(relates to chapter 32, “nursing assessment: cardiovascular system,” in the textbook) copyright...

(Relates to Chapter 32, “Nursing Assessment: Cardiovascular System,” in the textbook)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

HeartFour chambersComposed of three layers Endocardium Myocardium Epicardium


2

Blood Flow Through the Blood Flow Through the HeartHeart


3

Fig. 32-1. Schematic representation of blood flow through the heart. Arrows indicate direction of flow. 1, The rightatrium receives venous blood from the inferior and superior venae cavae and the coronary sinus. The blood thenpasses through the tricuspid valve into the right ventricle. 2, With each contraction, the right ventricle pumpsblood through the pulmonic valve into the pulmonary artery and to the lungs. 3, Oxygenated blood flows from thelungs to the left atrium by way of the pulmonary veins. 4, It then passes through the mitral valve and into the leftventricle. 5, As the heart contracts, blood is ejected through the aortic valve into the aorta and thus enters thesystemic circulation.


4

Fig. 32-2. Anatomic structures of the heart and heart valves.


5

Fig. 32-3. Coronary arteries and veins.


6

Fig. 34-4. Location of pain during angina or myocardial infarction.


7

Fig. 34-4. Location of pain during angina or myocardial infarction.

• Systole: Contraction of myocardium

• Diastole: Relaxation of myocardium

• Cardiac output: Amount of blood pumped by each ventricle in 1 minuteCO = SV × HR

• Cardiac index: CO divided by body surface area

Mechanical SystemMechanical System


8

• PreloadVolume of blood in ventricles at the end of diastole

• Contractility• Afterload

Peripheral resistance against which the left ventricle must pump

Factors Affecting Cardiac Factors Affecting Cardiac OutputOutput


9

A patient is receiving a drug that decreases afterload. To evaluate the effect of the drug, the nurse monitors the patient’s:

1. Heart rate.2. Lung sounds.3. Blood pressure.4. Jugular vein distention.

Audience Response Question


10

• Vascular systemBlood vessels

• Arteries, arterioles• Veins, venules• Capillaries


11


12

Fig. 32-5. Comparative thickness of layers of the artery, vein, and capillary.

• Regulation of the cardiovascular systemAutonomic nervous systemBaroreceptorsChemoreceptors


13

Blood pressure• Measurement of arterial blood

pressure• Pulse pressure • Mean arterial pressure


14

• Age alters the cardiovascular response to physical and emotional stress.

• Heart valves become thick and stiff.

• Frequent need for pacemakers• Less sensitive to β-adrenergic agonist drugs

• Increase in SBP; decrease or no change in DBP


15

• Subjective dataHealth information

• History of present illness• Past health history• Past and current medications• Surgery or other treatments


16

• Functional health patterns (Table 32-3)Health perceptionhealth management pattern

Nutritional-metabolic patternElimination patternActivity-exercise patternSleep-rest patternCognitive-perceptual pattern


17

• Functional health patternsSelf-perceptionself-concept pattern

Role-relationship patternSexuality-reproductive patternCopingstress tolerance patternValues-belief pattern


18

• Objective dataPhysical examination Vital signs Peripheral vascular system

Inspection Palpation Auscultation


19


20

Fig. 32-6. Common sites for palpating arteries.

• Physical examination (cont’d)Thorax

• Inspection • Palpation• Percussion• Auscultation


21


22

Fig. 32-7. Orientation of the heart within the thorax and cardiac auscultatory areas. Red lines indicate the midsternal line (MSL), midclavicular line (MCL), and anterior axillary line (AAL). ICS, intercostal space; PMI, point of maximal impulse.


23

Fig. 32-8. Relationship of electrocardiogram, cardiac cycle, and heart sounds.

• Noninvasive studiesBlood studiesChest x-rayElectrocardiogram Resting ECG Ambulatory ECG monitoring Event monitor or loop recorder Exercise or stress testing 6-minute walk test


24

Chest X-rayChest X-ray


25

Fig. 32-9. Chest radiograph: Standard posterior-anterior view.

A patient arrives at an urgent care center after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. The nurse reviews laboratory results with the understanding that at this point in time, a myocardial infarction would by indicated by peak levels of:

1. Troponin T.2. Homocysteine.3. Creatine kinase-MB.4. Type b natriuretic peptide.



26

• Noninvasive studiesEchocardiogramNuclear cardiology


27


28

Fig. 32-10. Apical four-chamber two-dimensional echocardiographic view in a normal patient. LA, Left atrium; LV, left ventricle; MV, mitral valve; RA, right atrium; RV, right ventricle; TV, tricuspid valve.

• Noninvasive studies (cont’d)Magnetic resonance imagingComputed tomography


29

Computed TomographyComputed Tomography


30

Fig. 32-11. Examples of coronary calcification of the left anterior descending coronary artery (large arrow) and left circumflex artery (small arrow) as seen on electron beam computed tomography.

• Invasive studiesCardiac catheterization and coronary angiography

Intracoronary ultrasoundFractional flow reserveElectrophysiology studyBlood flow and pressure measurements


31


32

Fig. 32-12. Normal left coronary artery angiogram.

A patient returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse?

1. Pedal pulses are 2+ bilaterally.2. Apical pulse is 54 beats/minute. 3. Mean arterial pressure is 72 mm Hg.4. ST-segment elevation develops on the ECG.



33

(relates to chapter 32, “nursing assessment: cardiovascular system,” in the textbook) copyright...

Documents

affiliate of elsevier

heart copyright

textbook copyright

venous blood

arterial pressure copyright

cardiac output copyright

right ventricle pumps

venules capillaries