MEDICAL – SURGICAL NURSING CARDIOVASCULAR DISORDERS Assoc. Prof. I. S. TIONKO
CARDIAC DISORDER
PATHOP HY HYSIOLOGY
ASS ES ESSMENT F IN INDINGS
INTERVENTIONS
Sinus 'ode slows because of stimulation of the parasympathetic fibers a!al nere.
ECG: Venr!c"#$r $n% Ar!$# R$e: 0 in Adult, Venr!c"# Venr!c"#$r $r $n% Ar!$# Ar!$# R&'&(: R&'&(: e!ular, )RS S&$*e $n% D"r$!on: )sually D"r$!on: )sually normal, but maybe re!ularly re!ularly abnormal, abnormal, P +$,e: +$,e: 'ormal and consistent shape, always in front of the 3S, PR Iner,$#: *onsistent Iner,$#: *onsistent interal between .12-.2 s, P:)RS- 141 P:)RS- 141
%f the decrease in 7 results from stimulation of the a!us nere, such as bearin! down durin! defecation or omitin!, attempts are made to preent further a!al stimulation
ECG: Venr!c"#$r $n% Ar!$# R$e: R$e: 51bpm in Adul Adult, t , Venr!c"# Venr!c"#$r $r $n% Ar!$# Ar!$# R&'&(: R&'&(: %rre!ular, )RS S&$*e $n% D"r$!on: )sually normal, normal, but maybe maybe re!ularly abnormal, abnormal, P +$,e: 'ormal +$,e: 'ormal and consistent shape, always in front of the 3S but maybe buried in the precedin! precedin! T 6ae 6ae PR Iner,$#: Iner,$#: *onsistent interal between .12-.2 s, P:)RS- 141 P:)RS- 141
Treat the underlyin! cause feer, shoc8, 9luid and :lectrolyte disturbances
ECG: Venr!c"#$r $n% Ar!$# R$e: R$e: 0-1bpm in Adult, Venr!c"#$r $n % Ar!$# R&'&(: %rre!ular, R&'&(: %rre!ular, )RS S&$*e $n% D"r$!on: )suall )sually normal normal, but maybe maybe re!ularly arly abnormal, P +$,e: +$,e: 'ormal and consistent shape, always in front of the 3S, PR Iner,$#: Iner,$#: *onsistent stent interal between .12-.2 s, P:)RS- 141 P:)RS- 141
Sinus arrhythmia does not cause any si!nificant hemodynamic effect and usually is not treated
MEDIC ATIONS
I. DYSRYTHMIAS are disord disorders ers of the format formation ion and/or and/or conduc conductio tionn of the electr electrica icall impuls impulses es within within the heart. heart. These These disorders can cause disturbances of the heart’s rate, rhythm, or both. A. SINUS DYSRYTHMIAS
A.1 Sinus Bradycardia - when the sinus node creates an impulse at a slower-tha slower-thannnormal rate
A.2 Sinus Tachycardia - occurs when the sinus node creates an impulse at a fasterthan-normal rate.
A. Sinus Arrythmia -occurs -occurs when the sinus node create createss an impuls impulsee at an irre!u irre!ular lar rhythm rhythm"" the rate rate usua usualllly incr increa ease sess with th inspiration and decreases with e#piration. $%ST%&'(&/)ST*&'/&+
The sympathetic fibers are stimulated thereby, speed up e#citation of the SA 'ode
An %rre!ularity in rhythm which is related to respiratory e#chan!e occurs when the SA 'ode creates an impulse at an irre!ular rhythm
Aro*!ne S"#f$e .+-1. S"#f$e .+-1. m!/%;< to bloc8 a!al stimulation Iso*roereno# 1m!/+ Iso*roereno# 1m!/+ m= >+6 to stimulate sympathetic response P$ce($er transcutaneous pacin!
D!!$#!s A%(!n!sr$!on C$#c!"( C&$nne# /#ocers /e$ /#ocers
'o medications !ien.
/. ATRIAL TRIAL DYSR DYSRYT YTHMI HMIAS AS B.1
&ccurs when an electrical impulse starts in the atrium before the ne#t normal impulse of the sinus node.
B.2 Atrial 9lutter - ectopic atrial focus captures th e h ea ea rtrt r hy hy th thm a nd nd dischar!es impulses at a rate between between 2-? 2-? times per minute
B. Atrial 9ibrillation - is a dysrhy dysrhythm thmia ia that is caus caused ed by the the rapi rapidd and and chaotic firin! of atrial impulses by a multitude of foci
$%ST%&'(&/)ST*&'/&+
&ccurs in the atrium and crates impulses at an atrial rate bet. 2+-? times per minute. Because the atrial rate is faster than the A; 'ode can conduct, not all atrial impulses are conducted into the entricle, causin! a therapeutic bloc8 at the A; 'ode
There is a rapid, disor!ani@ed and uncoordinated twitchin! of atrial musculature
ECG: Venr!c"#$r $n% Ar!$# R$e: >epends >epends on the underlyin! cause, Venr!c"#$r $n% Ar!$# R&'&(: %rre!ular %rre!ular due to early < 6aes, creatin! a << interal that is shorter than the others. others. This is sometimes followed followed by a lon!er-than-normal << interal, but one that is less than twice the normal << interal. This This type type of inte inter ral al is call called ed a '&'*&<:'SAT& '&'*&<:'SAT& <7AS: )RS S&$*e $n% D"r$!on: D"r$!on: The 3S that follows follows the early < wae is usually normal, but it maybe abnormal. %t maybe absent bloc8ed
ECG: Venr!c"#$r $n% Ar!$# R$e: 2+-? atrial rate, C+-1+ entricular rate , Venr!c"#$r $n% Ar!$# R&'&(: Atrial R&'&(: Atrial rhythm is re!ular, but the entricular rhythm is usually irre!ular bec. of a chan!e in A; conduction, conduction, )RS S&$*e $n% D"r$!on: D"r$!on: )sually normal, but maybe re!ularly re!ularly abnormal, P +$,e: +$,e: Saw toothed shape. These waes are referred as 9 waes, waes, PR Iner,$#: Iner,$#: multiple 9 waes maybe difficult to determine the < interal, P:)RS- 241. P:)RS- 241. 41, ?41
ECG: Venr!c"#$r $n% Ar!$# R$e: Atrial rate40, ;4 12-2 12-2 in untreated untreated fibrillation, fibrillation, Venr!c"# Venr!c"#$r $r $n% Ar!$# Ar!$# R&'&(: R&'&(: 'ormal, )RS S&$*e $n% D"r$!on: )sually D"r$!on: )sually normal, but maybe re!ularly abnormal, P +$,e: 'o +$,e: 'o discernibl discernible < waes" waes" irre!ular irre!ular undulatin! atin! waes are seen and are referred as 9 or fibrillatory llatory waes, PR Iner,$#: Iner,$#: *an’t be measured, P:)RS- many41 P:)RS- many41
%f
%f it increases in freDuency 50/min, )"!n!%!ne or C$#c!"( C&$nne# /#ocer maybe /#ocer maybe necessary
D!!$#!s *re*$r$!on or %!o0!n )"!n!%!ne C$#c!"( C&$nne# /#ocers /ee-$%rener!c /#ocers IV $%enos!ne C$r%!o,ers!on
>epends on its cause and duration and the patient symptoms, a!e and co-morbidities *ardioersion
D!!$#!s !f "nconro##e% "nconro##e% f!1r!##$!on )"!n!%!ne /e$ $%rener!c 1#ocers
C. VENTRICULAR
DYSRYTHMIAS *.1.
*.2 ;entricular Tachycardia - is a life f e thre threat aten enin in!! dysrhytmia dysrhytmia that ori!inates nates from an irritable focus within the entricle. - it is an effectie rhythm for maintainin! cardiac output.
*. ;entricular 9ibrillation -a dysr dysrhy hyth thmi mia that that is characteri characteri@ed @ed by the random random and chaotic chaotic dischar!in dischar!in!! of impulses within the entricle at rates that e#ceed beats per minute.
ysrythmias→ ↓ *&→ ↑ *ardiac %rritability → ↓ yocardial ysrythmia
&ri!inates form an irritable focus within the entricle. %t is an ineffectie rhythm for maintainin! *&
*haracteri@ed by random and chaotic dischar!in! of impulses within the entricle at rates e#ceed bpm.
-characteri@ed by absent 3S comple#es, althou!h the < waes my be apparent for a short duration in two -commonly called flatline, -'o heartbeat, heartbeat, no palpable palpable different leads.
*.?. ;entricular Asystole 9latline pulse, no respiration $%ST%&'(&/)ST*&'/&+
1. L!%oc$!ne3IVP4 %r!* %nitial bolus dose4 C+-1 m! then +-1 m! within 1-1+ min, as needed *ontinuous %; drip is >+6, ?41 concentration 2. Proc$!n$(!%e: %; Proc$!n$(!%e: %; drip bolus dose4 m! . /re'#!"(: continuous /re'#!"(: continuous infusion if =idocaine and procainamide are ineffectie
ECG: Venr!c"#$r $n% Ar!$# R$e: >epends >epends on the underlyi underlyin! n ! rhythm rhythm,, Venr!c"#$r $n% Ar!$# R&'&(: %rre!ular R&'&(: %rre!ular due to early 3S, creatin! one interal that’s shorter than the others. << interal interal may be re!ular, re!ular, indicatin! that the <;* did not depolari@e the sinus sinus node, node, )RS S&$*e $n% D"r$!on: >uration is .12 s or lon!er, bi@arre shape and abnormal, abnormal, P +$,e: ;isibility +$,e: ;isibility of < wae depends depends on the timin! of the <;*" may be absent or in front of 3S. %f the < wae follows the 3S, the shape of the < wae may be different, PR Iner,$#: %f Iner,$#: %f the < wae is in front of the 3S, the < interal is less than .12 s, P:)RS- 41, P:)RS- 41, 141
ECG: Venr!c"# Venr!c"#$r $r $n% Ar!$# Ar!$# R$e: R$e: Atrial rate4 depends on the underlyin! cause , ;4 12, Venr Venr!c" !c"#$r #$r $n% Ar!$# Ar!$# R&'&( R&'&(:: )sually re!ular, )RS S&$*e $n% D"r$!on: >uration is .12 s or more, P +$,e: difficult +$,e: difficult to detec detect, t, PR Iner,$#: Iner,$#: ;ery ;ery %rre!ular %rre!ular , P:)RS- >ifficult P:)RS- >ifficult to determine
>efibrillation if no pulse and unconscious *ardioersion if conscious
%mmediate DE2I/RILLATION: 2-? ECG: Venr!c"#$r R$e: R$e: 5 bpm, bpm, Venr!c"#$r watt/sec E :#tremely irre!ular irre!ular,, )RS S&$*e R&'&(: :#tremely $n% D"r$!on: D"r$!on: >uration is .12 s or more,4 %rre!u %rre!ular lar,, undula undulatin tin!! waes waes withou withoutt reco!ni@able 3S comple#
ECG: Absent 3S comple#, < waes maybe apparent for short duration
*< and : serices are necessary Transcutaneous pacin!
L!%oc$!ne: bolus L!%oc$!ne: bolus dose" followed by a continuous %; drip from 1-? m!/min
E*!ne*&r!ne
HCO5 to reliee lactic acidosis N$ HCO5 to which causes unsuccessful defibrillation
E*!ne*&r!ne 4 bolus, -+ minutes
interal
CARDIAC DISORDER
PATHOPHYSIOLOGY
II. CORONAR CORONARY Y ARTERY DISEASE -most common is atherosclerosis, which is an abnormal accumulation of lipid, or fatty substances and fibrous tissue in the the esse essell of the wall. l. Thes Thesee substances create bloc8a!es or narrow the essel in a way that reduces blood flow to the myocardium.
ANGINA PECTORIS -
clinic i nical al synd syndro rome me usua usuallllyy char charac acte teri ri@e @edd by epis episod odes es or paro#ysms of pain or pressure in the anterior anterior chest. The cause is usually insufficient coronary blood flow.
CAD be!ins as fatty strea8s, lipids that are are depo deposi site tedd in the the intima of the arterial wall. Althou t hou!h !h,, they they are are thou!ht to be the precursors of athero atheroscl sclero erosis sis,, fatty fatty stre strea8 a8ss are are comm common on een een in chil childhoo d hood. d. oreoer, not all deelop into into more more ada adanc nced ed lesions. The reason why fatty strea8s continue to dee deelo lopp is un8n un8now own, n, althou althou!h !h !eneti !eneticc and enironment enironment factors are inoled. inoled. The continued nued dee deelo lopm pmen entt of *A> *A> inoles an inflammatory response. T lymphocytes and monocytes monocytes infiltrate infiltrate the area to in!est in!est the lipids and then die" this causes smooth muscle cells within the essel to proliferat i feratee an die" die" this this causes smooth muscle cells within the essel to proliferat i feratee and from from a fibr fibrou ouss cap cap oer oer the the dead fatty core. These deposits called atheromas atheromas or plaDues, plaDues, protrude protrude into the lumen of the essel, narrowin! it and obstructin! blood flow. %f the fibrous cap of the plaDue is thic8 and the lipid lipid pool pool remain remainss relatiely ely stable, it can resist resist the stress stress from from
ASSESSMENT FINDINGS
An!ina
yocardial %schemia acute onset of chest pain
7eart 9ailure
:*F abnormalities
7i!h leels of cardiac en@ymes
>ysrythmias
I NT NTERVENTIONS
*ontrollin! *holesterol
MEDI CA CATIONS
5–H'%ro0'-5(e&'##"$r'#
Abnormalities
coen6'(e A 7HMG-CoA8
*ABF
re%"c$se !n&!1!ors or s$!ns G
>ietary easures
bloc8 cholesterol synthesis, lower
e!ulatin!
=>= and tri!lyceride leels, and
increase 7>= leels.
N!co!n!c $c!%s G $c!%s G decrease lipoprotein synthesis, lower =>= and tri!lyceride
2!1r!c Ac!% or f!1r$es G f!1r$es G decrease synthesis of cholesterol
Tre$(en
*A> *A> is beli belieed e ed to resu result lt from from inflammation of the arterial endothelium. *-reactie protein *< is a mar8er for inflammation of ascular endothelium. 7i!h blood leels of *< hae been
1. 2.
V$so%!#$ors V$so%!#$ors 7N!r$es8 /e$- $%rener!c 1#ocers C$#c!"( c&$nne# 1#ocers P#$e#e Are$!on In&!1!ors An!co$"#$ns
$%ST%&'(&/)ST*&'/&+
blood blood flow flow and essel essel moement. %f the cap is thin, the lipid core may !row causin! it to rupture and hemorrha!e into the plaD plaDue ue,, allowi l owin! n! a thrombu thrombuss to deelo deelop. p. The The thro thromb mbus us may may obst obstru ruct ct bloo bloodd flow flow,, l ea ea di di n! n! to su dd dd en en cardiac death or an cute % which is the death of heart tissue.
Atherosclerosis, hypertension, >,
thromboan!itis obliterans, polycythemia era, aortic re!ur!itation H Icoronary tissue perfusion H I myocardial o#y!enationH anaerobic metabolism H J lactic acid production lactic acidosis H an!ina
MYOCARDIAL IN2ARCTION formation formation of locali@ed i@ed necrotic necrotic areas within the myocardium.
Seeral factors are associated with an!inal pain4 1. physic physical al e#ert e#ertion ion which which can can precipitate an attac8 by ↑ myocardial o2 demand 2. :#posu :#posure re to to cold cold whic whichh can can cause asoconstriction and an eleated B< with ↑ &2 demand . :atin! :atin! a heay heay meal meal whic whichh ↑ blood flow to the mesenteric area for di!estion, thereby reducin! the blood supply aailable to the heart muscle ?. Stress Stress which c h incr increas eases es the the sympathetic response
associated associated with increased increased coronary coronary artery calcification and ris8 of an acute cardio cardioas ascul cular a r eent eent in seemin seemin!ly !ly healthy indiiduals. There is interest in usin! *< blood leels as an additional ris8 factor for cardioascular disease in clinical use and research. An eleated blood leel of homocysteine, an amino acid, has also been proposed as an indepe independe ndent nt ris8 ris8 factor factor for cardioascular oascular disease. disease. 7oweer, 7oweer, stud studie iess hae hae not not supp suppor orte tedd the the relationship between mild to moderate eleat eleation ionss of homocy homocyste steine ine and atheroscle atherosclerosis rosis.. 'o study study has yet shown that reducin! reducin! homocystei homocysteine ne leels reduces the ris8 for *A>.
. ?.
%ntraa %ntraascu scular lar Stenti Stentin! n! =ase =aserr ther therap apyy
S"r!c$# M$n$e(en: 1. *oronary Artery Bypass Fraft *ABF N"rs!n Iner,en!ons: 1. >iet>iet- =ow =ow 'a, 'a, low low fat and low cholesterol, hi!h fier 2. Aoi Aoidd satu satura rate tedd fats fats . 6hite t e meatmeat- chic chic8en 8en with without out s8in, fish are low in saturated fats ?. 'o restr restrict iction ionss are placed placed on on actiity within the patient’s limitations
CLINICAL MANI2ESTATIONS iaphoresis >yspnea i@@iness >i!estie >isturbance due to a!al simulation
Me%!c$# M$n$e(en: 1. Foals a.
An$#es!cs- Mor*&!ne SO9 T&ro(1o#'!c T&er$*' An!co$"#$n /e$ $%rener!c 1#ocers Se%$!,es
$%ST%&'(&/)ST*&'/&+
$%ST%&'(&/)ST*&'/&+
CARDIAC DISORDER
% is usuall usuallyy caused caused by reduce reduce blood flow in a coronary artery due to atherosclerosis and occlusion of an arte artery ry by an embo embolu luss or throm thrombus bus.. Beca Becaus usee unst unstab able le an !i !in a a nd nd a cu cu te te % a re re considered to be the same process. &the &therr caus causes es of % incl includ udee asospasm asospasm of coronary artery, artery, ↓ o#y!en o#y!en supply and ↑ demand for &2. &2. %n each each case case,, a profo profound und imba imbala lanc ncee e#is e#ists ts betw betwee eenn myocardial supply and demand.
PATHOPHYSIOLOGY
dysryhythmias iet >iet44 low cho chole lest ster erol ol,, low sal saltt Bed rest rest is is usual usually l y pres prescri cribed b ed for 2?-?N hours to ↓ o2 demand.
&li!uria - m=/hr
?.
9eer-sli!ht eleation of temp. occurs within 2? hours and e#tends -C days accompanie accompaniedd by leu8ocytosi leu8ocytosis and eleated :S
+. 0.
%ndi!estio %ndi!estionn -!as pains around around the heart, nausea and omitin!
Acute Acute yspnea, >yspnea, orthopnea, orthopnea, 1. 7, AST 0.
ASSESSMENT FINDINGS
I NT NTERVENTIONS
MEDI CA CATIONS
III. AC)UIRED AC)UIRED VA VASCUL SCULAR AR DISEASE MITRAL VALVE PROLAPSE - formerly 8nown as mitral prolapse syndrome, is a deformity that usually produces no symptoms. arely, it pro!resses and can result in sudden death.
%' ;<, a portion of a mitral leaflet balloons bac8 into the atrium durin! systol systole. e . arely arely,, the balloonin l oonin!! stretches the leaflet to the point that the ale e doesn’ doesn’t remain remain closed closed d ur ur in ! s ys ys to to le . Bl oo oo d t he he n re!ur!itates form the =; bac8 into the =A
aybe asymtomatic fati!ue, shortness of breath li!ht-headedness, di@@iness, syncope, palpitations, chest pain and an#iety
Me%!c$# M$n$e(en: 1. Symp Sympto toma mati ticc 2. Adise Adisedd to eliminate m inate caff caffein einee and alcohol . Stop Stop smo8 smo8in in!! S"r!c$# Iner,en!on 1.
itral itral ;ale ale epa epair ir or eplacement in adanced sta!es
' "rs!n M$n$e(en: . 7ealth education ;. %nstruct patients to ta8e the
C$#c!"( C&$nne# /#ocers /e$ A%rener!c /#ocers
5.
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9. <.
MITRAL STENOSIS
AORTIC REGURGITATION -
is the flow of blood bac8 into the left entricle entricle from the aorta durin! diasto a stole le.. %t may be cause causedd by inflammat inflammatory ory lesions lesions that deform the leaflets of the aortic ale, preentin! them form completely closin! the aortic ale orifice.
'ormally, the mitral ale openin! is as wide as the dm. &f fin!ers. %n cases of mar8ed stenosis, the openin! narrows to the width of a pencil. The =A has !reat difficulty moin! blood into the entricle beca becaus usee of the ↑ resistance of the narr narrow owed ed orif orific ice" e" it dilate l atess and and hypertrophies because of ↑ B; it holds. Because there is no ale to protect the pulmonary eins from the bac8ward flow of blood from the atrium, the pulmonary circulation circulation becomes con!ested. con!ested. As a result, the ; must contract a!ainst an abnorm abnormall ally hi!h hi!h pulmonary m onary arteri arterial al pressure pressure and is subMected to e#cessie e#cessie strain. :entually the ; fails.
The pulse is wea8 and often irre!ularly because of atrial fibrillation. A lowpitched, rumblin!, diastolic murmur is heard at the ape#. As a result of the increased blood olume and pressure, the atrium dilates, hypertrophies, and becomes electrically unstable, and the patient e#periences atrial dysrythmias. :chocardio!raphy is used to dia!nose mitral stenosis. :*F and cardiac catherteri@ation with an!io!raphy are used to determine the seerity of the mitral stenosis.
Blood from Aorta→ =; diastole → =; dilates and hypertrophies → arteries try to compensate for the ↑ pressure refle# asodi asodilat lation ion → peripheral peripheral arterioles oles rela#→ ↓ peripheral peripheral resistance resistance and diastolic B<
A diastolic murmur is heard as a hi!h-pitched, blowin! sound at the third or fourth intercostals space at the left sternal border. The pulse pressure is considerably widened in patients with aortic re!ur!itation. re!ur!itation. &ne characteristic si!n of the disease is the waterhammer pulse, in which the pulse stri8es the papatin! fin!er with a Duic8, sharp stro8e and then suddenly collapses.
Asyymptomatic forceful heart beat mar8ed arterial pulsations that are palpable e#ertional >yspnea fati!ue
prescribed medications on time and complete the dru! Tell the patients to aoid caffeine and alcohol :ncoura!e the patient to read dru! labels carefully :#plore with the patient’s possible diet, actiity, sleep and other lifestyle
Me%!c$# ($n$e(en 1. 2.
Antibi Antibiotic o tic prophyla prophyla#is #is thera therapy py Treat *7 *79
S"r!c$# M$n$e(en: 1. ;alu alulo lopl plas asty ty 2. itral itral ;ale ale epla eplacem cement ent
Pro*&'#$c!c An!1!o!cs
An!co$"#$ns - +$rf$r!n 7Co"($%!ne8
N"rs!n M$n$e(en: 1. 7eal 7ealth th educ educat atio ionn 2. %nstru %nstruct ct patie patients nts to to ta8e ta8e the prescribed medications on time and complete the dru! . Tell the the patie patients nts to to aoid aoid caffeine and alcohol ?. :ncoura :ncoura!e !e the patient patient to read read dru! labels carefully +. :#plor :#ploree with t h the the pati patient’ e nt’s possible diet, actiity, sleep and other lifestyle Me%!c$# M$n$e(en 1. Antibi Antibiotic o tic prophy prophyla# la#is is 2. Treat Treat dysryt dysrythmi hmias as and 79 S"r!c$# M$n$e(en: 1. Aortic Aortic alul uloplast o plastyy 2. ;ale ale epl eplac acem emen entt N"rs!n Iner,en!on: 1. 7eal 7ealth th educ educat atio ionn 2. %nstru %nstruct ct patie patients nts to to ta8e ta8e the prescribed medications on time and complete the dru! . Tell the the patie patients nts to to aoid aoid caffeine and alcohol
Pro*&'#$c!c An!1!o!cs
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AORTIC STENOSIS aortic ale is narrowin! narrowin! of the orifice between the left entricle and the aorta.
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pro!ressie si!ns of =*79 diastolic murmur at the rd or ?th %*S at the left sternal border 6ide ia!nosis confirmed by N>- :cho, % , radionuclide ima!in! and *ardiac catheteri@ation
Asymtomatic e#ertional >yspnea di@@iness and syncope an!ina pectoris =ow B< rou!h-loud systolic murmur is heard in the aortic area systolic crescendo-decrescendo murmur =;7- 12 lead :*F 2>-:cho- dia!nose and monitor the pro!ression
?. +.
:ncoura :ncoura!e !e the patient patient to read read dru! labels carefully :#plor :#ploree with t h the the pati patient’ e nt’s possible diet, actiity, sleep and other lifestyle
MEDICAL MANAGEMENT 1. Antibi Antibiotic o tic prophy prophyla# la#is is to to preent endocarditis SURGERY: replacement SURGERY: replacement of aortic ale
CARDIAC DISORDER IV. CADIOMYOPATHY is a heart muscle disease associated with cardiac dysfunction. dysfunction. %t is classified accordin! to the structural and functional abnormalitites of the heart muscle.
PATHOPHYSIOLOGY
↓ Stro8e ;olume → S'S and AA → ↑ Systemic ;ascular esistance → ↑ 'a and water retention → ↑ wor8load of the heart→ 7eart 9ailure
ASSESSMENT FINDINGS
I NT NTERVENTIONS
MEDI CA CATIONS
stable and asymptomatic si!ns and symptoms of 7eart 9ailure <'> orthopnea fluid retention peripheral edema nausea chest pain palpitations di@@iness syncope with e#ertion sudden death with 7* Tachycardia Tachycardia and e#tra heart sounds 2> :cho and :*F *O *ardiac *ath to rule out coronary artery disease as a cause :ndomyocardial biopsy
Me%!c$# ($n$e(en: 1. Treat Treat the the unde underly rlyin! in! cause cause 2 . = ow ow 'a d ie t . :#er :#erci cise se est est e!i e!ime menn ?. *ontro *ontroll dysry dysrythm thmias ias with with medications +. %f ther theree are are sympt symptoms oms of *79 *79 limit fluid inta8e into 2 =/day 0 . < ac ace ma ma 8e 8e r
An!%'s'&(!c %r"s for %'sr'&(!$
S"r!c$# M$n$e(en 1. 2. .
7eart 7eart Transp Transplan lantat tation ion =;A> =eft =eft ;entri ;entricul cular ar &utflo &utflow w Tract Tract Sur!ery
N"rs!n 1. 2. . ?.
M$n$e(en % mp mp ro ro e e *& %ncrea %ncrease se acti actiity ity tolera tolerance nce edu educe ce an# an#ie iety ty >ecr >ecrea ease se the the sen sense se of of powerlessness +.
V. IN2ECTIOUS DISEASES O2 THE HEART PERICARDITIS - refers to an infection of the pericardium, the membranous sac enelopin! the heart
$%ST%&'(&/)ST*&'/&+
)nderlyin! *ause4 idiopathic, iral and bact bacteri erial al infec infectition on,, diso disord rder erss of connec connecti tiee tissue tissue,, hypers hypersens ensiti itiity ity states, disorders of adMacent structures, neoplastic astic disease, disease, radiation radiation therapy, therapy, trauma, renal failure and uremia, TB → accumulati accumulation on of fluid in the pericardial al sac→ ↑ pressu pressure re on the heart→ cardiac tamponade
yspnea 9eer, sweatin!, chills Eoint pains Arrhythmias
Me%!c$# $n% S"r!c$# S"r!c$# M$n$e(en: 1. >ete >eterm rmin inee the cau cause se,, administer therapy and be alert for cardiac tamponade 2.
An$#es!cs NSAIDS Corocosero!%s
?. IN2ECTIVEENDOCARDITIS -
is the infection of the ales and the endothelium surface of the heart.
The inasi inasion on of bacter bacteria ia produc produces es e!etatie !rowths on the heart ales, the the endo endoca card rdia iall linin! n in! or the the endothelium of a blood essel that may emboli@e the spleen, 8idneys, *'S and lun!s
nonspecific and include malaise wea8ness, anore#ia, athral!ia, athral!ia, ni!ht sweats, chills, alular insufficiency and intermittent feer for wee8s loud re!ur!itant murmur
emboli@ation of other ital or!ans
pharmacotherapy Assist Assist in in perica pericardi rdioce ocente ntesis sis
Me%!c$# $n% S"r!c$# M$n$e(en: Supportie treatment- bed rest Sur!ical ale replacement aortic or mitral ale e#cision are reDuired
An!1!o!c &er$*' An!*'re!cs
N"rs!n M$n$e(en: onitor ital si!ns Assess si!ns of or!an dama!e Administer pharmacotherapy %nstruct actiity restrictions, medications and si!ns and symptoms of infection :motional support *opin! strate!ies %f patient receied sur!ical mana!ement, strict post-op care is obsered
MYOCARDITIS - is an inflammatory process inolin! the myocardium. yocarditis can cause heart dilation, thrombi on the heart wall, infiltration of circulatin! blood cells around coronary essels and between the muscle fibers.
;iral, bacterial, fun!al, parasitic, proto@oal infection → inflammation in one small area and spread throu!hout the myocardium→ myocarditis
chest pain dysrythmias cardiome!aly faint heart sounds !allop rhythm systolic murmur
Me%!c$# $n% S"r!c$# M$n$e(en: Bed rest =imit sports or strenuous actiities for 0 months
An!1!o!c &er$*' cor!cosero!%s An!*'re!cs
CARDIAC DISORDER
PATHOPHYSIOLOGY
VI. COMPICA COMPICATION TIONS S 2ROM HEART DISEASES
ASSESSMENT FINDINGS
7eart >ama!e, ;entricular &erload, ↓ ;entricular *ontraction→ it may lead to Tachycardia, a, ,entricular dilatation. yocardial hypertrophy→ ↓ *& → ↓ renal perfusion → ↑ 'a retention→ ↑ osmotic pressure → ↑ A>7 → ↑ water absorption→ edema → heart failure
Lef CH2
CONGESTIVE HEART 2AILURE
I NT NTERVENTIONS
>yspnea <'> &rthopnea ales /*rac8les oist cou!h whee@in! blood tin!ed frothy sputum syncope fati!ue wea8ness anore#ia hypo8alemia clubbin! of fin!ers polycythemia S,S? sounds, pulsus alternans ↑ <
R!& CH2
CARDIOGENIC SHOCK 7PO+ER3PUMP 2AILURE8
ASS%;: % → ↓ yocardial *ontractility → ↓ *& → 7ypoperfusion heart, brain , 8idney → Tissue 7ypo#ia → &r!an >ama!e → >eath
1. 2. .
?.
Eu!ular ;ein :n!or!ement 7epatome!aly Splenome!aly
↓ Systolic Blood
D!!$#!s T&er$*' D!"re!c T&er$*' V$so%!#$ors
N"rs!n M$n$e(en
&#y!en therapy balanced pro!ram of actiity and rest Sodium restricted to preent fluid e#cess
MEDI CA CATIONS
ecrease an#iety 9acilitate fluid balance
If $c"e *"#(on$r' e%e($ occ"rs: 7i!h 9owler’s position orphine Sulfate &#y!en therapy Aminophylline apid di!itali@ation >iuretic therapy ;asodilators >opamine or dobutamine onitor serum (
Me%!c$# $n% N"rs!n M$n$e(en 1.
V$so%!#$ors Inoro*&!c Aens D!"re!cs
0. C. N.
CARDIAC DISORDER
PATHOPHYSIOLOGY
ASSESSMENT FINDINGS
arrhythmias ecrea >ecrease se pulmon pulmonary ary edema edema )tili@ )tili@ee counter counterpul pulsation s ation to to decrease entricular wor8 with seere shoc8
I NT NTERVENTIONS
MEDI CA CATIONS
VII. PERIPHERA PERIPHERAL L VA VASCUL SCULAR AR DISORDERS HYPERTENSION
ARTERIOSCLEROSIS
7istory. A!e, RISK 2ACTORS4 2ACTORS4 9amily 7istory. 7i!h Salt %nta8e, =ow ( inta8e, &besity, :#cess Alcohol *onsumption, Smo8in!, Stress → *han!es in Arteriolar Bed → ↑ Systemic ;ascular esistance → ↑ Afterload→ ↓ Blood 9low to &r!ans → enal
The most common direct result of artherosclerosis include narrowin! of the lumen, obstruction, aneurysm, ulceration and rupture. %ts indirect results are malnutrition and subseDuent fibrosis of the or!ans. All actiely functionin! tissue cells reDuire an abundant supply of nutrients and o#y!en and are sensitie to any reduction in the supply of these nutrients. %f such reductions are seere and permanent, the cell under!oes
headache. The most characteristic si!n epista#is di@@iness tinnitus unsteadiness blurred ision depression nocturia retinopathy,papilledema aybe asymptomatic
Pre,en!on $. Pr!($r' Pr!($r' oderation in 'a inta8e, ↓ saturated fats, maintenance of %B6, maintenance of re!ular pattern of e#ercise, cessation of ci!arette smo8in!, moderation in alcohol consumption, stress reduction b. Secondary Secondary *ontrol of 7<' in hi!h ris8 !roups
.
D!"re!cs $. T&!$6!%es 1. Loo* c. Po$ss!"( s*$r!n A%re A%rene ner r!c !c In&!1 In&!1! !or orss $. /e$ A% A%rener!c /#ocers 1. Cenr$## ' $c! n n $#*&$ 1#ocers c. Pe r!r! *& *&e r$ r$ ####' $ c c! n n A%rener!c $n$on!ss %. A# *& *&$ - - $ %r %re ne ne r r! c 1#ocers e. V$so%!#$ors f. ACE In&!1!ors . C$#c!"( C& C&$nne# /#ocers
;.
NURSING INTERVENTIONS: INTERVENTIONS: 1.
%ntermittent claudication is an achin!, persistent crampli8e sDuee@in! pain that occurs after a certain amount of e#ercise of the affected e#tremity. %t is relieed by rest *oldness or cold sensitiity *olor chan!es )lceration and !an!rene :dema Se#ual dysfunction
aily wal8in! 8in! pro!ram
SURGICAL MANAGEMENT 1. Bypa Bypass ss Fraf Fraftt
V$so%!#$ors An!&'*er#!*!%e(!cs
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necrosis and is replaced by fibrous tissue, which reDuire lesser blood flow.
2. . ?. +. 0. C.
:nda :ndart rtere erect ctom omyy :ndo :ndoa asc scul ular ar Sur!e Sur!ery ry Ball Balloo oonn an!i an!iopl oplasty a sty =ase =aserr an! an!io iopl plas asty ty Stent Ampu Amputa tati tion on
NURSING INTERVENTION INTERVENTION 1.
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Atheromatous plaDues → ↓ blood flow → tissue %schemia → tissue hypo#ia → necrosis → ulceration and !an!rene
intermittent *laudication *oldness or cold sensitiity *olor chan!es )lceration and !an!rene Se#ual dysfunction %mpaired arterial pulsation :dema
MEDICAL MANAGEMENT
:#ercise
V$so%!#$ors An!&'*er#!*!%e(!cs
Antihypertensies
SURGICAL MANAGEMENT Bypass Fraft :ndarterectomy :ndoascular Sur!ery Balloon an!ioplasty =aser an!ioplasty Stent Amputation
AORTIC ANEURYSM
7ypertension → Alteration in inte!rity of its wall → irreersible. =ocali@ed dilatation of an artery
pulsatile mass oer the abdomen =ow bac8 pain =ower abdominal pain 9lan8 pain *ollapse Shoc8
MEDICAL MANAGEMENT 1. edi edica cati tions o ns S"rer': %f !reater than ? cm Teflon/>acron/!orte# Teflon/>acron/!orte# !raft may be used in a sur!ical repair ')S%'F %'T:;:'T%&' A9T: S)F:4 1. onitor ;S and hemodynamic
measurements, urine output, B)' creatinine, bowel sounds peripheral pulses 2.
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RAYNAUD=S DISEASE
*old e#posure, stress → >i!ital artery *ontraction/ Spasm → &cclusion of arteries → Tissue %schemia → Tissue 7ypo#ia → Tissue 'ecrosis → Tissue )lceration → Fan!rene
pallor cyanotic color seDuence4 white-blue-red numbness, tin!lin! and burnin! pain
MEDICAL MANAGEMENT Aoid e#posure to cold 3uit smo8in! Teach effects of smo8in! Teach to to aoid e#posure to cold >iscuss importance of reducin! emotional stress Aoid dru!s that causes asoconstriction such as pills, beta bloc8ers and er!otamines
C$#c!"( C&$nne# /#ocers V$so%!#$ors NSAIDS
S"rer' 1. Amputation - Sympathectomy to reliee asospastic symptoms
THROM/OPHLE/ITIS
esults form enous thrombosis and inflammation in a superficial ein
DEEP VEIN THROM/OSIS
;enous Stasis, ;essel 6all %nMury, 7ypercoa!ulability of the Blood → >;T
pain tenderness palpable induration alon! the course of ein no edema
MEDICAL MANAGEMENT> Bed rest with le! eleation =ocal moist heat application *ompression support stoc8in!s
NURSING INTERVENTIONS: INTERVENTIONS:
calf pain Q 7oman Si!n edema tenderness
'SA%> 'on-narcotic anal!esic
MEDICAL MANAGEMENT: inimi@e inta8e of !reen leafy e!etables
Anticoa!ulation therapy Thrombolytics
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VARICOSE VEINS
/UERGER=S DISEASE 7T&ro(1o$n!!s 7T&ro(1o $n!!s O1#!er$ns8
*on!enital absence of ales of the eins, hereditary wea8ness of the ales, prolon!ed sittin! or standin!, wearin! of constrictin! clothin!, obesity, thrombophlebitis, pre!nancy, *79, lier cirrhosis → effects of !raity on enous pressure → dilated, prominent eins
palpable induartion alon! the course of the brain
SURGERY: Thromboembolectomy Freenfield ena caa fiber to preent pulmonary embolism
NURSING INTERVENTIONS: INTERVENTIONS: aintainin! tissue perfusion
dilated, purplish, tortuous eins le! pain le! edema heainess in the le!s
%ntermittent *laudication S8in *yanosis
1.Anal!esics as ordered
Anticoa!ulants *alcium *hannel Bloc8ers
MEDICAL MANAGEMENT: :leation of affected limp for 1+- min at a time. Aera!e of 2 min.R *ompression with support stoc8in!s Sclerotherapy :arly ambulation SURGERY: 1. ;ein ;ein li!ation ! ation and and strip strippin pin!! to relie pain
>iffuse inflammation of the small and medium arteries→ then eins
NURSING INTERVENTION INTERVENTION .
;. 5.
6ear elastic stoc8in!s durin! actiities reDuirin! lon! periods of standin! or durin! pre!nancy oderate e#ercise and eleate the le!s durin! sittin!
Me%!c$# M$n$e(en: 1. elim elimin inate ate smo8 smo8in in!! S"rer': . Sympathectomy ;. Amputation of ulcerated fin!ers and toes N"rs!n M$n$e(en: . durin! actiities reDuirin! lon! periods of standin! or durin!
;. 5.
pre!nancy oderate e#ercise and eleate the le!s durin! sittin!
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