Post on 18-Jan-2018
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Care of Patient with Cardiovascular Disorder
( NUR 240) DR. Samah Mohammed Outlines overview of cardiovascular
system. Atherosclerosis. Angina.
Management of dysrhythmia. Congestive heart failure. Definition
Causes and pathophysiology Clinical manifestation Types Diagnostic
evaluation Management Nursing process Introduction The
cardiovascular/circulatory system transports food, hormones,
metabolic wastes, and gases (oxygen, carbon dioxide) to and from
cells. Anatomy and physiology
Hearts job is to pump blood to supply oxygen-enriched red blood
cells to tissues. Divided into left and right sides Contain of 4
champers (two) Atria receives incoming blood, and ( two) ventricles
pump outgoing blood. One-way valves keep blood flowing in the
proper direction. Aorta, bodys main artery, receives blood ejected
from left ventricle. Anatomy and physiology
Hearts electrical system controls blood pressure and heart rate and
coordinates atria and ventricles. The cardiac muscle is the
(myocardium). The heart membrane is the (pericardium). Autonomic
nervous system (ANS) controls involuntary activities. The ANS has
two parts: Sympathetic nervous system Fight-or-flight system as (
Anxiety, Stress,..) Parasympathetic nervous system Slows various
bodily functions as ( Defecation, Rest,) Anatomy and
physiology
Arterioles and capillaries are smaller. Capillaries connect
arterioles to venules. Venules are the smallest branches of the
veins. Vena cava return blood to the heart. Superior vena cava:
from the head and arms Inferior vena cava: from the abdomen,
kidneys, and legs Coronary arteries are blood vessels that supply
blood to heart muscle. Anatomy and physiology
Blood pressure: is the pressure of circulating blood against artery
walls. Systolic blood pressure The max pressure generated by left
ventricle. Top number in the reading. Diastolic blood pressure The
pressure while the left ventricle is at rest. A pulse: is felt when
blood passes through an artery during systole. Peripheral pulses
felt in the extremities. Functions of the heart pump blood to all
parts of the
body Anatomy and physiology
Blood consists of: Red blood cells, which carry oxygen. White blood
cells, which fight infection. Platelets, which help blood to clot.
Plasma, which is the fluid cells float in. Cardio vascular
Diseases
Acute Rheumatic Fever. Chronic Rheumatic Heart Diseases.
Hypertensive Diseases. Ischemic Heart Diseases. Pulmonary Heart
Diseases & Diseases of Pulmonary Circulation. Other forms of
Heart Disease. Cerebrovascular Diseases. Diseases of Arteries,
Arterioles and Capillaries. Diseases of Veins, Lymphatic Vessels
& Lymph Nodes. Other and Unspecified Disorders of the
Circulatory System Hypertension Commonly called high blood
pressure
Systolic and diastolic measurements Normal systolic mmHg Normal
diastolic mm 160/95 mm Hg? 140/90 mm Hg? Common symptoms Sudden,
severe headache. Strong, bounding pulse, Ringing in the ears.
Nausea and vomiting, Dizziness. Warm skin (dry or moist),
Nosebleed. Coronary Atherosclerosis
Diseases of the coronary arteries is almost always due to plaque.
Atherosclerosis: defined as the buildup of calcium and cholesterol
in the arteries can cause occlusion of arteries. Fatty material
accumulates with age. Atherosclerosis Signs & symptoms Causes
Tachycardia Family history
Smoking Hypertension Diabetes (DM Physical activity Obesity Alcohol
High Cholesterol Signs & symptoms Tachycardia Bradycardia
Palpitations Weakness nausea sweating Shortness of breath fainting
Chest pain Sudden death Prevention of atherosclerosis
Control of risk factors as ( dont smoking). Take regular exercise
(20 min 3 times a week) Maintain ideal body weight Eat a mixed diet
rich in fresh fruit and vegetables Change diet to reduce the amount
of sodium, fats and cholesterol. Reduce the amount of stress in
your everyday life Regular Medical checkups Medication Angina
Angina defined as: It is a clinical syndrome, characterized of
chest pain, occurs when the hearts need for oxygen exceeds supply.
Causes caused by atherosclerotic plaque. Cigarette smoking, high
blood pressure, high cholesterol, high blood glucose level
(diabetes), lack of exercise, and stress. Angina Signs &
symptoms :- Weakness, nausea, sweating.
Shortness of breath, fainting. Chest pain that does not change.
Irregular heartbeat. Lower jaw, arm, back, abdomen, neck pain and
Sudden death. Numbness of arms and hands. Types of angina Stable
angina (classic angina)
Stable angina is characterized by central chest pain, discomfort or
breathlessness, and is relieved by rest or nitroglycerin Unstable
angina (Acute coronary syndrome) Unstable angina is characterized
by rapidly worsening angina. It is most dangerous and does not
follow a pattern, do not relieved with rest or medicine. the common
signs of unstable angina are breathlessness, nausea & vomiting.
Management of angina Advice to patients with stable angina:-
control of risk factors such as smoking, hypertension. Aim for
ideal body weight. Take regular exercise. The use of measures to
control symptoms. Give Medication Anti-anginal drug treatment Five
groups of drug are used to help relieve or prevent the symptoms of
angina: nitrates, -blockers, calcium antagonists and potassium
channel activators. Management of angina Percutaneous transluminal
coronary angioplasty (PTCA): is a surgical procedure in which tiny
a balloon catheter is inserted into a blocked blood vessel to
increase the blood flow of that vessel. Narrowed artery with
balloon catheter positioned. Inflated balloon presses against
arterial wall. Management of angina 2. Cardiac pacemakers:-
This technology is very reliable. Pacemaker malfunction can cause
dizziness, or weakness due to an excessively slow heart rate.
Transport patients promptly and safely. Function of Cardiac
Pacemakers:- Maintain regular cardiac rhythm and rate. Deliver
electrical impulse through wires in direct contact with the
myocardium. Implanted under a heavy muscle or fold of skin in the
upper left portion of the chest. Angioplasty Pacemakers Congestive
heart failure
(CHF): It is defined as the condition in which heart is unable to
pump an adequate amount of blood required for normal body
functions. Heart failure is a serious condition and needs immediate
medical care. Causes of Heart Failure
Coronary artery disease. Uncontrolled Hypertension. Other factors
that contribute to weakness of the heart muscle are toxins,
Infections, myocarditis, valves Diseases and damage from myocardial
infarction (MI) Classification of Heart Failure
Left-sided heart failure It occurs primarily in the lungs from
backup of blood into pulmonary veins and capillaries because of
left ventricular pump failure. As blood backs up into the pulmonary
bed, increased hydrostatic pressure causes fluid accumulation in
the lungs. Blood flow is consequently decreased to the brain,
kidneys, and other tissues Classification of Heart Failure
2. Right-sided heart failure (or left ventricular) It systemic
circulation results from right ventricular pump failure. As blood
backs up into the pulmonary bed, increased hydrostatic pressure
produces peripheral and dependent pitting edema. Venous congestion
in the kidneys, liver, and GI tract also develops. Signs and
Symptoms Management of Heart Failure
1. Non-Pharmacologic lifestyle modification Healthy Diet: Salt
restriction Fluid restriction Weightloss Lipid control Stop Smoking
Activity is restricted to decrease cardiac workload Reduce stress
Social Support Loose weight Follow up Pharmacologic Medication
Surgical Arrhythmias Arrhythmia defined as: is failure of
conduction of impulses through the A. V. Node. Causes: drugs,
ischemia, and failure of S.A node. Signs & symptoms:
tachycardia, palpation, fatigue, and sudden death. Management of
Arrhythmias
Record BP, HR and rhythm, rate and depth of respirations, and
breath sounds to determine the dysrhythmias hemodynamic effect. Ask
patients about, dizziness, or fainting. Make ECGfor the patient.
Administer anti arrhythmic medications. Assess for factors that
contribute to the dysrhythmia (e.g, caffeine, stress, and
medication ) and assist the patient in making lifestyle changes as
diet and exercise. Nursing process 1. Assessment
The nurse should observe & ask the patient about: When do
attack tend to occur? How does the patient describe the pain? Is
the onset of pain gradual or sudden How long does it last? Is the
pain is steady? Is the discomfort accompanied by other symptoms?
How many minutes after taking the nitroglycerin does the pain last?
Full history Physical examination & clinical manifestation
Interpretation of the finding of the diagnostic tests Nursing
process 2. Nursing diagnosis:
Nursing diagnosis may include the following: Chest: pain related to
decreased O2 supply to the heart muscle secondary to arterial
stenosis. Anxiety: related to fear of death. Health: maintenance
altered related to knowledge deficit about nature of the diseases
and ways to avoid. High: risk for complications ( myocardial
infarction) related to non adherence to the therapeutic regimen
& non acceptance of necessary life- style changes. Nursing
process Patient's goals: ( patient will) Nursing intervention
Report pain free or pain is decreased Report anxiety level is
decreased Understand nature of the disease & capable to avoid
complications Accept the necessary of life-style changes. Nursing
intervention Prevention of pain Control of pain Reduction of
anxiety Understanding of illness & ways to avoid complications
Adherence to the self care program