Cardiovascular Disorders Proper

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Cardiovascular Disorders

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Cardiovascular Disorders Proper

  1. 1. Cardiovascular Disorders Nio C. Noveno, RN
  2. 2. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Chest x-ray Fluoroscopy Cardiac Enzymes LDH - elevated in 48 hrs SGOT CPK – elevated 4-24 hrs CPK-MM [skeletal muscles] CPK-BB [brain] CPK-MB [myocardium, cardio-specific] Echocardiography [Ultrasound cardiography] Electrocardiography [ECG] – electrical activity nionoveno@yc Cardiovascular Diseases 2
  3. 3. CARDIAC ENZYMES AST/SGOT 5 – 40 U/L CPK M 12 – 70 F 10 – 55 CPK-MB 0% LDH 45 – 90 U/L Myoglobin < 85 ng/mL Troponin I < 0.03 Troponin T < 0.2 CRP < 0.8 mg/dL nionoveno@yc Cardiovascular Diseases 3
  4. 4. ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY nionoveno@yc Cardiovascular Diseases 4
  5. 5. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Electrocardiography [ECG] – graphic record of the electrical activity of the heart nionoveno@yc Cardiovascular Diseases 5
  6. 6. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Electrocardiography [ECG] nionoveno@yc Cardiovascular Diseases 6
  7. 7. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Stress test (treadmill) Transesophageal echocardiography [TEE] Angiocardiography Positron Emission Tomography [PET] Coronary Arteriography Cardiac catheterization Hemodynamic monitoring nionoveno@yc Cardiovascular Diseases 7
  8. 8. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Coronary Arteriography - introduction of radiopaque catheter into brachial or femoral artery [arteriotomy w/ percutaneous puncture] to ascending aorta to coronary artery for fluoroscopy Nursing Intervention NPO Vital signs Check for bleeding at puncture site Check color of extremity and pulses nionoveno@yc Cardiovascular Diseases 8
  9. 9. CARDIAC ARTERIOGRAPHY CATHETERIZATION nionoveno@yc Cardiovascular Diseases 9
  10. 10. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Cardiac Catheterization - catheter into heart & BV to : measure O2 conc., saturation, tension & pressure of heart chambers Detect shunts, heart output & pulmonary outflow Right CC – antecubital v → VC → R A&V → Pulm a. Left CC – brachia/femoral a → aorta → R V Nursing Intervention Before: NPO, allergic hx, mark distal pulse, instruct pt thudding sensations in chest & strong desire to cough and transient heat After: VS, peripheral pulses, site, chest pain, bed rest for 12-24hrs; Femoral site – bleeding inflammation, tenderness, apply sandbag & ice on site, HOB >30°, avoid flexing femoral region Cardiovascular Diseases nionoveno@yc 10
  11. 11. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Hemodynamic Monitoring: assessment of circulatory status Central Venous Pressure [CVP] (N= 5-12 cms H2O) Catheter into external jugular vein → antecubital or femoral v. → vena cava Provides information on blood volume & adequacy of venous return Reveals right atrial pressure Route for drawing blood samples, administration of fluids or meds and pacing nionoveno@yc Cardiovascular Diseases 11
  12. 12. CVP nionoveno@yc Cardiovascular Diseases 12
  13. 13. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Hemodynamic Monitoring (CVP) Nursing Intervention Pt. in supine. Changes in position, coughing or straining during reading may result to inaccuracies of readings Zero point of manometer should be at a level with the pt’s R atrium (midaxillary line) To measure CVP: turn stopcock so that IV solution flows into manometer filling to about 20-25cm level, then turn stopcock to let flow the solution in the manometer into pt. Observe the fall in the height of column of fluid in manometer. Read where it stops. nionoveno@yc Cardiovascular Diseases 13
  14. 14. OXYGENATION (Cardiovascular) DIAGNOSTIC ASSESSMENT Hemodynamic Monitoring Swan-Ganz Pressure (N=5-12 cms H2O) Catheter into external jugular vein/subclavian → superior vena cava → R atrium → tricuspid valve → R vent → pulm a. → pulm capillary [pulm capillary wedge pressure] Interpretations of Pressure Readings: Pulmonary Artery Pressure [PAP]: 10-20 mmHg; - increased in pts w/ chronic pulmonary disease & CHF Pulmonary Capillary Wedge Pressure: 4-12 mmHg - indicative of pressure in the L cardiac chambers nionoveno@yc Cardiovascular Diseases 14
  15. 15. Swan-Ganz Procedure PAWP CATHETER nionoveno@yc Cardiovascular Diseases 15
  16. 16. The PRESSURE Guidelines P ressure monitor R ise slowly to reduce orthostatic hypotension E ating must be considered S tay on medications S topping or skipping is discouraged U ndesirable responses R emind to exercise, stop alcohol E liminate smoking, educate nionoveno@yc Cardiovascular Diseases 16
  17. 17. Pharmacology Nitroglycerin Interventions: MOA: relaxes vascular Monitor BP & AP smooth system, ↓ Have client sit or lie myocardial demand down (first time) for O2, ↓ LV preload by dilating veins, NO defibrillation over thus indeirectly ↓ area of nitro patch afterload Assist during ambulation nionoveno@yc Cardiovascular Diseases 17
  18. 18. Pharmacology Nitroglycerin cont… Health Teachings: Oral: – Take on an empty stomach, with a glass of water. SL: – Take at first sign of anginal pain – Take every 5 mins to a maximum of 3 doses • NO relief, seek MD – Stinging or biting sensation – Protect from light, moisture and heat Transderm patch: – OD in AM – Rotate sites nionoveno@yc Cardiovascular Diseases 18
  19. 19. Pharmacology Lidocaine MOA: decreases cardiac excitability, cardiac conduction is delayed in the atrium or ventricle Drug interactions: – ↑ effects with Phenytoin, Undesirable effects: Procainamide, Propranolol, quinidine, – ↓ or ↑ HR – ↑ risk of toxicity with ß- – ↓ BP adrenergic blockers, cimetidine – Confusion Drowsiness (1st sign of – toxicity) – Dizziness – Nausea, vomiting – Seizures (severe toxicity) – Cardiac arrest nionoveno@yc Cardiovascular Diseases 19
  20. 20. Pharmacology Lidocaine cont… Interventions: • Give I.V. • Monitor serum levels: 1.5-5 mcg/ml • Monitor EKG, BP, PR • Monitor I & O • Do not mix syringes with cefazolin and amphotericin B • Have Dopamine available for circulatory collapse • Assist and provide safety nionoveno@yc Cardiovascular Diseases 20
  21. 21. Pharmacology Interactions: ACE INHIBITORS – Probenecid: ↓ MOA: suppress the RAAS; blocks elimination the conversion of angiotensin I – NSAIDs: hypotensive to angiotensin II effect – Other anti-HTN: ↑ Undesirable effects: hypotensive effects – Gastric irritation – Hyperkalemia – Headache – Dizziness – ↑ HR Interventions: – Angioedema – Assess for renal function – Cough – Do not give with food – Maculopapular rash – Pruritus – Do not take potassium- – Infection rich foods – Hyperkalemia nionoveno@yc Cardiovascular Diseases 21
  22. 22. Pharmacology ACE INHIBITORS cont… ACE INHIBITORS cont… S VR/PVR decreased C ough; contraindicated with renal artery T reatment for MI stenosis R elease of aldosterone is low H ypotension; hyperlipidemia O occult diabetic nephropathy F ood has less taste; L VD after MI is low WOF hypotension nionoveno@yc Cardiovascular Diseases 22
  23. 23. Pharmacology A dminister without Angiotensin II receptor blockers (ARB) regard to meals MOA: blocks angiotensin II from binding with angiotensin receptors; R enal function tests – lowering BP review Information: B locks vasoconstriction – Same with ACE inhibitors effect of RAAS S alt substitution or potassium supplements is not allowed nionoveno@yc Cardiovascular Diseases 23
  24. 24. Pharmacology Alpha adrenergic blockers S yncope; sexual MOA: blocks alpha1 dysfunction adrenergic receptors resulting in vasodilation of arteries and veins; I ncreased drowsiness; decreases PVR; relaxes orthostatic smooth muscles of hypotension, HR bladder and prostate Undesirable effects: N eed to be recumbent – Same as other anti-HTN for 3-4 H after the meds initial dose – WOF: 1st dose syncope • 2-3 H post initial dose nionoveno@yc Cardiovascular Diseases 24
  25. 25. Pharmacology Beta adrenergic blockers B radycardia L ipidemia/libido MOA: blocks ß1 (heart) or ß2 (lungs) receptors to decreased prevent the release of br O nchospasm catecholamines; decreases contractility, C HF; conduction renin release and sympathetic output abnormalities K onstriction, peripheral Caution: vascular – COPD E exhaustion; emotional – CHF – Sinus bradycardia depression – Heart block R educes glucose – DM nionoveno@yc Cardiovascular Diseases 25
  26. 26. Pharmacology Calcium channel blockers MOA: blocks Ca2+ influx into Interventions: the cells causing • Elevate extremity affected decreased contractility, • Increased dietary fiber; decreased PVR and low increase OFI BP • Take with meals or milk Undesirable effects: – Hypotension – Headache – Dizziness – Peripheral edema – Constipation nionoveno@yc Cardiovascular Diseases 26
  27. 27. Pharmacology Central alpha2 agonist C ontrols release of adrenergic hormones A dverse effects: low BP, MOA: decreased hepatotoxicity, release of hemolytic anemia adrenergic T ransient drowsiness hormones from the A rterial pressure is brain resulting in a lowered decrease PVR, P aradoxical HTN with hence BP propranolol R ecord baseline VS E valuate weight and liver function S lowly taper the doses nionoveno@yc Cardiovascular Diseases 27
  28. 28. Pharmacology Vasodilators D ilates vascular muscles I ncreases renal and cerebral flow L upus-like reaction (fever, facial rash, muscle and MOA: direct relaxation of joint ache, splenomegaly) vascular smooth muscles, A ssess for peripheral edema decreases afterload T ake with food O ther SE: headache, dizziness, anorexia, tachycardia, hypotension R eview BP nionoveno@yc Cardiovascular Diseases 28
  29. 29. D iet high in K+ for all except aldactone I ntake and output daily U undesirable effects: fluid & electrolye imbalance R review HR, BP E lderly with caution T ake with or after meals in AM I ncrease risk of orthostatic hypotension; move slowly C ancel alcohol nionoveno@yc Cardiovascular Diseases 29
  30. 30. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CORONARY ARTERY DISEASE or Coronary Ischemic HD Myocardial impairment due to imbalance between coronary blood flow myocardial O2 demand Manifested as: Ischemia [Angina Pectoris] – reversible Infarction – irreversible Ischemia – reversible if myocardial blood flow is ↑ or the need for the demand is ↓ may progress to infarction nionoveno@yc Cardiovascular Diseases 30
  31. 31. nionoveno@yc Cardiovascular Diseases 31
  32. 32. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Angina Pectoris Chest pain associated w/ transient myocardial ischemia Causes: Atherosclerosis – most common Vasospasm Aortic stenosis Kinds: Stable [Effort] AP Unstable [Preinfarction] AP nionoveno@yc Cardiovascular Diseases 32
  33. 33. ASSESSMENT OF PAIN P rovoking/precipitating Q uality R adiation S everity T iming nionoveno@yc Cardiovascular Diseases 33
  34. 34. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Angina Pectoris Signs & Symptoms: Substernal or precordial pain radiating to L shoulder lasting for 3-5 mins, relieved by rest Heaviness, tightness, squeezing precipitated by exertion, emotion and exposure to cold VS may be normal Diagnostic Tests: Nitroglycerine test – relieves pain Blood chemistry - ↑ cholesterol Stress test, abnormal ECG – inverted T-waves Cardiac enzymes – N Coronary arteriography – plaque accumulation nionoveno@yc Cardiovascular Diseases 34
  35. 35. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Angina Pectoris Nursing Intervention ↑ O2 to the myocardium & relief of acute attacks Administer meds as ordered. Short & long acting nitrates [NG] β-adrenergic agonists [Propranolol] Reducing demand for O2 Limit activities, moderate exercise Sedatives, tranquilizers, antidepressants Helping client prevent future attacks Diet – low calorie, saturated fat 5-6 small frequent feedings Daily exercise; avoid cold environment, smoking nionoveno@yc Cardiovascular Diseases 35
  36. 36. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Myocardial Infarction Life threatening condition caused by occlusion of coronary artery or its branches leading to death of myocardial cells Causes: Atherosclerosis Thrombus Embolus Coronary artery spasm nionoveno@yc Cardiovascular Diseases 36
  37. 37. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES nionoveno@yc Cardiovascular Diseases 37
  38. 38. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES nionoveno@yc Cardiovascular Diseases 38
  39. 39. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Myocardial Infarction Signs & Symptoms: Steady constrictive substernal chest pain, sever, not relieved by rest & Nitroglycerine Symptoms of shock, increase in temp Nausea & vomiting, diaphoresis, pallor Anxiety and apprehension Management: Provide rest – CBR, use bedside commode Relieve pain – demerol or morphine O2 by mask, cannula or nasal catheter ECG monitoring IVF to KVO nionoveno@yc Cardiovascular Diseases 39
  40. 40. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Myocardial Infarction Management: Diuretics β-adrenergic agonists Anti-arrhythmics [Procainamide, Lidocaine] Diet: no iced or very hot drinks, may precipitate arrhythmias, no gas-forming foods Mild laxatives, stool softeners If due to thrombus: give Thrombolytics [Streptokinase] Follow up therapy w/ anticoagulant Heparin, Coumadin, ASA, Dicumarol nionoveno@yc Cardiovascular Diseases 40
  41. 41. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONGESTIVE HEART FAILURE (CHF) Inability of the heart to pump blood from the ventricles as quickly as it enters the atria leading to congestion in the lungs & systemic circulation Causes: inflow of blood → heart is greatly reduced inflow of blood → heart is greatly increased outflow of blood from the heart is obstructed myocardial damage increased metabolic state nionoveno@yc Cardiovascular Diseases 41
  42. 42. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONGESTIVE HEART FAILURE (CHF) Cardiac Compensatory Mechanisms: Ventricular dilatation Ventricular hypertrophy Tachycardia Forms of CHF: Left ventricular failure Right ventricular failure nionoveno@yc Cardiovascular Diseases 42
  43. 43. nionoveno@yc Cardiovascular Diseases 43
  44. 44. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES Signs and Symptoms of CHF Left-sided HF Right-sided HF Forward Effects: Forward Effects: Weakness, fatigue Decreased volume to the mental confusion, lungs insomnia, anxiety, oliguria Backward Effects: ankle/pretibial swelling, Backward Effects: pitting edema, abdominal breathlessness, distention, ascites, cough, anorexia, JV distention, orthopnea, hepatomegaly crackles, ↑ PCWP, splenomegaly, wt. gain, frothy sputum ↑ CVP nionoveno@yc Cardiovascular Diseases 44
  45. 45. Congestive Heart Failure nionoveno@yc Cardiovascular Diseases 45
  46. 46. nionoveno@yc Cardiovascular Diseases 46
  47. 47. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONGESTIVE HEART FAILURE (CHF) Interventions: Improve ventricular pump performance Inotropic agents [Digitalis] Administer O2 therapy Reduce myocardial workload Preload: Administer diuretics Restrict fluid & Na intake Upright position Phlebotomy Afterload: Vasodilators Reduce physical and emotional stress nionoveno@yc Cardiovascular Diseases 47
  48. 48. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ACUTE PULMONARY EDEMA Complication of L-sided HF Edema results from the heart’s inability to pump adequately Results in impaired oxygenation & hypoxia Causes: Heart failure Atherosclerosis Valvular disease nionoveno@yc Cardiovascular Diseases 48
  49. 49. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ACUTE PULMONARY EDEMA Assessment findings: Dyspnea • Paroxysmal cough • Blood-tinged frothy sputum • Orthopnea • Restlessness • Diagnostic test findings: CXR: interstitial edema ABGs: respiratory alkalosis or acidosis ECG: tachycardia, ventricular enlargement EMODYNAMICS: ↑ PAWP, CVP, ↓ CO nionoveno@yc Cardiovascular Diseases 49
  50. 50. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ACUTE PULMONARY EDEMA Medical management: Low-sodium diet; limit fluids O2 therapy High-Fowler’s position VS, I/O, ECG, & hemodynamics Analgesics Vasodilators Cardiac inotropes & glycosides Nitrates Bronchodilators Pulse oximetry nionoveno@yc Cardiovascular Diseases 50
  51. 51. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ACUTE PULMONARY EDEMA Nursing management: Assess CV & respiratory status Withhold food & fluid Provide: Suctioning Turning Coughing Deep breathing Keep in High-Fowler’s Allay anxiety Note the color, amount & consistency of sputum nionoveno@yc Cardiovascular Diseases 51
  52. 52. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ACUTE PULMONARY EDEMA Home instructions: Recognize the signs of fluid overload & • respiratory distress Sleep with the head of the bed elevated • Complications: Digitalis toxicity Fluid overload Pulmonary embolism Hypokalemia Hyernatremia nionoveno@yc Cardiovascular Diseases 52
  53. 53. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOGENIC SHOCK Failure of the heart to pump adequately, thereby educing the CO & compromising tissue perfusion Causes: MI Myocarditis Advanced heart block Heart failure Metabolic abnormalities Cardiac tamponade Pulmonary embolus nionoveno@yc Cardiovascular Diseases 53
  54. 54. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOGENIC SHOCK Assessment findings: Hypotension SBP <90 mm Hg Oliguria: <30 mL/H Cold, clammy, pale skin Tachycardia Restlessness Diagnostic findings: ABGs: metabolic acidosis, hypoxemia ECG: MI (enlarge Q wave, ST elevation) nionoveno@yc Cardiovascular Diseases 54
  55. 55. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ↓ Injury ↓ SV ↑ HR Myocardial contractility ↓ Coronary ↓ LV emptying artery perfusion LV dialtion & backup of blood Myocardial hypoxia ↑ Preload ↓ CO CARDIOGENIC SHOCK Pulmonary congestion Compensation Decompensation ↓ & death Myocardial contractility nionoveno@yc Cardiovascular Diseases 55
  56. 56. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOGENIC SHOCK Management: O2 therapy Semi-Fowler’s position Intra-aortic balloon pump Diuretics Vasodilators Cardiac inotropes Vasopressors Adrenergic agents nionoveno@yc Cardiovascular Diseases 56
  57. 57. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOGENIC SHOCK Nursing management: Administer: IVF, O2, medications Assess CV, respiratory status, & fluid balance Monitor & record: VS I/O Hemodynamics LOC Lab values nionoveno@yc Cardiovascular Diseases 57
  58. 58. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOGENIC SHOCK Complications: Arrhythmias • Cardiac arrest • Infection • Surgical interventions: CABG Heart transplantation nionoveno@yc Cardiovascular Diseases 58
  59. 59. nionoveno@yc Cardiovascular Diseases 59
  60. 60. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL STENOSIS Narrowing of the mitral valve opening Due to: Rheumatic endocarditis Congenital Assessment findings: Fatigue • Dyspnea on exertion • Peripheral edema • Orthopnea • Diagnostic findings: CXR: enlargement of the LA & RV; pulmonary congestion ECHOCARDIOGRAM: thickened mitral valve & LA enlargement nionoveno@yc Cardiovascular Diseases 60
  61. 61. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL STENOSIS Management: Low-sodium diet; fluid restrictions Semi-Fowler’s position Cardiac glycosides Nitrates Diuretics Anti-arrhythmics Ani-coagulants Antibiotics nionoveno@yc Cardiovascular Diseases 61
  62. 62. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL STENOSIS Nursing management: Administer: IVF, O2, medications Assess CV & respiratory response Monitor & record: VS I/O Hemodynamics ECG readings Lab values nionoveno@yc Cardiovascular Diseases 62
  63. 63. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL STENOSIS Home care: Signs & symptoms Activity limitations Infection control Occult blood Complications: Thrombosis Embolism HF Atrial fibrillation Surgery: Valve replacement Open mitral commissurotomy nionoveno@yc Cardiovascular Diseases 63
  64. 64. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL INSUFFICIENCY Incomplete closure of the mitral valve Due to: ↑ LA pressure Pulmonary HTN LA hypertrophy Assessment findings: Fatigue • Dyspnea on exertion • Peripheral edema • Angina pectoris • Orthopnea • nionoveno@yc Cardiovascular Diseases 64
  65. 65. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL INSUFFICIENCY Diagnostic findings: ECHOCARDIOGRAM: enlarged LA, abnormal movement of the mitral valve CARDIAC CATH: ↑ LA pressure & ↑ LV pressure Management: Low-sodium diet; fluid restrictions Semi-Fowler’s position Cardiac glycosides Nitrates Diuretics Anti-arrhythmics Ani-coagulants nionoveno@yc Cardiovascular Diseases 65
  66. 66. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES MITRAL INSUFFICIENCY Nursing management: Maintain on diet; limit OFI Keep on semi-Fowler’s position Assess peripheral edema nionoveno@yc Cardiovascular Diseases 66
  67. 67. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC STENOSIS Narrowing of the aortic valve Lower CO leads to increased congestion in the lungs causing RSHF Causes: Syphilis Rheumatic fever Atherosclerosis Congenital malformations nionoveno@yc Cardiovascular Diseases 67
  68. 68. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC STENOSIS Assessment findings: Angina pectoris • Pulmonary HTN • LSHF • Orthopnea • Diagnostic findings: ECG: L bundle branch block, 10 heart block, LV hypertrophy ECHOCARDIOGRAM: thickened LV wall, thickened aortic valve that moves abnormally nionoveno@yc Cardiovascular Diseases 68
  69. 69. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC STENOSIS Management: Low-sodium diet; fluid restrictions • Monitor lab studies • Cardiac glycosides • Nitrates • Diuretics • Anti-arrhythmics • Percutaneous transluminal valvuloplasty • Nursing management: Maintain on diet; limit OFI Assess CV & respi status Monitor & record: VS , I/O, Hemodynamics, ECG readings, Lab values nionoveno@yc Cardiovascular Diseases 69
  70. 70. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC STENOSIS Complications: HF • Pulmonary edema • Surgery: Aortic valve replacement Commissurotomy nionoveno@yc Cardiovascular Diseases 70
  71. 71. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC INSUFFICIENCY Retrograde flow of blood from the aorta to the LV An incomplete closure of the aortic valve Causes: Syphilis Rheumatic fever Infective endocarditis Atherosclerosis Congenital defect nionoveno@yc Cardiovascular Diseases 71
  72. 72. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC INSUFFICIENCY Assessment findings: Signs of LSHF • Dyspnea on exertion • Dizziness • Angina pectoris • Diagnostic findings: CXR: enlarged LV, aortic valve calcification ECHOCARDIOGRAM: LV enlargement, abnormal valve movement nionoveno@yc Cardiovascular Diseases 72
  73. 73. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC INSUFFICIENCY Management: Low-sodium diet; fluid restrictions • Antibiotics • Cardiac glycosides • Nitrates • Diuretics • ACE inhibitors • Anti-arrhythmics • Percutaneous transluminal valvuloplasty • Nursing management: Maintain on diet; limit OFI Assess CV & respi status Monitor & record: VS , I/O, Hemodynamics, ECG readings, Lab values nionoveno@yc Cardiovascular Diseases 73
  74. 74. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES AORTIC INSUFFICIENCY Complications: HF • Thrombosis • Embolism • Infection • Surgery: Valvuloplasty Valve replacement nionoveno@yc Cardiovascular Diseases 74
  75. 75. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Chronic inadequate blood flow in the lower extremities Types: Arteriosclerosis obliterans – sclerosis of arterioles 1. resulting in thickening of the walls & occlusion Raynaud’s phenomenon – intermittent 2. vasoconstriction & ischemia of fingers & toes accompanied by pallor & cyanosis Buerger’s disease (thromboangiitis obliterans) – 3. inflammation of BV resulting in occlusion of the vessel Causes: Atherosclerosis Vasospasm Inflammation nionoveno@yc Cardiovascular Diseases 75
  76. 76. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Assessment findings: Intermittent claudication Pain at rest Trophic changes: thickened nails, absence of hair, & taut skin Diminished or absent pulses in extremities (unilateral) Temperature changes in extremities Color changes: Rubor, cyanosis, pallor Ulcerations in extremities Diagnostic findings: ARTERIOGRAPHY: location of obstruction DOPPLER STUDIES: decreased blood flow & arterial pressure nionoveno@yc Cardiovascular Diseases 76
  77. 77. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Buerger’s disease Raynaud’s phenomenon nionoveno@yc Cardiovascular Diseases 77
  78. 78. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Management: Active ROM & isometric exercises • Antiplatelet agents • Vasodilators • Anticoagulants • Antilipemics • Nursing management: Assess for: Pulses Color Temperature Complaints of abnormal sensations Numbness or tingling nionoveno@yc Cardiovascular Diseases 78
  79. 79. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Home care: Symptoms of ↓ peripheral circulation Skin breakdown Foot care Avoid stress Prolonged standing Extremes of temperature Constrictive clothing Crossing legs at knee when seated nionoveno@yc Cardiovascular Diseases 79
  80. 80. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERIPHERAL VASCULAR DISEASE Complication: Gangrene • Septicemia • Pressure sores • Acute vascular occlusion • Surgery: Bypass grafting Endarterectomy Sympathectomy Amputation Embolectomy nionoveno@yc Cardiovascular Diseases 80
  81. 81. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES THROMBOPHLEBITIS Massing of RBCs in a fibrin network Obstruction by enlarged thrombus Results to inflammation of the venous wall causing clots to form Causes: Venous stasis Varicose veins, pregnancy, HF, prolonged bed rest Hypercoagulability Cancer, blood dyscrasias, oral contraceptives Injury to venous wall IV, fractures, antibiotics nionoveno@yc Cardiovascular Diseases 81
  82. 82. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES THROMBOPHLEBITIS Assessment findings: SUPERFICIAL VEINS: Red, warm skin that’s tender to touch DEEP VEINS: Major venous trunks: Edema (+) Homans sign Tenderness Cramping pain, Cyanosis Venous distention SMALL VEINS: Tenderness Induration Minimal to no distention nionoveno@yc Cardiovascular Diseases 82
  83. 83. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES THROMBOPHLEBITIS Diagnostic findings: VENOGRAPHY/ PHLEBOGRAPHY : venous filling defects UTZ: ↓ blood flow Management: Activity limitation Antiembolism stockings Anticoagulants Nursing management: Assess for Homans sign Apply warm, moist compress Measure & record circumference of thighs & calves Keep patient I bed & elevate extremities nionoveno@yc Cardiovascular Diseases 83
  84. 84. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES THROMBOPHLEBITIS Complications: Pulmonary embolism • Stroke • Surgical intervention: Vena cava filter Vein ligation & stripping Thrombectomy nionoveno@yc Cardiovascular Diseases 84
  85. 85. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Obstruction or narrowing of the aorta’s lumen & its major branches Reduced perfusion Obstruction: endogenous or exogenous Causes: Atherosclerosis Emboli Thrombosis Trauma or fracture Risk factors: Age DM Family history Hyperlipidemia HTN Smoking nionoveno@yc Cardiovascular Diseases 85
  86. 86. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Assessment findings: Femoral, popliteal or innominate arteries: ↓ decreased distal pulses Mottling & pallor Paralysis & paresthesia Sudden & localized pain* Internal & external carotid arteries: stroke., TIA Subclavian: Subclavian steal syndrome Vertebral & basilar: TIA nionoveno@yc Cardiovascular Diseases 86
  87. 87. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Angiography findings: The type (thrombus or embolus), location, & degree of obstruction Collateral circulation Medications: Antilipemics Antiplatelets Pentoxyfilline Anticoagulants Throbolytics nionoveno@yc Cardiovascular Diseases 87
  88. 88. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Nursing management: Assess distal pulses, skin color, & temperature Assess pain & give analgesics Administer IV fluids, O2, & medications as Rx Monitor for signs of stroke nionoveno@yc Cardiovascular Diseases 88
  89. 89. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ABDOMINAL AORTIC ANEURYSM Dilation of or localized weakness in the medial layer of an abdominal artery Causes: Atherosclerosis HTN Smoking 4 types: Saccular – unilateral, pouch-like bulge 1. Fusiform – spindle-shaped bulge; encompasses entire 2. diameter of the vessel Dissecting – hemorrhagic separation of the medial 3. layer of vessel wall; creates a false lumen False – pulsating hematoma; often mistaken for an 4. abdominal aneurysm nionoveno@yc Cardiovascular Diseases 89
  90. 90. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES nionoveno@yc Cardiovascular Diseases 90
  91. 91. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Assessment findings: Asymptomatic Lower abdominal pain, lower back pain Abdominal mass to the left of the midline Abdominal pulsations Bruits Diagnostic findings: Apparent on CXR, abdominal UTZ, aortography Medications: Analgesics ß-blockers nionoveno@yc Cardiovascular Diseases 91
  92. 92. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Nursing management: Check peripheral circulation Observe for signs of shock: Anxiety Restlessness Decreased pulse pressure Increased thready pulse Pale, cool, moist, clammy skin Palpate abdomen for distention Teach signs & symptoms of decreased peripheral circulation nionoveno@yc Cardiovascular Diseases 92
  93. 93. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ARTERIAL OCCLUSIVE DISEASE Complication: Rupture of aneurysm Hemorrhage Renal insufficiency Surgery: Resection of aneurysm Endovascular graft repair nionoveno@yc Cardiovascular Diseases 93
  94. 94. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOMYOPATHY Disease of the heart’s muscle impacting the structure & function of the ventricle Heart failure develops later Myocardium becomes flabby Types: Congestive (dilated) – chronic alcoholism 1. Hypertrophic – idiopathic hypertrophic subaortic 2. stenosis Pressure overload hypertension or aortic valve stenosis Hypertrophic cardiomyopathy Restrictive (obliterative) – amyloidosis, cancer 3. nionoveno@yc Cardiovascular Diseases 94
  95. 95. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOMYOPATHY Major manifestations: Dyspnea • Dry cough • Fatigue • Palpitations • Weakness • Diagnostic findings: ECG: LV hypertrophy ECHOCARDIOGRAM: decreased myocardial function CXR: cardiomegaly nionoveno@yc Cardiovascular Diseases 95
  96. 96. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOMYOPATHY Management: Low-sodium diet; fluid restrictions • LV assist device • Diuretics • ß-blockers • Anticoagulants • CCBs • ACE inhibitors • Nursing management: Keep in semi-Fowler’s position Monitor ECG results Administer O2 & medications nionoveno@yc Cardiovascular Diseases 96
  97. 97. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CARDIOMYOPATHY Home care: Signs & symptoms of HF Weigh daily Report increments of 3 lbs. Demonstrate exercises to increase CO Refrain from smoking & drinking alcohol Complications: Heart failure • Arterial emboli • Surgery: Ventricular myomectomy Heart transplant nionoveno@yc Cardiovascular Diseases 97
  98. 98. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ENDOCARDITIS Endocardial lining inflammation Destruction of heart valve leaflets Causes: ß-hemolytic strep infections S. aureus, Candida, G(-) Rheumatic heart disease Dental procedures Invasive monitoring IV drug abuse nionoveno@yc Cardiovascular Diseases 98
  99. 99. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ENDOCARDITIS Assessment findings: Elevated temperature • Heart murmur • Malaise • Diagnostic findings: BLOOD CULTURES: (+) microorganisms • ECHOCARDIOGRAPHY: valvular damage, • vegetations Medical management: Antibiotics (+) inotropic agents Antipyretics Anticoagulants nionoveno@yc Cardiovascular Diseases 99
  100. 100. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES ENDOCARDITIS Nursing management: Administer medications • Asses CV status • Encourage rest periods • Home care: Avoid infections • Monitor for infections specially after dental or gynecologic • exam; seek treatment Wear ID • Complications: Embolism • HF • Mycotic aneurysm • Surgery: Valve replacement nionoveno@yc Cardiovascular Diseases 100
  101. 101. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERICARDITIS Inflammation of the pericardium May be: fibrinous or effusive Causes: Infection Neoplasms High dose radiation to the chest Hypersensitivity or autoimmune disease Hydralazine or procainamide Postcardiac injury Aortic aneurysm Myxedema nionoveno@yc Cardiovascular Diseases 101
  102. 102. OXYGENATION (Cardiovascular) nionoveno@yc Cardiovascular Diseases 102
  103. 103. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERICARDITIS Assessment findings: Pain characteristics: Sharp, usually sudden over the sternum Radiates to the neck, shoulders, back & arms Increases with deep inspiration or when lying down Decreases when sitting up & leaning forward nionoveno@yc Cardiovascular Diseases 103
  104. 104. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERICARDITIS Diagnostic findings: ECG Elevated ST segments QRS segments may be diminished with pericardial effusion Rhythm changes may occur: Atrial ectopic rhythms – atrial fibrillation & sinus arrhythmia Echocardiography reveals the problem Management: Bed as long as fever & pain persist NSAIDS Corticosteroids Antibiotics nionoveno@yc Cardiovascular Diseases 104
  105. 105. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES PERICARDITIS Nursing management: Maintain CBR • Place on upright position • Monitor & record VS, I/O, & hemodynamics • Assess pain & give analgesics as Rx • Complications: Pericardial effusion • HF • Chronic RSHF • Cardiac tamponade • Surgery: Pericardectomy nionoveno@yc Cardiovascular Diseases 105
  106. 106. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONDUCTION ARRHYTHMIAS Disruption in the normal events of cardiac cycle Sinus Tachycardia – HR > 100 beats/min originating from the SA node (100-160bpm); regular rhythm Causes: fever, apprehension, physical activity, anemia, hyperthyroidism, epinephrine, caffeine Management: Correction of underlying cause No stimulants Drug of choice: propranolol [Inderal], Digoxin nionoveno@yc Cardiovascular Diseases 106
  107. 107. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONDUCTION ARRHYTHMIAS Sinus Bradycardia – HR < 60 beats/min; regular rhythm May be caused by: Excessive vagal/or ↓ sympathetic tone MI, intracranial tumors, meningitis N variation of HR in well-trained athlete Management: Not needed, unless CO is inadequate Pharmacotherapy: Atropine, Isuprel Pacemakers – pulse generator to control potentially dangerous dysrhythmias nionoveno@yc Cardiovascular Diseases 107
  108. 108. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONDUCTION ARRHYTHMIAS Atrial Fibrillation: Atrial rate: 35-600bpm; Vent. rate: 100-160 bpm; irregular May be seen it pts with: Rheumatic mitral stenosis, thyrotoxicosis, hypertensive disease, cardiomyopathy, pericarditis and CHD Management Digitalis, Propranolol Verapamil in conjunction w/ digitalis Direct-current cardioversion nionoveno@yc Cardiovascular Diseases 108
  109. 109. OXYGENATION (Cardiovascular) CONDUCTION ARRHYTHMIAS Ventricular Tachycardia – run of 3 or more consec. PVCs; Atrial rate: 60-100bpm; Vent. rate: 110-250bpm; occ’l ventricular irregularity May be caused by: Acute MI, CAD, intoxication, hypokalemia Management IV push Lidocaine, then IV drip Procainamide via IV infusion Propranolol [Inderal], Bretylium Direct-current cardioversion nionoveno@yc Cardiovascular Diseases 109
  110. 110. OXYGENATION (Cardiovascular) COMMON CARDIOVASCULAR DISEASES CONDUCTION ARRHYTHMIAS Premature Ventricular Contractions – HR varies according to number of PVCs; irregular rhythm May be caused by: Myocardial dse, CHD, hypoxia Electrolyte imbalance [hypokalemia] Digitalis tx, stimulants Management IV push Lidocaine, then IV drip Procainamide [Pronestyl] Treatment of underlying cause nionoveno@yc Cardiovascular Diseases 110
  111. 111. Cardiovascular Disorders THANK YOU! Nio C. Noveno, RN

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