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Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
Unit 5 f11
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Unit 5 f11

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  • Figure 32–1 The hemodynamic effects of left-sided heart failure.
  • Figure 32–2 The hemodynamic effects of right-sided heart failure.
  • Myocarditis
  • Figure 30–2 Coverings and layers of the heart.
  • Figure 30–9 Pericardiocentesis.
  • 276 ish
  • Transcript

    • 1. Unit 4 Problems of Cardiac Output and Tissue Perfusion Lemone and Burke Ch 30-32
    • 2. Objectives <ul><li>Review the anatomy and physiology of the cardiovascular system. </li></ul><ul><li>Identify normal heart sounds and relate them to the corresponding events in the cardiac cycle. </li></ul><ul><li>Explain cardiac output and explain the influence of various factors in its regulation. </li></ul>
    • 3. More Objectives <ul><li>Describe normal variations in assessment findings for the older adult. </li></ul><ul><li>Identify manifestations of Cardiac Emergency, Chronic CHF, Inflammatory Heart Diseases and Shock. </li></ul><ul><li>Compare and contrast the pathophysiology and manifestations of Cardiac Emergency, Chronic CHF, Inflammatory Heart Diseases and Shock. </li></ul>
    • 4. The rest of the objectives <ul><li>Relate the outcomes of diagnostic tests and procedures to the pathophysiology of Cardiac Emergency, Chronic CHF, Inflammatory Heart Diseases and Shock and implications of client responses to the disorder and associated nursing care for each. </li></ul><ul><li>Discuss nursing implications for medications and treatments used in the prevention, treatment and management of Cardiac Emergency,, Chronic CHF, Inflammatory Heart Diseases and Shock. </li></ul><ul><li>Explain risk factors and preventive measures for Cardiac Emergency, Chronic CHF, Inflammatory Heart Diseases and Shock. </li></ul>
    • 5. ECG brief intro <ul><li>P wave </li></ul><ul><li>QRS </li></ul><ul><li>T </li></ul><ul><li>U </li></ul><ul><li>http://www.youtube.com/watch?v=rguztY8aqpk&feature=related </li></ul>
    • 6. Heart Sounds <ul><li>http://www.youtube.com/watch?v=ax9B6g6gEOc </li></ul><ul><li>http://www.youtube.com/watch?v=Ge12P7u0aQo&feature=related </li></ul>
    • 7. What is Cardiac Output? <ul><li>CO = HR x SV </li></ul><ul><ul><li>CO=cardiac output </li></ul></ul><ul><ul><li>HR= heart rate </li></ul></ul><ul><ul><li>SV= stroke volume </li></ul></ul><ul><li>Factors that affect SV: </li></ul><ul><ul><li>HR </li></ul></ul><ul><ul><li>Preload </li></ul></ul><ul><ul><li>Afterload </li></ul></ul><ul><ul><li>Contractility </li></ul></ul>
    • 8. Assessing CV status <ul><li>Other than physical assessment </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><li>Family History </li></ul></ul><ul><ul><li>Genetic Risk </li></ul></ul><ul><ul><li>Personal History </li></ul></ul><ul><ul><li>Diet History </li></ul></ul><ul><ul><li>Socioeconomic Status </li></ul></ul>
    • 9. Risk Factors <ul><li>Modifiable </li></ul><ul><ul><li>HTN </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Hyperlipidemia </li></ul></ul><ul><ul><li>Cigarette smoking </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Physical inactivity </li></ul></ul><ul><ul><li>Diet </li></ul></ul><ul><li>Nonmodifiable </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Genetic Factors </li></ul></ul>The text also discusses Metabolic Syndrome and Risk factors unique to women on page 964
    • 10. CV Assessment <ul><li>Focused physical assessment </li></ul><ul><ul><li>General appearance </li></ul></ul><ul><ul><li>Integumentary system </li></ul></ul><ul><ul><ul><li>Color </li></ul></ul></ul><ul><ul><ul><li>Temperature </li></ul></ul></ul><ul><ul><li>Extremeties </li></ul></ul><ul><ul><ul><li>Blood pressure </li></ul></ul></ul><ul><ul><ul><li>Edema </li></ul></ul></ul><ul><ul><li>Venous flow and arterial pulses </li></ul></ul>
    • 11. CV Diagnostic exams <ul><li>Lab tests: </li></ul><ul><ul><li>CBC </li></ul></ul><ul><ul><li>Serum electrolytes </li></ul></ul><ul><ul><li>BNP </li></ul></ul><ul><li>Mark cardiac damage </li></ul><ul><ul><li>Troponin </li></ul></ul><ul><ul><li>CK-MB </li></ul></ul><ul><ul><li>Myoglobin </li></ul></ul>
    • 12. Cardiac lab tests
    • 13. Diagnostic exams <ul><li>Chest x-ray </li></ul><ul><li>Angiography </li></ul><ul><li>Cardiac Catheterization </li></ul><ul><li>ECG </li></ul><ul><li>Nursing interventions??? </li></ul>
    • 14. Diversity concerns CV client <ul><li>Clients often fear diseases r/t cardiovascular system </li></ul><ul><li>Require good education, opportunity for client and family to voice concerns/fears </li></ul><ul><li>Support groups </li></ul><ul><li>Cardiac rehab referral </li></ul>
    • 15. Pathophysiology of Common Cardiac Disorders <ul><li>Heart Failure </li></ul><ul><li>Infective Endocarditis </li></ul><ul><li>Myocarditis </li></ul><ul><li>Pericarditis </li></ul>
    • 16. Risk Factors and Preventive Measures for Cardiac Disorders <ul><li>Heart Failure </li></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><ul><li>Coronary artery disease </li></ul></ul></ul><ul><ul><ul><li>Cardiomyopathies </li></ul></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Congenital and valvular heart disease prevention </li></ul></ul></ul><ul><ul><li>Education regarding coronary artery disease and diabetes </li></ul></ul>
    • 17. Pathophysiology of Common Cardiac Disorders
    • 18. Pathophysiology of Common Cardiac Disorders
    • 19. Right vs Left heart failure <ul><li>Right </li></ul><ul><ul><li>Peripheral edema </li></ul></ul><ul><ul><li>Weight gain </li></ul></ul><ul><ul><li>anorexia </li></ul></ul><ul><li>Left </li></ul><ul><ul><li>SOB </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Crackles on auscultation of breath sounds </li></ul></ul>
    • 20. Heart Failure <ul><li>Right vs Left </li></ul><ul><li>Systolic vs Diastolic </li></ul><ul><li>High and low output </li></ul><ul><li>Chronic vs Acute </li></ul>
    • 21. Risk Factors and Preventive Measures for Cardiac Disorders <ul><li>Heart Failure </li></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><ul><li>Coronary artery disease </li></ul></ul></ul><ul><ul><ul><li>Cardiomyopathies </li></ul></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Congenital and valvular heart disease prevention </li></ul></ul></ul><ul><ul><li>Education regarding coronary artery disease and diabetes </li></ul></ul>
    • 22. Pulmonary edema
    • 23. Classic symptoms of Pulmonary Edema Rapid onset <ul><li>Extreme shortness of breath or difficulty breathing </li></ul><ul><li>A feeling of suffocating or drowning </li></ul><ul><li>Wheezing or gasping for breath </li></ul><ul><li>Anxiety, restlessness or a sense of apprehension </li></ul><ul><li>A cough that produces frothy sputum that may be tinged with blood </li></ul><ul><li>Excessive sweating </li></ul><ul><li>Pale skin </li></ul><ul><li>Chest pain, if pulmonary edema is caused by heart disease </li></ul><ul><li>A rapid, irregular heartbeat (palpitations) </li></ul>
    • 24. Slow onset symptoms of CHF <ul><li>Increased shortness of breath when physically active. </li></ul><ul><li>Difficulty breathing with exertion, often when lying flat as opposed to sitting up. </li></ul><ul><li>Awakening at night with a breathless feeling that may be relieved by sitting up. </li></ul><ul><li>Rapid weight gain when pulmonary edema develops as a result of congestive heart failure. </li></ul><ul><li>Loss of appetite. </li></ul><ul><li>Fatigue </li></ul>
    • 25. Clinical manifestations of Inflammatory Heart Disease <ul><li>Types of inflammatory diseases: </li></ul><ul><ul><li>Myocarditis </li></ul></ul><ul><ul><li>Infective endocarditis </li></ul></ul><ul><ul><li>Pericarditis </li></ul></ul><ul><ul><li>Rheumatic Carditis </li></ul></ul>
    • 26. Risk Factors and Preventive Measures for Cardiac Disorders <ul><li>Myocarditis </li></ul><ul><ul><li>Risk factors are any thing that alters immune response </li></ul></ul><ul><ul><ul><li>Advanced age </li></ul></ul></ul><ul><ul><ul><li>Malnutrition </li></ul></ul></ul><ul><ul><ul><li>Alcohol use </li></ul></ul></ul><ul><ul><ul><li>Immunosuppression </li></ul></ul></ul><ul><ul><ul><li>Exposure to radiation </li></ul></ul></ul><ul><ul><ul><li>Stress </li></ul></ul></ul>
    • 27. Anatomy, Physiology, and Functions of the Heart <ul><li>The Pericardium </li></ul><ul><ul><li>Double-layered fibroserous membrane surrounding the heart </li></ul></ul><ul><ul><ul><li>Anchors the heart to surrounding structures </li></ul></ul></ul><ul><ul><li>Space between layers is filled with pericardial fluid </li></ul></ul><ul><ul><ul><li>Lubricates heart muscle </li></ul></ul></ul><ul><ul><ul><li>Helps to cushion the heart </li></ul></ul></ul>
    • 28. Anatomy, Physiology, and Functions of the Heart
    • 29. Infective endocarditis <ul><li>An infection of the endocardium </li></ul><ul><li>Common in clients who abuse drugs, had valve replacements, systemic infections or structural cardiac defects </li></ul>
    • 30. Risk Factors and Preventive Measures for Cardiac Disorders <ul><li>Infective Endocarditis </li></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><ul><li>Congenital deformities </li></ul></ul></ul><ul><ul><ul><li>Tissue damage due to ischemic disease </li></ul></ul></ul><ul><ul><ul><li>Valve prosthesis </li></ul></ul></ul><ul><ul><ul><li>Intravenous drug use </li></ul></ul></ul><ul><ul><ul><li>Invasive catheters </li></ul></ul></ul><ul><ul><ul><li>Dental procedures or poor dental health </li></ul></ul></ul><ul><ul><ul><li>Recent heart surgery </li></ul></ul></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><ul><li>Education is key </li></ul></ul></ul><ul><ul><ul><li>Prophylactic antibiotics </li></ul></ul></ul>
    • 31. Infective endocarditis <ul><li>Most common complication is heart failure </li></ul><ul><li>50% have embolic complications due to vegetation </li></ul><ul><li>Common to have clients with petechia and splinter hemorrhages </li></ul><ul><li>Diagnosed with positive blood culture or echocardiogram </li></ul><ul><li>Treat with antibiotics </li></ul><ul><li>Often need antibiotics before dental procedures </li></ul>
    • 32. Petechiae and splinter hemorrhage
    • 33. Pericarditis vs endocarditis
    • 34. Pericarditis <ul><li>Often follows a respiratory infection </li></ul><ul><li>Often presents with pain in supine position releived by sitting or leaning forward </li></ul><ul><li>May hear friction rub with stethoscope </li></ul><ul><li>Treated with NSAIDS relieved within 48 hrs. depends on cause for further treatment </li></ul><ul><li>Short term course of illness (2-6 weeks) for acute </li></ul><ul><li>Chronic may require surgery </li></ul>
    • 35. Pericardiocentesis
    • 36. Risk Factors and Preventive Measures for Cardiac Disorders <ul><li>Rheumatic Fever and Rheumatic Heart Disease </li></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><ul><li>Crowded living conditions </li></ul></ul></ul><ul><ul><ul><li>Malnutrition </li></ul></ul></ul><ul><ul><ul><li>Immunodeficiency </li></ul></ul></ul><ul><ul><ul><li>Poor access to health care </li></ul></ul></ul><ul><ul><ul><li>Genetic factor may be present </li></ul></ul></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><ul><li>Prompt identification, treatment </li></ul></ul></ul><ul><ul><ul><li>Importance of finishing medications </li></ul></ul></ul>
    • 37. Ultimately when the heart fails, the patient will have shock Chapter 11 Lemone and Burke
    • 38. Cellular Homeostasis and Basic Hemodynamics <ul><li>Homeostatic regulation maintained primarily by cardiovascular system </li></ul><ul><li>Four physiologic components </li></ul><ul><ul><li>Sufficient cardiac output </li></ul></ul><ul><ul><li>Uncompromised vascular system </li></ul></ul><ul><ul><li>Sufficient blood volume and blood pressure </li></ul></ul><ul><ul><li>Tissues that are able to extract and use oxygen </li></ul></ul>
    • 39. Types of Shock <ul><li>Hypovolemic Shock </li></ul><ul><ul><li>Affects all body systems </li></ul></ul><ul><ul><li>Most common type of shock </li></ul></ul><ul><li>Cardiogenic Shock </li></ul><ul><ul><li>Loss of pumping action of the heart </li></ul></ul><ul><li>Obstructive Shock </li></ul><ul><ul><li>Impaired diastolic filling (pericardial tamponade, pneumothorax) </li></ul></ul><ul><li>Distributive Shock </li></ul><ul><ul><li>Also known as vasogenic shock </li></ul></ul>
    • 40. Shock <ul><li>Hypovolemic </li></ul><ul><ul><li>Too little circulating blood causes decrease in MAP thus not meeting the body’s total need for oxygen </li></ul></ul><ul><ul><li>Internal hemorrhage </li></ul></ul><ul><ul><ul><li>GI bleed </li></ul></ul></ul><ul><ul><li>External hemorrhage </li></ul></ul><ul><ul><ul><li>trauma </li></ul></ul></ul><ul><ul><li>Dehydration </li></ul></ul>
    • 41. Shock <ul><li>Cardiogenic </li></ul><ul><ul><li>Heart muscle is unhealthy or pumping is impaired </li></ul></ul><ul><ul><li>Causes a decrease CO, afterload and reduces MAP </li></ul></ul><ul><li>This is seen with an MI </li></ul>
    • 42. Shock <ul><li>Obstructive </li></ul><ul><li>Affects the heart muscles ability to pump effectively </li></ul><ul><li>The heart itself is normal however manifestations outside the heart affect filling or contraction </li></ul><ul><ul><li>Cardiac tamponade </li></ul></ul><ul><ul><li>Tension pneumothorax </li></ul></ul><ul><ul><li>Pulmonary embolism </li></ul></ul>
    • 43. Shock <ul><li>Distributive </li></ul><ul><ul><li>Loss of sympathetic tone </li></ul></ul><ul><ul><li>Vasodilation </li></ul></ul><ul><ul><ul><li>Leaky capillaries </li></ul></ul></ul><ul><ul><ul><li>Spinal cord injury </li></ul></ul></ul><ul><ul><ul><li>Sepsis </li></ul></ul></ul><ul><ul><ul><li>Anaphylaxis </li></ul></ul></ul>
    • 44. Interventions for Clients Shock <ul><li>Medications </li></ul><ul><ul><li>Inotropic: increases cardiac contractility </li></ul></ul><ul><ul><li>Vasopressors: used to treat neurogenic, septic, or anaphylactic shock </li></ul></ul><ul><ul><li>Opioids: used to treat pain </li></ul></ul><ul><ul><li>Immunizations: tetanus prophylaxis </li></ul></ul>
    • 45. Shock <ul><li>Look at the patient </li></ul><ul><li>Compensated vs uncompensated </li></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Urine output </li></ul></ul><ul><ul><li>HR </li></ul></ul><ul><ul><li>RR </li></ul></ul><ul><li>Mental status </li></ul>
    • 46. Emergency
    • 47. Cardiac Emergency <ul><li>Crash cart </li></ul><ul><li>BLS </li></ul><ul><li>Systematic Approach </li></ul><ul><li>Code Team </li></ul>
    • 48. Rapid Response Team <ul><li>ABC </li></ul><ul><ul><li>Act Before Code </li></ul></ul><ul><li>Early intervention </li></ul><ul><ul><li>Early recognintion = increased survival </li></ul></ul>
    • 49. What if it happens to me? <ul><li>Don’t panic </li></ul><ul><li>Activate the code Blue </li></ul><ul><ul><li>Call for help if no button exists </li></ul></ul><ul><li>BLS (you know this) </li></ul><ul><ul><li>Get in there! </li></ul></ul><ul><li>Record your findings </li></ul>
    • 50. Review your ABG’s
    • 51. Questions?? Mid Term Exam Next Week. Cumulative to include everything to now. You will have the whole class time to take the exam.

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