cardiac.pptx
TRANSCRIPT
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Chapter 14
The Cardiovascular System
Chapter 14
The Cardiovascular System
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Anatomy and Physiology
Location of the Heart and Great Vessels
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Anatomy and Physiology(cont’d)
Location of the Heart and Great Vessels
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Anatomy and Physiology (cont’d)
Cardiac Chambers, Valves, and Circulation
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Anatomy and Physiology(cont’d)
• The cardiac cycle– Ventricular pressures• Systole: period of
ventricular contraction
• Diastole: period of ventricular relaxation
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Anatomy and Physiology(cont’d)
• The cardiac cycle (cont’d)– Valve openings and closings
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Anatomy and Physiology(cont’d)
• The cardiac cycle (cont’d)– Valve openings and closings (cont’d)
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Anatomy and Physiology(cont’d)
• The splitting of heart sounds– Split S2
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Anatomy and Physiology(cont’d)
• The splitting of heart sounds– Split S1
• Earlier mitral and later tricuspid
• Heard throughout precordium
• Loudest at cardiac apex
• Softer tricuspid best at lower left sternal border
• Does not vary with respiration
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Anatomy and Physiology(cont’d)
Heart Murmurs
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Anatomy and Physiology(cont’d)
Relation of Auscultatory Findings to the Chest Wall
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Anatomy and Physiology(cont’d)
• Conduction system– SA node– AV node– Bundle of His– Bundle branches– Purkinje fibers
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Anatomy and Physiology (cont’d)
• Conduction system (cont’d)
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Anatomy and Physiology(cont’d)
• Conduction system (cont’d)
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Anatomy and Physiology(cont’d)
• The heart as a pump– Cardiac output: volume of blood ejected from each ventricle in
one minute
– Stroke volume: volume of blood ejected with each heartbeat
– Preload: the load that stretches the cardiac muscle before contraction
– Myocardial contractility: ability of cardiac muscle when given a load, to contract or shorten
– Afterload: degree of vascular resistance to ventricular contraction
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Anatomy and Physiology(cont’d)
• Arterial pressure– Factors influencing arterial pressure• Left ventricular stroke volume
• Distensibility of the aorta and the large arteries
• Peripheral vascular resistance, particularly at the arteriolar level
• Volume of blood in the arterial system
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Anatomy and Physiology(cont’d)
• Jugular venous pressure– Reflects right atrial
pressure
– Best estimated from right internal jugular vein
– Right external jugular vein useful for estimating CVP
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Anatomy and Physiology(cont’d)
Jugular Venous Pressure (cont’d)
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The Health History• Common or concerning symptoms
– Chest pain
– Pain or discomfort radiating to the neck, left shoulder or arm, and back
– Nausea
– Diaphoresis
– Arrhythmias: skipped beats, palpitations
– Dyspnea
– Orthopnea
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The Health History(cont’d)
• Common or concerning symptoms (cont’d)– Paroxysmal nocturnal dyspnea
– Cough
– Edema
– Nocturia
– Fatigue
– Cyanosis
– Pallor
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The Health History(cont’d)
• Assessing cardiac symptoms– Chest pain
• Angina pectoris, coronary artery disease, myocardial infarction, acute coronary syndrome
– Palpitations• Heart skipping, racing, fluttering, pounding
– Shortness of Breath• Dyspnea, orthopnea, paroxysmal nocturnal
dyspnea
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The Health History(cont’d)
• Assessing cardiac symptoms (cont’d)– Cough
• Heart failure, fine crackles and rales
– Edema• Dependent edema, congestive heart disease,
hypoalbuminemia
– Nocturia• Dependent edema, clears at night when patient
supine
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The Health History(cont’d)
• Assessing cardiac symptoms (cont’d)– Fatigue• Signals heart is not adequately supplying
oxygen
– Cyanosis or pallor• Poor oxygenation of body
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Past History• Heart problems?
• Heart disease?
• Murmurs?
• Congenital heart disease/defect?
• Rheumatic fever?
• Hypertension?
• Elevated cholesterol or triglycerides?
• Diabetes?
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Family History
• Coronary artery disease?• Hypertension?• Sudden death younger than 60?• Stroke?• Diabetes?• Obesity?
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Lifestyle Habits
• Nutrition• Smoking• Alcohol• Exercise• Medications, over-the-counter drugs,
herbs, nutritional supplements
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Physical Examination
• Preparation of the patient– Comfortable and calm
– Explain procedure
– Examination gown (opened in the front)
– Assist to examining table
– Cover with drape
– Perform examination from patient’s right side
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Physical Examination(cont’d)
• Equipment– Stethoscope with a bell and diaphragm
– Sphygmomanometer
– Two 15-cm rulers
– Watch with second hand
– Examination light for tangential lighting
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Physical Examination(cont’d)
• Blood pressure and heart rate– Review measurements recorded from General Survey and Vital
Signs.
– Repeat if needed.
– Refer to Table 14-1.
• Face– Color: cyanosis, pallor
– Orbital edema
– Anxiety: occurs during myocardial infarctions
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Physical Examination(cont’d)
• Great vessels of the neck– Carotid artery pulse• Amplitude and contour
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Physical Examination(cont’d)
• Great vessels of the neck– Carotid artery pulse• Thrills and bruits
– Brachial artery
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Physical Examination(cont’d)
• Great vessels of the neck– Jugular venous pressure• Head of bed: elevated 30 degrees
• Hypovolemic: may need to be flat
• Hypervolemic: may need to be higher
• Note height of head of bed in record
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Physical Examination(cont’d)
• Jugular venous pressure (cont’d)– Refer to page 359.
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Physical Examination(cont’d)
• Hepatojugular reflux
• If heart failure is present, jugular venous pressure will remain elevated.
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Physical Examination(cont’d)
• The heart– Positioning patient• Supine
• Turning to left side
• Sitting and leaning forward
– Correlate findings with jugular venous pressure and carotid pulse.
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The Physical Examination(cont’d)
Sequence of the Cardiac Examination
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Physical Examination(cont’d)
• The heart (cont’d)– Inspection
• Apical pulse• See Table 14-3.
– Palpation
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Physical Examination(cont’d)
Apical Pulse
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Physical Examination(cont’d)
• Apical pulse (cont’d)– Location
– Diameter
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Physical Examination(cont’d)
Apical Pulse (cont’d)
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Physical Examination(cont’d)
• The heart (cont’d)– Percussion• Rarely used to estimate cardiac size
• X-rays, ECG, and echocardiography provide more accurate measurements
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Physical Examination(cont’d)• The heart (cont’d)
– Auscultation• Overview• Know your stethoscope
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Physical Examination(cont’d)
• The heart (cont’d)– “Inching” your stethoscope
– Importance of timing S1 and S2
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Physical Examination(cont’d)
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Physical Examination(cont’d)
• The heart (cont’d)– Listening for heart sounds
• S1 (see Table 14-4)
• S2 (see Table 14-5)
• Split S2
• Extra sounds in systole (see Table 14-6)
• Extra sounds in diastole (see Table 14-7)
• Systolic and diastolic murmurs (see Tables 14-8 thorugh 14-11)
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Physical Examination(cont’d)
• The heart (cont’d)– Correctly identifying heart murmurs
• Tips for identifying heart murmurs– Time the murmur.
– Locate where it is the loudest
– Conduct any necessary maneuvers
– Shape
– Grade intensity
– Associated features
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Physical Examination(cont’d)
• Peripheral edema– Inspect feet, ankles, and legs.
– May indicate heart failure
– To be covered in detail in Chapter 15
• Integrating cardiovascular assessment– Correlate complaints with findings.
– Put together information to form hypothesis of patient complaint’s.
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Recording Your Findings
• Structures
• Colors
• Auscultations
• Pulsations
• Palpations
• Heart sounds
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Health Promotion
• Topics– Coronary heart disease
– Stroke prevention
– Hypertension prevention and management
– Hyperlipidemia prevention and management
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Health Promotion(cont’d)
• Key roles for nurse– Screening patients for disease and risk factors
– Teaching patients relationship of risk factors to disease
– Educating patients on lifestyle changes to reduce risk factors
– Encouraging patients to adhere to healthy lifestyles and medical regimens to reduce the incidence of disease morbidity
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Health Promotion(cont’d)
Blood Pressure Classification
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Health Promotion(cont’d)
• Risk reduction– Coronary heart disease risk factors• Modifiable risk factors
– Diabetes
– Systolic and/or diastolic hypertension
– Smoking
– Obesity
– Physical inactivity
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Health Promotion(cont’d)
• Risk reduction (cont’d)– Coronary heart disease risk factors
(cont’d)• Nonmodifiable factors
– Increasing age
– History of cardiovascular disease
– Family history of early heart disease
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Health Promotion(cont’d)
• Hypertension risk factors– Modifiable risk factors
• Obesity
• Physical inactivity
• Smoking
• Microalbuminuria
• Excess dietary sodium
• Insufficient intake of potassium
• Excess alcohol consumption
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Health Promotion(cont’d)
• Hypertension risk factors (cont’d)– Nonmodifiable factors• Age
• Family history of hypertension or CVD
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Health Promotion(cont’d)
• Risk factors used to assess the 10-year coronary heart disease risk score– Age
– Gender
– Height, weight, waist circumference (of BMI)
– Smoking
– History of cardiovascular disease or diabetes
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Health Promotion(cont’d)
• Risk factors used to assess the 10-year coronary heart disease risk score (cont’d)– Systolic and diastolic blood pressure
– Total cholesterol, LDL, and HDL cholesterol
– Triglycerides
– Family history of early heart disease
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Health Promotion(cont’d)
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Health Promotion(cont’d)
Healthy Lifestyles
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Health Promotion(cont’d)Healthy Lifestyles (cont’d)
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Health Promotion(cont’d)
• Healthy eating– Healthy fats• Foods high in monounsaturated fat
• Foods high in polyunsaturated fat
• Foods high in omega-3
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Health Promotion(cont’d)
• Healthy eating (cont’d)– Unhealthy Fats• Foods high in trans fat
• Foods high in cholesterol
• Foods high in saturated fat
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Health Promotion(cont’d)
• Counseling about weight and exercise– Dietary factors are associated with 4 of the 10
leading causes of death.
– Discuss principles of healthy eating.
– Encourage exercising, at least 30 minutes on most days of the week.
– Evaluate any cardiovascular, pulmonary, or musculoskeletal conditions before selecting an exercise regimen.