Care of the Patient with a Cardiovascular or a Peripheral ... · Cardiovascular or a Peripheral...
Transcript of Care of the Patient with a Cardiovascular or a Peripheral ... · Cardiovascular or a Peripheral...
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1
Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder
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• human heart
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MECHANICAL: PUSHES BLOOD FROM HEAD TO TOES AND BACK
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ELECTRICAL SYSTEM: TRIGGERS THE MECHANICAL PHASE
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Overview of Anatomy and Physiology
• Cardiac cycle– A complete heartbeat
• Atria contract while ventricles relax• Ventricles contract while atria relax
– Systole• Phase of contraction (picture next slide)
– Diastole• Phase of relaxation• Period between contraction of the atria or
ventricles during which the blood enters the relaxed chambers
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IF THE PLUMBING IS PLUGGED OR DISEASED
• Blood vessels– Capillaries
• Tiny blood vessels joining arterioles and veins– Arteries
• Large vessels carrying blood away from the heart• Carry enriched oxygen or arterial blood
– Veins• Vessels that convey blood from the capillaries to
the heart carrying venous blood, de-saturated of oxygen
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Circulation
• Coronary blood supply– Right and left coronary arteries
• Branch off of the aorta• Encircle the heart like a crown• Supply the myocardium with blood
– Coronary veins• Return the venous blood to the coronary sinus,
then to the right atrium
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Arterial coronary circulation (anterior).
(From Canobbio, M. [1990]. Cardiovascular disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
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How many people need and receive heart transplants?
• There were 2,210 heart transplants performed in the United States in 2007 and 2,192 in 2006.
• Each year thousands more adults would benefit from a heart transplant if more donated hearts were available.
• As of May 30, 2008, the one-year survival rate was 87.5 percent for males and 85.5 percent for females; the three-year survival rate was about 78.8 percent for males and 76.0 percent for females. The five-year survival rate was 72.3 percent for males and 67.4 percent for females.
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Heart and Lung Transplants
• Heart-and-lung transplant operations have been performed since 1980 in the United States. Since 1995, between 30 and 70 heart-lung transplants are performed each year, according to the United Network for Organ Sharing (UNOS).
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Risk factors for MI
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Diagnostic Examinations
• Diagnostic imaging– Fluoroscopy– Angiogram– Aortogram
• Cardiac catheterization and angiography• Electrocardiography
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Disorders of the Cardiovascular System
• Modifiable risk factors• Smoking• Hyperlipidemia• Hypertension• Diabetes mellitus• Obesity• Sedentary lifestyle• Stress• Psychosocial factors
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Disorders of the Cardiovascular System
• Cardiac Arrest– No cardiac output – Signs and symptoms: abrupt loss of
consciousness with no response to stimuli; absence of pulse and blood pressure
– Treatment: cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS)
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Disorders of the Heart• Coronary atherosclerotic heart disease
– Coronary artery disease (CAD)• A variety of conditions that obstruct blood flow in
the coronary arteries– Atherosclerosis (picture next slide)
• A common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of the arteries
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Progressive development of coronary atherosclerosis.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
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Disorders of the Heart
• Angina – Etiology/pathophysiology
• Cardiac muscle is deprived of oxygenClinical manifestations/assessment• Pain (usually relieved by rest)• Dyspnea• Anxiety; apprehension• Diaphoresis• Nausea
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Disorders of the Heart
• Angina – Medical management
• Medications
–Dilate coronary arteries and decrease workload of heart
–Nitroglycerin–Beta-adrenergic blocking agents–Calcium channel blockers
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Disorders of the Heart
• Angina – Medical management/nursing interventions
• Surgical interventions–Coronary artery bypass graft (CABG) –Coronary angioplasty (PTCA)–Stent placement
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Disorders of the Heart
• Myocardial infarction• Also known as a Heart Attack• Etiology/pathophysiology
–Occlusion of a major coronary artery or one of its branches with subsequent necrosis (death) of myocardium
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Disorders of the Heart
• Heart Attack• Clinical manifestations/assessment
• Pain (not relieved by rest, position, or nitroglycerin)• Nausea• SOB; dizziness; weakness• Diaphoresis• Pallor—ashen color• Sense of impending doom
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A, Saphenous vein. B, Saphenousaortocoronary artery bypass.
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Figure 48-13
Coronary artery bypass graft.
(From Phipps, W., et al. [1995]. Medical-surgical nursing: concepts and clinical practice. [5th ed.]. St. Louis: Mosby.)
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Disorders of the Heart
• Heart failure– Etiology/pathophysiology
• Abnormal condition characterized by circulatory congestion resulting from the heart’s inability to act as an effective pump
• Remember it must pump from head to toe and back
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Disorders of the Heart
• Valvular heart disease– Etiology/pathophysiology
• Heart valves are compromised and do not open and close properly
–Stenosis: means to stiffen –Insufficiency
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Disorders of the Heart
• Endocarditis– Etiology/pathophysiology
• Infection or inflammation of the inner membranous lining of the heart
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Disorders of the Heart
• Myocarditis–Inflammation of the myocardium
• Rheumatic heart disease• Viral, bacterial, or fungal infection
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• Arterial assessment– PATCHES
• P = Pulses • A = Appearance• T = Temperature• C = Capillary refill• H = Hardness• E = Edema• S = Sensation
Disorders of the Peripheral Vascular System
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• Venous assessment– First symptom is usually edema– Dark pigmentation– Dryness and scaling– Ulcerations– Pain, aching, and cramping
• Usually relieved by rest or elevation
Disorders of the Peripheral Vascular System
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• Hypertension– Etiology/pathophysiology
• A sustained elevated systolic blood pressure greater than 140 mm Hg and/or a sustainedelevated diastolic blood pressure greater than 90 mm Hg.
Disorders of the Peripheral Vascular System
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• Hypertension (continued)– Clinical manifestations/assessment
• Headache; blurred vision• Epistaxis• Angina
– Medical management/nursing interventions• Antihypertensive medications; diuretics• Diet: weight control, reduction of saturated fats,
and low sodium• No smoking
Disorders of the Peripheral Vascular System
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• Arterial aneurysm (picture next slide) – Etiology/pathophysiology
• Enlarged, dilated portion of an artery• Causes: arteriosclerosis; trauma; congenital
– Clinical manifestations/assessment• Asymptomatic • Large pulsating mass• Pain, if large enough to press on other structures
Disorders of the Peripheral Vascular System
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Types of aneurysms. A, Fusiform. B, Saccular. C, Dissecting.
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• Thrombophlebitis– Etiology/pathophysiology
• Inflammation of a vein in conjunction with the formation of a thrombus
• Risk factors: venous stasis, hypercoagulability, trauma of a blood vessel, immobilization after surgery
– Clinical manifestations/assessment• Pain• Edema• Positive Homans’ sign• Erythema, warmth, and tenderness along the vein
Disorders of the Peripheral Vascular System
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Figure 48-22
Deep vein thrombophlebitis.
(From Kamal, A., Brockelhurst, J.C. [1991]. Color atlas of geriatric medicine. [3rd ed.]. St. Louis: Mosby-Year Book —Europe.)
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• Thrombophlebitis (continued)– Medical management/nursing interventions
• Superficial– Bedrest– Moist heat– Elevate extremity– NSAIDs
» Motrin» Aspirin
Disorders of the Peripheral Vascular System
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• Thrombophlebitis (continued)– Medical management/nursing interventions
• Deep– Bedrest– Anticoagulants– Fibrinolytics– Elevate extremity – Antiembolism stockings– Surgery: thrombectomy; vena cava umbrella (Greenfield
filter)
Disorders of the Peripheral Vascular System
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Another day down