery disease (CAD) A variety of conditions that obstruct blood flow in the coronary arteries Atherosclerosis (picture next slide) A common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of the arteries Slide 16 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6 th ed.]. St. Louis: Mosby.) Progressive development of coronary atherosclerosis. Slide 17 Slide 18 6
Slide 19 Disorders of the Heart Angina Etiology/pathophysiology Cardiac muscle is deprived of oxygen Clinical manifestations/assessment Pain (usually relieved by rest) Dyspnea Anxiety; apprehension Diaphoresis Nausea Slide 20 Disorders of the Heart Angina Medical management Medications Dilate coronary arteries and decrease workload of heart Nitroglycerin Beta-adrenergic blocking agents Calcium channel blockers Slide 21 7
Disorders of the Heart Angina Medical management/nursing interventions Surgical interventions Coronary artery bypass graft (CABG) Coronary angioplasty (PTCA) Stent placement Slide 22 Disorders of the Heart Myocardial infarction Also known as a Heart Attack Etiology/pathophysiology Occlusion of a major coronary artery or one of its branches with subsequent necrosis (death) of myocardium Slide 23 Disorders of the Heart Heart Attack Clinical manifestations/assessment Pain (not relieved by rest, position, or nitroglycerin) Nausea SOB; dizziness; weakness Diaphoresis Pallor ashen color Sense of impending doom Slide 24 8
A, Saphenous vein. B, Saphenous aortocoronary artery bypass. Slide 25 Figure 48-13 (From Phipps, W., et al. [1995]. Medical-surgical nursing: concepts and clinical practice. [5 th ed.]. St. Louis: Mosby.) Coronary artery bypass graft. Slide 26 Slide 27 9
Slide 28 Slide 29 Disorders of the Heart Heart failure Etiology/pathophysiology Abnormal condition characterized by circulatory congestion resulting from the heart s inability to act as an effective pump Remember it must pump from head to toe and back Slide 30 10
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Disorders of the Heart Valvular heart disease Etiology/pathophysiology Heart valves are compromised and do not open and close properly Stenosis: means to stiffen Insufficiency Slide 34 Slide 35 Disorders of the Heart Endocarditis Etiology/pathophysiology Infection or inflammation of the inner membranous lining of the heart Slide 36 12
Disorders of the Heart Myocarditis Inflammation of the myocardium Rheumatic heart disease Viral, bacterial, or fungal infection Slide 37 Disorders of the Peripheral Vascular System Arterial assessment PATCHES P = Pulses A = Appearance T = Temperature C = Capillary refill H = Hardness E = Edema S = Sensation Slide 38 Disorders of the Peripheral Vascular System Venous assessment First symptom is usually edema Dark pigmentation Dryness and scaling Ulcerations Pain, aching, and cramping Usually relieved by rest or elevation Slide 39 13
Disorders of the Peripheral Vascular System Hypertension Etiology/pathophysiology A sustained elevated systolic blood pressure greater than 140 mm Hg and/or a sustained elevated diastolic blood pressure greater than 90 mm Hg. Slide 40 Disorders of the Peripheral Vascular System Hypertension (continued) Clinical manifestations/assessment Headache; blurred vision Epistaxis Angina Medical management/nursing interventions Antihypertensive medications; diuretics Diet: weight control, reduction of saturated fats, and low sodium No smoking Slide 41 Slide 42 14
Disorders of the Peripheral Vascular System Arterial aneurysm (picture next slide) Etiology/pathophysiology Enlarged, dilated portion of an artery Causes: arteriosclerosis; trauma; congenital Clinical manifestations/assessment Asymptomatic Large pulsating mass Pain, if large enough to press on other structures Slide 43 Types of aneurysms. A, Fusiform. B, Saccular. C, Dissecting. Slide 44 Disorders of the Peripheral Vascular System Thrombophlebitis Etiology/pathophysiology Inflammation of a vein in conjunction with the formation of a thrombus Risk factors: venous stasis, hypercoagulability, trauma of a blood vessel, immobilization after surgery Clinical manifestations/assessment Pain Edema Positive Homans sign Erythema, warmth, and tenderness along the vein Slide 45 15
Figure 48-22 (From Kamal, A., Brockelhurst, J.C. [1991]. Color atlas of geriatric medicine. [3 rd ed.]. St. Louis: Mosby-Year Book Europe.) Deep vein thrombophlebitis. Slide 46 Disorders of the Peripheral Vascular System Thrombophlebitis (continued) Medical management/nursing interventions Superficial Bedrest Moist heat Elevate extremity NSAIDs» Motrin» Aspirin Slide 47 Disorders of the Peripheral Vascular System Thrombophlebitis (continued) Medical management/nursing interventions Deep Bedrest Anticoagulants Fibrinolytics Elevate extremity Antiembolism stockings Surgery: thrombectomy; vena cava umbrella (Greenfield filter) Slide 48 16
Another day down Slide 49 17