The cardiac system consists of the heart, arteries, veins and capillaries. The heart has four chambers and valves that allow blood to flow in one direction. It is surrounded by membranes and has a specialized conduction system. The vascular system transports blood and exchanges gases and nutrients. Assessment of the cardiac system involves history, physical exam, and diagnostic tests like ECG, echocardiogram and cardiac catheterization. Nursing care focuses on monitoring fluid balance, cardiac output, tissue perfusion and reducing pain and anxiety.
Hemodynamic monitoring of critically ill patientsV4Veeru25
Hemodynamic monitoring measures the blood pressure inside the veins, heart, and arteries. It also measures blood flow and oxygen proportion in the blood. Monitoring hemodynamic events provides information about the adequacy of a patient's circulation , perfusion, and oxygenation of the tissues and organ systems. The effectiveness of hemodynamic monitoring depends both on available technology and on physician ability to diagnose and effectively treat the disease
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
Pulmonary artery catheterisation, Cardiac surgeries, Non cardiac surgeries, LVEDD and PA pressure relationship, Technique and complications of PA placement
Hemodynamic monitoring of critically ill patientsV4Veeru25
Hemodynamic monitoring measures the blood pressure inside the veins, heart, and arteries. It also measures blood flow and oxygen proportion in the blood. Monitoring hemodynamic events provides information about the adequacy of a patient's circulation , perfusion, and oxygenation of the tissues and organ systems. The effectiveness of hemodynamic monitoring depends both on available technology and on physician ability to diagnose and effectively treat the disease
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
Pulmonary artery catheterisation, Cardiac surgeries, Non cardiac surgeries, LVEDD and PA pressure relationship, Technique and complications of PA placement
A very narrative discussion over Shock & Haemorrhage, Blood Transfusion, Blood Products which is presented in seminers. A concise guideline of a vast chapter.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Normal anatomy & physiology
CVS
• Consists: heart, arteries, veins, capillaries
• Functions:
1. circulation of blood
2. delivery of oxygen and other nutrients to
tissues of the body
3. removal of carbon dioxide and other
products of cellular metabolism
3. HEART
Anatomy and physiology:
A. Heart wall/ Layers
1. pericardium
a. fibrous
b. serous
2. epicardium
3. myocardium
4. endocardium
4. B. Chambers
1. Atria a. right
b. left
2. Ventricles a. right
b. left
C. Valves
1. Atrioventricular valves
a. Mitral valve/bicuspid
b. Tricuspid valve
5. AV valve Function
- permit unidirectional flow of blood from
specific atrium to specific ventricle during
ventricular diastole
- prevent reflux of blood during ventricular
systole
- valve leaflets open during ventricular diastole
and close during ventricular systole; valve
closure produces the first heart sounds (S1)
6. 2. Semilunar valves
a. Pulmonic valve
b. Aortic valve
Functions:
- permit unidirectional flow of blood from
specific ventricle to arterial vessel during
ventricular systole
-prevent reflux during ventricular diastole
- open when ventricles contract and close during
ventricular diastole; closure produces the
second heart sound (S2)
7. D. Conduction System
1. Sino atrial (SA) node
2. Intermodal Tracts – at upper right atrium
3. Atrioventricular (AV) node
4. Bundle of His – group of muscle fibers
- right bundle branch
- left bundle branch
5. Purkinje fibers – through out ventricles
* Electrical activity of heart can be visualized by
ECG
8. E. Coronary Circulation
1. Arteries
a. right coronary artery
b. left coronary artery
2. Veins
a. coronary sinus veins – group of small
veins
10. TYPES OF BLOOD VESSELS
A. Arteries
B. Arterioles
C. Capillaries: the following exchanges
occur:
- oxygen and carbon dioxide
- solutes between the blood and tissues
- fluid volume transfer between the plasma
and interstitial spaces
D. Veins
E. Venules
11. ASSESSMENT
HISTORY TAKING
A. Presenting problem
1. Nonspecific symptoms
include:-
- fatigue - cough
- Headache - weight loss/gain
- syncope (dizziness) - difficulty of
sleeping
- anorexia
12. 2. Specific signs and symptoms
a. chest pain
b. dyspnea (shortness/difficulty of breath)
c. orthopnea / paroxysmal nocturnal dyspnea
d. palpitations
e. edema
f. cyanosis
B. Lifestyle: occupation, hobbies, financial
status, stressors, exercise, smoking, living
conditions
13. C. Use of medications: OTC drugs,
contraceptives, cardiac drugs
D. Personality: Type A, manic-depressive,
anxieties
E. Nutrition: dietary habits, cholesterol, salt
intake, alcohol consumption
F. Past Medical History
G. Family history: heart disease (congenital,
acute, chronic); risk factors (DM,
hypertension, obesity)
14. PHYSICAL EXAMINATION
A. Skin and mucous membranes:
- color/texture, temperature, hair distribution
on extremities, atrophy or edema, petechial
B. Peripheral pulses:
- palpate and rate all arterial pulses (temporal,
carotid, brachial, radial, femoral, popliteal,
dorsalis pedis and posterior tibia) on scale of:
0=absent
1=weak
2=normal
3=full /bounding
15. C. Measure and record blood pressure
D. Inspect and palpate the neck vessels:
a. jugular veins: note; location,
characteristics, jugular venous pressure
b. carotid arteries: location and
characteristics
E. Auscultate heart sounds
- normal - (S1, S2)
- abnormal - gallop (S3, S4)
- murmur
- pericardial friction rub
16. LABORATORY / DIAGNOSTIC
TESTS
A. Chemistry and electrolyte analysis
1. Cardiac enzymes: in MI
a. Troponin T: detected 3-12 hours after chest
pain
b. Troponin I: detected 3-12 hrs.
c. creatinine phosphokinase (CPK ): 6-12Hrs
d. Aspartate aminotransferase (AST) (SGOT):
with in 24 Hrs. after chest pain
e. Lactic dehydrogenase (LDH): with in 36
Hrs.
17. 2. Electrolytes
a. Sodium (Na): 135-145meq/L
- hyponatremia: may cause fluid excess
- hypernatremia: fluid deficit
b. Potassium (K): 3.5-5 meq/L
- Inc. or Dec. levels can cause dysrhythmias
c. Magnesium (Mg): 1.3-2.1 meq/L
- decrease levels can cause dysrhythmias
18. d. Calcium (Ca): 4.5-5.3 meq/L:
-Normal values for blood clotting and
neuromuscular activity
- decrease levels cause tetany,
- Inc. levels causes muscle atony
- Dec. and Inc. levels causes dysrhythmias
3. Serum Lipids
a. Total Cholesterol : 150-200mg/dl:
- high levels predispose to atherosclerotic
Heart disease
19. b. High density lipids (HDL): 30-85 mg/dl
- low levels predispose to CVD
c. Low density lipids (LDL): 50-140 mg/dl:
- high levels predispose to atherosclerotic
plaque formation
d. Triglycerides :10-150 mg/dl:
- high levels increase risk of atherosclerotic
heart disease
20. B. Hematologic Studies
1. CBC – their number,size,infections
2. Coagulation time: 5-15mins; Inc. levels
indicate bleeding tendency, used to monitor
heparin Rx.
3. Prothrombin time (PT): 9.5-12sec.; used to
monitor warfarin Rx.
4. Activated partial thromboplastin time (APTT):
20-45sec; used to monitor heparin therapy
5. Erythrocyte sedimentation rate(ESR) :
<20mm/hr; Inc. level indicate inflammatory
process
21. C. Urine Studies (U/A)
D. Electrocardiogram (ECG/EKG)
1. Noninvasive ECG – a graphic record of
the electrical activity of the heart
2. Portable recorder (Holter monitor) –
provides continuous recording of ECG for up
to 24 hrs.
3. Exercise ECG (stress test): the ECG is
recorded during prescribed exercise; may
show heart disease when resting ECG does
not.
E. Echocardiogram: noninvasive recording of the
cardiac structures using ultrasound
22. F. Cardiac catheterization: invasive, but often
definitive test for diagnosis of cardiac
disease.
1. A catheter is inserted into the right or left
side of the heart to obtain information
2. Purpose: to measure intracardiac pressures
and oxygen levels in various parts of the
heart; with injection of a dye,
• allows visualization of the heart chambers,
blood vessels and blood flow (angiography)
23. 3. Nursing care for C.catheterization
prior to the test
- informed consent
- any allergies especially to iodine
- keep client on NPO for 8-12 hrs.
- record V/S, height, weight
- inform client that a feeling of warmth
and fluttering sensation as catheter is
inserted
24. post test
- assess circulation to the extremity used for
catheter insertion
- check peripheral pulses, color, sensation of
affected extremity
- if protocol requires, keep affected extremity
straight for approximately 8 hrs.
- observe catheter insertion site for swelling,
bleeding
- assess V/S and report for significant changes
25. G. Coronary arteriography
1. visualization of coronary arteries by injection
of radiopaque dye/ contrast medium and
recording on a movie film.
2. Purpose: evaluation of heart disease and
angina, location of areas of infarction and
extent of lesions, ruling out coronary artery
disease in clients with MI.
3. Nursing care: same as cardiac catheterization
26. ANALYSIS
Nursing diagnosis for the client with CVD include
A. Fluid volume excess r/t…as evidenced by..
B. Decreased cardiac output
C. Altered peripheral tissue perfusion
D. Impaired skin integrity
E. Risk for activity intolerance
F. Pain
G. Ineffective coping
H. Fear
I. Anxiety
27. PLANNING
GOALS
A. Fluid imbalance will be resolved, edema will be
minimized
B. Cardiac output will be improved.
C. peripheral tissue perfusion will be improved
D. Adequate skin integrity will be maintained
E. Activity intolerance will progressively resolved
F. Pain in the chest will be diminished
G. Client’s level of fear and anxiety will be decreased
28. INTERVENTIONS
CARDIAC MONITORING
A. ECG
1. P wave: produced by atrial depolarization;
indicates SA node function
2. P-R interval
a. indicates AV conduction time or the time
it takes an impulse to travel from the atria
down and through the AV node
b. measured from beginning of P wave to
beginning of QRS complex
29. 3. QRS complex
a. indicates ventricular depolarization
b. measured from onset of Q wave to end of S wave
4. ST segment
a. indicates time interval between complete
depolarization of ventricles and repolarization of
ventricles
b. measured after QRS complex to beginning of T
wave
5. T wave
a. represents ventricular repolarization
b. follows ST segment
30. HEMODYNAMIC MONITORING
(Swan Ganz Catheter)
A. A multilumen catheter with a balloon tip that
is advanced through the superior vena cava
into the RA, RV, and Pulmonary Artery/PA.
When it is wedged it is in the distal arterial
branch of the pulmonary artery.
B. Purpose:
1. Proximal port: measures RA pressure
2. Distal port:
a. measures PA pressure
31. b. normal values: PA pressure (systolic and
diastolic) less than 20mmHg
C. Nursing care
1. a sterile dry dressing should be applied to
site and changed Q 24 hours; inspect site
daily and report signs of infection
2. if catheter is inserted via an extremity,
immobilize extremity to prevent catheter
dislodgment or trauma.
32. 3. Observe catheter site for leakage
4. Continuously monitor PA systolic and
diastolic pressures and report significant
variations
5. Maintain client in same position for each
reading
6. Record PA systolic and diastolic readings
at least every hour
33. Central venous pressure (cvp)
A. Obtained by inserting a catheter into the
external jugular, ante cubital, or femoral vein
and threading it into the vena cava. The
catheter is attached to an IV infusion and
H2O manometer by a three way stopcock
B. Purposes:
1. Reveals RA pressure, reflecting alterations
in the RV pressure
34. 2. Provides information concerning blood
volume and adequacy of central venous
return
3. Provides an IV route for drawing blood
samples, administering fluids or medication,
and possibly inserting a pacing catheter
C. Normal range is 4-10 cmH20;
- elevation indicates hypervolemia,
- decreased level indicates hypovolemia
D. Nursing care
1. Ensure client is relaxed
35. 2. Maintain zero point of manometer always at
level of right atrium (miaxillary line)
3. Determine patency of catheter by opening IV
infusion line
4. Turn stopcock to allow IV solution to run into
manometer to a level of 10-20cm above
expected pressure reading
5. Turn stopcock to allow IV solution to flow
from manometer into catheter; fluid level in
manometer fluctuates with respiration
36. 6. Stop ventilatory assistance during
measurement of CVP
7. After CVP reading, return stopcock to IV
infusion position
8. Record CVP reading and position of client
EVALUATION
• Act of examining improvements previously
stated problems
• May lead to re assessment