The Cardiac ClientLa Jolla Nurses Homecare HHA/PCA

In-service Powerpoint

General Overview• Cardiovascular (CV) disease leads to

6 million hospitalizations a year • CV disease:

– High blood pressure (Hypertension)– Heart disease– Stroke

• Coronary artery disease: Abnormal conditions of arteries of heart

• Coronary heart disease: Disorders of the heart’s blood supply

• High blood pressure: Systolic of 140 or higher, Diastolic of 90 or higher

Structures of the Heart

• Layers: pericardium, myocardium, endocardium• The heart has four main chambers

• Valves open and close to allow blood to flow through the vessels• Heart Pumping- Animation (turn up volume)

The Circulatory System

• Includes:– Heart– Lungs– Blood vessels

• Allows blood to flow throughout the body, bringing necessary oxygen and nutrients to all the organs and tissues

Path of the Circulatory System• Blood travels in a figure-8

pattern• Lungs saturate blood with

oxygen• Heart pumps blood to

body and lungs• Systemic circulation is the

exchange of blood from the heart and the body

Cardiovascular Diseases• Coronary Artery

Disease• Angina Pectoris• Arteriosclerosis• Heart failure• Valvular heart disease• Cardiomyopathy• Hypertension• Cardiac Arrhythmia• Myocardial Infarction

Coronary Artery Disease/Angina Pectoris

• Affects arteries of the heart • Reduces blood flow to the

heart muscle (myocardium)• Decrease in amount of

oxygen/nutrients the body receives

• Angina (crushing chest pain) is caused by decreased oxygen to the heart

• Classic symptom of CAD= Angina

• Stable Angina: Occurs after physical activity, relieived by rest

• Unstable Angina: Can occur at anytime, not relieved by rest

Arteriosclerosis

• Definition: Thickening of the walls of the arteries

• Caused by a build up of plaque inside the arteries

• Atherosclerosis can lead to:– Stroke/MI

How is CAD treated?

• Medications:–Antianginal agents–Anticoagulants–Antidysrhythmics–Antihypertensives–Diuretics–Vasodilators

How is CAD treated?• Invasive Procedures and Surgery

– Cardiac catheterization– Percutaneous Transluminal

Coronary Angioplasty (A)– Coronary Stenting (B)– Laser angioplasty – Coronary Artery Bypass Graft

Surgery (C)– Coronary Ablation

B

A

C

Heart Failure• Prevents the heart from working

properly• People nowadays are living longer

with damaged heart muscles due to advancements in medicine/technology

• People are living longer with damaged heart muscles

• Eventually, the heart loses ability to contract properly

• Common S/S of heart failure: Fatigue, shortness of breath, swelling at ankles

Left Heart Failure vs. Right Heart Failure

• Left Side:– Blood backs up into

the lungs• Right Side:– Fluid entering the

heart backs up and veins and tissues in the body begin to swell

Congestive Heart Failure and Pulmonary Edema

• Congestive heart failure: When fluid backs up into the lungs, feet, legs and abdomen. Kidneys lose their ability to excrete sodium & water.

• Pulmonary edema: Build up of fluid in the lung tissue and alveoli

Valvular Heart Disease and Cardiomyopathy

• Valvular heart disease: (see picture to the right)– Narrowing of valves cause

back-ups of blood– Improperly closing valves

cause blood to leak back into heart chamber

• Cardiomyopathy:– Diseases that damage the

heart muscle such as infections or abuse of drugs/alcohol

Hypertension

• Definition: Force of the blood against the vessel walls during contraction and relaxation of the heart

• Systolic=Pressure during contraction

• Diastolic=Pressure during relaxation

• Hypertension is also known as “high blood pressure”

Hypertension continued…• Characteristics:

– Elevated blood pressure– “Silent killer”; lack of

symptoms– If untreated, hypertension can

lead to stroke, MI, heart failure, and kidney disease

– Hypertension: Systolic greater than 140 mm Hg, Diastolic pressure greater than 90 mm Hg

• Treatments:– Antihypertensive drugs– Weight loss– Diet

Cardiac Arrythmia

• Definition: Abnormal heart rate or rhythm• Usually caused by a problem with the electrical impulses of the heart• Symptoms: Dizziness, fainting, shortness of breath• Causes: Hypertension, coronary heart disease, valvular heart disease, certain

medications• Treatments: Medications, cardioversion, pacemaker• Example: Atrial fibrillation

– Definition: Very rapid and irregular heartbeat of the atria

Myocardial Infarction• Myocardial Infarction AKA “Heart

Attack”- Occurs from a lack of oxygen to the heart muscle

• Underlying cause is usually atherosclerosis

• Symptoms: Severe/crushing chest pain, pain radiating to neck/jaw/shoulder/back, heaviness or pressure on the chest, aching, burning, “squeezing” pain, nausea, heartburn, pale and clammy skin, sweating, difficulty breathing, irregular heartbeat with palpitations, elevated blood pressure, feeling of “doom”

Caring for the Cardiac Client at Home• Observe and report• Promote independence• Assist with personal care• Plan meals• Monitor Exercise and

Activity• Maintain a safe

environment• Provide emergency care• Provide emotional support• Assist with medications

Case Study: Mr. SteweyMr. Stewey was recently discharged from the hospital, following a diagnosis of congestive heart

failure. The caregiver, Carol, had been working with Mr. Stewey for a few days. She went for her visit and while making the bed, noticed that there were four additional pillows on the bed. Initially, Carol thought nothing of it. The next day when she returned, she noticed that the bed was never slept in. Carol assumed that the client was no longer comfortable in his bed, but she never questioned the client about his change in sleeping habits.

When Carol returned a couple of days later, she found the client was diaphoretic and short of breath. She called the nursing supervisor, and the client was eventually admitted to the hospital with congestive heart failure.

Discussion Questions:1. List the observations that the caregiver should have reported to the nursing supervisor

earlier. Why are they important?2. What should the caregiver have done when she noticed that the bed was never slept in?3. List some other symptoms of heart failure that Mr. Stewey could have been exhibiting.