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Timby

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 9/e Chapter 28: Introduction to the Cardiovascular System Anatomy and Physiology • The Cardiovascular System – Comprises heart, major blood vessels, and a vast network of smaller peripheral blood vessels – Five qualities unique to cardiac tissues • Heart Chambers – Four-chambered muscular pump – Upper chamber: Right and left atria – Lower chamber: Right and left ventricles – Thick septum separates the right from the left side of the heart Anatomy and Physiology • Cardiac Tissue Layers – Heart wall: Three distinct layers of tissue—epicardium; myocardium; endocardium – Pericardium: Sac-like structure; surrounds and supports the heart; two membranous layers • Heart Valves – Membranous structures: Ensures one-way flow of blood; forward direction – Two atrioventricular valves: Separate the atria from the ventricles Anatomy and Physiology • Heart Valves (Cont’d) – Cusped valves: Tricuspid; bicuspid – Chordaea tendineae: Papillary muscles contract and prevent eversion of valves and regurgitation of blood – Semilunar valves: Prevents blood from flowing back into the ventricles after the heart contracts – Pulmonary valve; aortic valve Anatomy and Physiology • Arteries and Veins – Arteries: Carry oxygenated blood from heart – Veins: Return deoxygenated blood to heart – Arterioles: Smallest arteries; branches into capillaries
  • 2. – Capillaries: Connecting network between arterioles and venules; delivers oxygen and metabolic substances to blood and cells – Venules: Smallest veins – Consist of three layers Anatomy and Physiology • Cardiopulmonary Circulation – Inferior and superior venae cavae—bring venous blood from all areas of body into the right atrium – Pulmonary artery: Branches to deliver venous blood to the right and left lungs – Pulmonary veins: Bring oxygenated blood into the left atrium— leave left atrium through the bicuspid, or mitral, valve – Left ventricle pumps blood through the aorta to all the body’s cells and tissues Anatomy and Physiology • Blood Supply to the Heart – Left and right coronary arteries: Supply oxygenated blood to cardiac muscle – Myocardium first tissue supplied with oxygenated blood – Left coronary artery and its branches: Maintain pumping function of the heart – Right coronary artery and branches: Maintain heart rhythm – Coronary veins: Empty into the coronary sinus in the right atrium – Blood from inferior and superior venae cavae is recirculated to the lungs Anatomy and Physiology • Cardiac Cycle – Contraction and relaxation of both atria and ventricles – Contraction of left ventricle: Wave-like impulse in peripheral arteries – Auscultated “lub-dub” sounds: Valves alternately snap shut – Starling’s law Anatomy and Physiology Anatomy and Physiology • Conduction System – Sustains the electrical activity of the heart
  • 3. – Sinoatrial (SA) node: Pacemaker of the heart – Atrioventricular (AV) node: Impulse is delayed a few hundredths of a second – Normal sequence of events of the cardiac impulse – Bundle of His, bundle branches, and Purkinje fibers Anatomy and Physiology • Conduction System – Polarization; depolarization – Repolarization; refractory period – Normal ranges of potassium and calcium ions – ECG: Record of electrical changes caused by depolarization or repolarization Anatomy and Physiology Anatomy and Physiology • Regulation of Heart Rate – Fluctuates according to stimulation from the autonomic nervous system, baroreceptors, and chemoreceptors – Autonomic nervous system: Sympathetic and parasympathetic nervous system innervation; increased heart rate – Parasympathetic innervation: Vagus nerve; decreased heart rate – Responses to baroreceptors – Chemoreceptors Anatomy and Physiology • Cardiac Output – Amount of blood pumped out of the left ventricle each minute – Cardiac output = heart rate x stroke volume – Heart adjusts cardiac output to the body’s changing needs – Two ways of increasing cardiac output – Stroke volume: Amount of blood pumped per contraction of heart Assessment • History – Client assessment • Symptoms, medical history, and family history – Prescription and nonprescription drugs being taken by the client – Illicit drug usage
  • 4. – Drug and food allergies • Allergy to iodine (used in diagnostic procedures) Assessment • Physical Examination – General appearance: Nonverbal behavior and body position – Pain: Classic sign of ischemia – Vital signs: Temperature, pulse, respiratory rate, and blood pressure – Cardiac rhythm • Electrical activity: Produces heart rhythm • Observed continuously with bedside cardiac monitoring; telemetry; dysrhythmias Assessment • Physical Examination – Cardiac rhythm (cont’d) • Mechanical activity: Assessed by auscultation and palpation of pulses – Heart sounds: Normal heart sounds • First heart sound: S1—“lub” closure of mitral and tricuspid valves; apex of heart • Second heart sound: S2—“dub” closure of aortic and pulmonic valves; second intercostal space Assessment • Physical Examination – Heart sounds: Abnormal heart sounds • S3 (ventricular gallop); indication of heart failure in adult • S4 (atrial gallop); hypertensive heart disease; abnormal sounds—murmurs, clicks, and friction rub – Peripheral pulses • Palpate radial arteries and the major arteries of the leg bilaterally Assessment • Physical Examination – Peripheral pulses (cont’d) • Record: Pulses and their strength Assessment
  • 5. • Physical Examination – Skin • Cyanosis: Oral mucous membranes, lips, earlobes, skin, and nail beds • Pallor detection: Bloodless; grayish cast • Temperature; sparse hair growth Assessment • Physical Examination – Peripheral edema • Occurs when – Blood is not pumped efficiently – Plasma protein levels are inadequate • Areas prone: Fingers, hands, and sacrum – Dependent edema • Pitting edema • Evaluated on scale +1 to +4 Assessment • Physical Examination – Weight • Weight gain: Indicates edema • Weight loss: Loss of excess fluid from tissues; used to evaluate drug therapy, diuretics; recording weight – Jugular veins • Procedure to assess • Indicates increased fluid volume and pressure in right side of heart Assessment • Physical Examination – Lung sounds • Auscultates lungs for abnormal and normal breath sounds • Left-sided CHF: Crackles, wheezes, and gurgle • Uncorrected: Leads to right-sided failure – Sputum • Assess: Type and frequency of cough; amount and appearance of the sputum Assessment • Physical Examination – Mental status • Confusion, disorientation: Decrease in O2
  • 6. • Chest pain and dyspnea: Anxiety • Report abnormals to physician • Diagnostic tests – Laboratory tests • Diagnosis of heart disease • Monitoring client’s progress Assessment • Diagnostic Tests – Laboratory tests • Blood chemistry, serum enzymes, and Isoenzymes – Electron beam computed tomography • Radiologic test • Detect and quantify calcified plaque in the coronary arteries • Symptomatic clients • Calcium plaque: Risk of MI Assessment • Diagnostic Tests – Radiography and radionuclide studies • Chest radiography and fluoroscopy – Determines size and position of the heart and condition of the lungs – Guides insertion and confirms the placement of cardiac catheters and pacemaker wires • CT scan and MRI: Determines heart size and detects lung involvement Assessment • Diagnostic Tests – Magnetic resonance imaging (MRI) • Used to diagnose cardiac disorders • Nurses role: Preparation for cardiac MRI – Echocardiography • Uses ultrasound waves; determines functioning of the left ventricle • Detects cardiac tumors, congenital defects, and changes in tissue layers of the heart; second ultrasound technique • Obese clients Assessment • Diagnostic Tests
  • 7. – Phonocardiography • Graphic representation of normal and abnormal heart sounds • Diagnosis: Valvular and cardiac disorders – Electrocardiography • Graphic recording of the electrical currents generated by the heart muscle • Detects cardiac dysrhythmias and myocardial damage Assessment • Diagnostic Tests – Electrocardiography • Ambulatory electrocardiography: Halter monitor • Exercise-induced stress testing • Drug-induced stress testing Assessment • Diagnostic Tests – Cardiac catheterization • Measures fluid pressures in the chambers of the heart • Collects blood samples to analyze the oxygen and CO2 content • Procedure preparation – Food and fluids, allergies, and IV fluids – Medications and sedatives Assessment • Diagnostic Tests – Cardiac catheterization • Client teaching: Postprocedure – Keep extremities straight – Frequently monitor BP, pulse, and dressing over insertion site – Palpate pulse; check color and temperature in the extremities – Report any warm, wet feeling – Drink a large volume of fluid Assessment • Diagnostic Tests – Electrophysiology studies • Enable physicians to examine the electrical activity of the heart: Clients with dysrhythmias • Client preparation, management, and recovery: Similar to those for a client undergoing a heart catheterization
  • 8. Assessment • Diagnostic Tests – Arteriography: Coronary arteriography • Diagnostic procedure; instilling dye into an artery • Determines blockage of coronary arteries • Postprocedure nursing care – Assess insertion site, bed rest, restrictions, and vascular assessments – Monitor and report abnormalities Assessment • Diagnostic Tests – Arteriography: Angiocardiography • Radiopaque dye injected into a vein • Records course through the heart • Radiographic pictures taken in rapid succession; client preparation – Nursing interventions • Administer sedative and an antihistaminic medication before taken to the radiography department Assessment • Diagnostic Tests – Arteriography: Aortography • Detects aortic abnormalities – Arteriography: Peripheral arteriography • Diagnoses occlusive arterial disease in smaller arteries • Postprocedure assessments and potential abnormalities Assessment • Diagnostic Tests – Hemodynamic monitoring • Used to assess the volume and pressure of blood in the heart and vascular system • Direct blood pressure monitoring • Central venous pressure monitoring • Pulmonary artery monitoring Nursing Process: Diagnostic Procedures of the Cardiovascular System
  • 9. • Assessment – History; medications; over the counter – Self-treatment; herbal preparations – Characteristics of symptoms and pain – Anxiety; knowledge – Baseline data: Vital signs and weight – Physical assessment: Pulses, edema, and auscultation of heart and lungs Nursing Process: Diagnostic Procedures of the Cardiovascular System • Diagnosis, Planning, and Interventions – Anxiety: Insecurity – Deficient knowledge: Test’s purpose, performance, and aftercare – Pain and activity intolerance: Ischemia – Risk for injury: Untoward reactions during or after diagnostic tests – Expected outcome • Reduced anxiety; demonstrate sufficient knowledge • Pain will be relieved, limited activity; condition will remain stable General Considerations • Nutritional – Food and fluid restrictions: Procedural preparations • Pharmacologic – Client medication history, and allergies – Client teaching; intense flushed feeling during a cardiac catheterization • Gerontologic – Age-related changes – Client teaching; diagnostic studies
  • 10. • Assessment – History; medications; over the counter – Self-treatment; herbal preparations – Characteristics of symptoms and pain – Anxiety; knowledge – Baseline data: Vital signs and weight – Physical assessment: Pulses, edema, and auscultation of heart and lungs Nursing Process: Diagnostic Procedures of the Cardiovascular System • Diagnosis, Planning, and Interventions – Anxiety: Insecurity – Deficient knowledge: Test’s purpose, performance, and aftercare – Pain and activity intolerance: Ischemia – Risk for injury: Untoward reactions during or after diagnostic tests – Expected outcome • Reduced anxiety; demonstrate sufficient knowledge • Pain will be relieved, limited activity; condition will remain stable General Considerations • Nutritional – Food and fluid restrictions: Procedural preparations • Pharmacologic – Client medication history, and allergies – Client teaching; intense flushed feeling during a cardiac catheterization • Gerontologic – Age-related changes – Client teaching; diagnostic studies

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