ALTERED OXYGENATION:  CARDIOVASCULAR
DISTURBANCES IN OXYGENTRANSPORT MECHANISM       Structural Cardiac           Disorders
HEART VALVES
MITRAL VALVE
MITRAL VALVE PROLAPSE
MITRAL VALVE PROLAPSE•   Directed at controlling the symptoms•   Nitrates•   Calcium-channel blockers•   Beta-blockers•   ...
MITRAL REGURGITATION
MITRAL REGURGITATION•   Systolic murmur•   Dyspnea•   Fatigue•   Palpitations•   Shortness of breath on exertion•   Cough ...
MITRAL STENOSIS
MITRAL STENOSIS• Dyspnea on exertion = 1st  symptom• Progressive fatigue• Hemoptysis• Repeated respiratoty infections
MITRAL STENOSIS• Antibiotic prophylaxis• Anticoagulants• Valvuloplasty• Percutaneous transluminal  valvuloplasty• Mitral v...
AORTIC REGURGITATION
AORTIC REGURGITATION• Asymptomatic• Clients may be aware of forceful heartbeats (head  & neck)    – Visible or palpable on...
AORTIC STENOSIS
AORTIC STENOSIS•   Asymptomatic•   Exertional dyspnea•   Dizziness and syncope•   Rough systolic murmur
Surgical Management• Valvuloplasty
Surgical Management• Valvuloplasty
Surgical Management• Valve Repair and Replacement:
Surgical Management• Valve Repair and Replacement:
NURSING MANAGEMENT• Education on diagnosis (it may be  hereditary), symptoms that may develop• Need for prophylactic antib...
DISTURBANCES IN OXYGENTRANSPORT MECHANISM  Infectious Disorders
Rheumatic Heart Disease
Rheumatic Heart DiseaseStrep Throat S/Sx             Rheumatic Fever S/Sx• sudden onset of sore       • fever  throat     ...
Rheumatic Heart Disease• Best defense = prevent rheumatic fever  from occurring• Treat strep throat with penicillin or oth...
Infective Endocarditis(Bacterial Endocarditis)
• Manifestations:   – Remittent fever (high or low) accompanied by chills*   – Malaise, fatigue, anorexia, weight loss   –...
Splinter Hemorrhages
Osler’s nodes
Roth’s Spots
Myocarditis
Pericarditis
Manifestations & Management:1. Acute: chest pain exacerbated with respirations – Pericardial friction rub (classic sign) –...
DISTURBANCES IN OXYGENTRANSPORT MECHANISM                  Vascular and           Peripheral Disorders      Colleen C. Flo...
Vascular System
Aortic Aneurysm
Clinical ManifestationThoracic Aortic Aneurism     May be asymptomatic                             Pain is usually constan...
Buerger’s Disease
Raynaud’s Disease
Raynaud’s Disease
Management
Veins               Cause/s             Clinical ManifestationsSuperficial         Varicose veins, IVs        Tender, indu...
Pharmacological Management• Anti-coagulants - prevents clot  formation   –Heparin (Liquaemin)   –Warfarin (Coumadin• Throm...
Surgical ManagementVenous ThrombectomyUmbrella Procedure
Nursing Management• Superficial thrombophlebitis – local  measures (i.e. warm pack, extremity  elevation); sometimes anti-...
Colleen C. Flores, RN
12  cardio-infectious
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12 cardio-infectious

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  • A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients during exercise.Rubor, a reddish blue discoloration of the extremities, may be observed within 20 seconds to 2 minutes after the extremity is dependent. Rubor suggests severe peripheral arterial damage in which vessels that cannot constrict remain dilated. Even with rubor, the extremity begins to turn pale with elevation.
  • Repair of an ascending aortic aneurysm and aortic valve replacement. (A) Incision into aorticaneurysm. (B) Aortic valve replacement with aortic graft implant to repair ascending aortic aneurysm. (C) Aortic aneurysm trimmed and closed over graft.
  • 12 cardio-infectious

    1. 1. ALTERED OXYGENATION: CARDIOVASCULAR
    2. 2. DISTURBANCES IN OXYGENTRANSPORT MECHANISM Structural Cardiac Disorders
    3. 3. HEART VALVES
    4. 4. MITRAL VALVE
    5. 5. MITRAL VALVE PROLAPSE
    6. 6. MITRAL VALVE PROLAPSE• Directed at controlling the symptoms• Nitrates• Calcium-channel blockers• Beta-blockers• For heart failure, it is treated as it would be for any other heart with heart failure
    7. 7. MITRAL REGURGITATION
    8. 8. MITRAL REGURGITATION• Systolic murmur• Dyspnea• Fatigue• Palpitations• Shortness of breath on exertion• Cough due to pulmonary congestion
    9. 9. MITRAL STENOSIS
    10. 10. MITRAL STENOSIS• Dyspnea on exertion = 1st symptom• Progressive fatigue• Hemoptysis• Repeated respiratoty infections
    11. 11. MITRAL STENOSIS• Antibiotic prophylaxis• Anticoagulants• Valvuloplasty• Percutaneous transluminal valvuloplasty• Mitral valve replacement Colleen C. Flores, RN
    12. 12. AORTIC REGURGITATION
    13. 13. AORTIC REGURGITATION• Asymptomatic• Clients may be aware of forceful heartbeats (head & neck) – Visible or palpable on carotid or temporal arteries• Exertional dyspnea followed by fatigue• Diastolic murmur• Widened pulse pressure• Water-hammer pulse• Breathing difficulties (Progressive signs and symptoms)
    14. 14. AORTIC STENOSIS
    15. 15. AORTIC STENOSIS• Asymptomatic• Exertional dyspnea• Dizziness and syncope• Rough systolic murmur
    16. 16. Surgical Management• Valvuloplasty
    17. 17. Surgical Management• Valvuloplasty
    18. 18. Surgical Management• Valve Repair and Replacement:
    19. 19. Surgical Management• Valve Repair and Replacement:
    20. 20. NURSING MANAGEMENT• Education on diagnosis (it may be hereditary), symptoms that may develop• Need for prophylactic antibiotics before any invasive procedure• Diet :
    21. 21. DISTURBANCES IN OXYGENTRANSPORT MECHANISM Infectious Disorders
    22. 22. Rheumatic Heart Disease
    23. 23. Rheumatic Heart DiseaseStrep Throat S/Sx Rheumatic Fever S/Sx• sudden onset of sore • fever throat • painful, tender, red swollen joints• pain on swallowing • pain in one joint that• fever, usually 101–104°F migrates to another one• headache • heart palpitations• red throat/tonsils • chest pain, SOB• abdominal pain, nausea • skin rashes and vomiting may also • fatigue occur, especially in • small, painless nodules under children the skin
    24. 24. Rheumatic Heart Disease• Best defense = prevent rheumatic fever from occurring• Treat strep throat with penicillin or other antibiotics• People with history of rheumatic fever are more susceptible to recurrent attacks and heart damage.
    25. 25. Infective Endocarditis(Bacterial Endocarditis)
    26. 26. • Manifestations: – Remittent fever (high or low) accompanied by chills* – Malaise, fatigue, anorexia, weight loss – Headache & musculoskeletal complaints (arthralgia) – Murmurs – Petichiae (conjunctiva), splinter hemorrhages (dark red lines) under the nails, Painful finger or toe tip (Osler’s node – pea-sized nodules)• Dx: blood culture – at least 6 (taken during chills or at height of fever), ECG, CBC• Tx: antimicrobials – depend on organism involved (Penicillin & Streptomycin commonly used) – IV 4-6wks – Prosthetic heart valves may need to be replaced Colleen C. Flores, RN
    27. 27. Splinter Hemorrhages
    28. 28. Osler’s nodes
    29. 29. Roth’s Spots
    30. 30. Myocarditis
    31. 31. Pericarditis
    32. 32. Manifestations & Management:1. Acute: chest pain exacerbated with respirations – Pericardial friction rub (classic sign) – MGT: tx of underlying cause, NSAID (ASA), morphine, provide reassurance on temporary nature of disease2. Cardiac tamponade: narrow pulse pressure – Tachycardia (compensatory) → shock & death – Hypotension, jugular vein distention, cyanosis, muffled heart sounds, paradoxic pulse – MGT: pericardiocentesis; prompt intervention needed to prevent shock & death3. Constrictive: RV failure & ↓cardiac output – Fatigue on exertion, dyspnea, low pulse pressure, distended neck veins, delayed capillary refill time – leg edema, ascites – MGT: digitalis, diuretics, Na+ restriction; pericardiectomy Colleen C. Flores, RN
    33. 33. DISTURBANCES IN OXYGENTRANSPORT MECHANISM Vascular and Peripheral Disorders Colleen C. Flores, RN
    34. 34. Vascular System
    35. 35. Aortic Aneurysm
    36. 36. Clinical ManifestationThoracic Aortic Aneurism May be asymptomatic Pain is usually constant and boring (when patient is supine) Dyspnea, brassy cough, hoarseness of voiceAbdominal Aortic Aneurism Feels that heart is beating in the(AAA) abdomen while lying down May feel abdominal mass or abdominal throbbingDissecting Aneurism of the Sudden severe and persistent painAorta described as tearing or ripping in the anterior chest or back and extends to the shoulders, epigastric area or abdomen
    37. 37. Buerger’s Disease
    38. 38. Raynaud’s Disease
    39. 39. Raynaud’s Disease
    40. 40. Management
    41. 41. Veins Cause/s Clinical ManifestationsSuperficial Varicose veins, IVs Tender, indurated,(Thrombo- injections, visible, & palpablephlebitis) Buerger’s, cancer, vein; ovoid nodules in- Saphenous blood dyscrasias skin- Median cephalic& basilicDeep Vein (DVT) Immobility, CHF, cancer, (+)Homan’s sign, blood dyscrasias, tenderness, warmth,- Femoral, iliac, fracture, dislocation, superficial venoustibial, popliteal obesity, oral distention, cyanosis contraceptives (severe occlusion)
    42. 42. Pharmacological Management• Anti-coagulants - prevents clot formation –Heparin (Liquaemin) –Warfarin (Coumadin• Thrombolytics = Streptokinase - dissolves clot
    43. 43. Surgical ManagementVenous ThrombectomyUmbrella Procedure
    44. 44. Nursing Management• Superficial thrombophlebitis – local measures (i.e. warm pack, extremity elevation); sometimes anti-inflammatory meds are required• DVT – CBR until local signs of inflammation subsides; after 7-15days = ambulate with elastic stockings
    45. 45. Colleen C. Flores, RN

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