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 PreventiveMeasures 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, andFunctions 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, andFunctions 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 PreventiveMeasures 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 PreventiveMeasures 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

Shock

� Cardiogenic

� Heart muscle is unhealthy or pumping is impaired

� Causes a decrease CO, afterload and reduces MAP

� This is seen with an MI

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

Shock

� Distributive

� 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