new heart

8/8/2019 new heart

http://slidepdf.com/reader/full/new-heart 1/180

e

Heart

8/8/2019 new heart


4-chambered muscular organ

Located in the mediastinum coronary artery

The layer that covers the heart is the

PERICARDIUM Myocardium

The Atrio-ventricular valves-

The Semilunar valves-

8/8/2019 new heart


8/8/2019 new heart


The CONDUCTING SYSTEM OF THE HEART

Consists of the

The SA (sinoatrial ) node, or pacemaker ,initiates the heartbeat and contracts the atria

The AV (atrioventricular ) node conveys the

stimulus and initiates contraction of theventricles.

The signal for the ventricles to contract travelsfrom the AV node through the atrioventricular

bundle.These branch profusely to the smaller Purkinje fibers

8/8/2019 new heart


8/8/2019 new heart


Periods of the Cardiac Cycle

Diastole

± Period of rest

± Blood is returned to the heart Systole

± Period of contraction

± Blood is pumped out of the heart

8/8/2019 new heart


Cardiac Output Regulation

The heart pumps approximately 5 L of

blood/minute

8/8/2019 new heart


STROKE VOLUME- the amount of bloodthe heart pumps out in each beat

Heart rate

Sympathetic systemParasympathetic system (Vagus)

8/8/2019 new heart


Cardiac output=Stroke volume x heart rate

8/8/2019 new heart


Factors regulating Stroke Volume

1. Preload- the degree to which the ventricles are

stretched prior to contracting.

2. Afterload- the pressure against which the

ventricle ejects blood

- Determined primarily by bloodviscosity and the resistance of vascular system itself

8/8/2019 new heart


Extrinsic Control of Heartbeat

A cardiac control center up or slowsdown the heart rate by way of theautonomic nervous systembranches:

1. parasympathetic system (slows heartrate)

2. sympathetic system (increases heart

rate). Hormones epinephrine and

norepinephrine from the adrenal

medulla also stimulate faster heart rate.

8/8/2019 new heart


Blood pressure

Hormones- ADH, Adrenergic hormones,Aldosterone and ANF

ADH increases water retention

Aldosterone increases sodium retention andwater retention secondarily

Epinephrine and NE increase HR and BP

ANF= causes sodium excretion

8/8/2019 new heart


Cardiac compensatory mechanisms

When the normal compensatory

mechanisms cannot maintain cardiac output

to meet body needs, the client is in a state of

cardiac decompensation.

8/8/2019 new heart


8/8/2019 new heart


The vascular system consists of the

arteries, veins and capillaries The arteries are vessels that carry blood

away from the heart to the periphery

The veins are the vessels that carry blood

to the heart The capillaries are lined with squamous

cells, they connect the veins and arteries

8/8/2019 new heart


8/8/2019 new heart


The lymphatic system also is part of the

vascular systemFXN: to collect the extravasated fluid from

the tissues and return it to the blood

8/8/2019 new heart


Slide 11.26

Differences Between Blood VesselTypes

y Walls of arteries are the thickest

y

Lumens of veins are larger y Skeletal muscle ³milks´ blood in veins

toward the heart

y Walls of capillaries are only one celllayer thick to allow for exchangesbetween blood and tissue

8/8/2019 new heart


Slide 11.27

Movement of Blood Through Vessels

y Most arterial blood ispumped by the heart

y

Veins use the milkingaction of muscles tohelp move blood

Figure 11.9

8/8/2019 new heart


Slide 11.30

Major Arteries of Systemic Circulation

Figure 11.11

8/8/2019 new heart


Slide 11.31

Major Veins of Systemic Circulation

Figure 11.12

8/8/2019 new heart


Slide 11.34

Circulation to the Fetus

8/8/2019 new heart


Blood Pressure

Measure of force exerted by bloodagainst the wall

Blood moves through vessels because of

blood pressure

8/8/2019 new heart


Slide 11.39b

Blood Pressure: Effects of Factors

y TemperatureyHeat has a vasodilation effect

yCold has a vasoconstricting effect

y Chemicals

yVarious substances can cause increase or decrease

y Diet

8/8/2019 new heart


Slide 11.40

Factors Determining Blood Pressure

Figure 11.19

8/8/2019 new heart


Slide 11.35

Pulse

y

Pulse ±pressure waveof blood

y Monitored at³pressure

points´ wherepulse is easily

palpated

Figure 11.16

8/8/2019 new heart


C ardiac Assessment

8/8/2019 new heart


Physical examination

InspectionSkin color. Note for pallor, cyanosis or jaundice.

Pallor and cyanosis are due to inadequate

oxygenation. Jaundice is due to hemolysis of rbc.

Neck vein distention. This is due to venous

congestion

Respiration. Note for signs of dyspnea

Point mf Maximal Impulse (PMI). It is located inthe left, mid-clavicular fifth intercostals space (ICS)

Peripheral Edema. This is due to venous

insufficiency

8/8/2019 new heart


Palpation

Peripheral pulses. Weak or bounding and irregular pulses may indicate presence of cardiovascular disorders

Apical pulse. It is assessed at the point of maximum

impulsePercussion

Pulmonary edema produces dullness on percussionof the chest

AuscultationHeart sounds

8/8/2019 new heart


LABORATORY PROCEDURES

CARDIAC Proteins and enzymes

1. CBC

2. BUN 3. Blood l ipids

8/8/2019 new heart


CARDIAC Proteins and enzymes

4. CK- MB ( creatine kinase)Normal value is 0-7 U/L

Elevates in MI w ithin 4hours, peaks in 18 hoursand then dec l ines ti ll 3 days

8/8/2019 new heart


5. Lactic Dehydrogenase (LDH)

Among the LDH isoenzymes,LDH1 is the most sensitiveindicator of myocardial

damageNormal value is 70-200 IU/L

Elevates in MI in 24 hours,

peaks in 48-72 hours

8/8/2019 new heart


Troponin

Most specific laboratory test to detect

MI

Has three components:C, I, T

8/8/2019 new heart


SERUM LIPIDS

Lipid profile measures the serumcholesterol, triglycerides andlipoprotein levels

Cholesterol= <200 mg/dL

Triglycerides- 40- 150 mg/dL

LDL- 130 mg/dL

HDL- 30-70- mg/dL NPO post midnight (usuall y 12 hours)

8/8/2019 new heart


ELECTROCARDIOGRAM (ECG)

A non-invasive procedure thatevaluates the electrical activityof the heart

Electrodes and wires areattached to the patient

Tell the patient that there is no riskof electrocution

Avoid muscularcontraction/movement

8/8/2019 new heart


8/8/2019 new heart


Holter Monitoring

A non-invasive test in whichthe client wears a Holtermonitor and an ECG tracing

recorded continuously over aperiod of 24 hours

8/8/2019 new heart


Holter Monitoring

Instruct the client to resume

normal activities and maintain a

diary of activities and anysymptoms that may develop

8/8/2019 new heart


8/8/2019 new heart


ECHOCARDIOGRAM

Non-invasive test that studiesthe structural and functionalchanges of the heart with the

use of ultrasound No special preparation is

needed

8/8/2019 new heart


8/8/2019 new heart


Stress Test

A non-invasive test that studiesthe heart during activity anddetects and evaluates CAD

Treadmill testing is the mostcommonly used stress test

8/8/2019 new heart


Stress Test

Pre-test: consent may berequired, adequate rest, eat alight meal or fast for 4 hours

and avoid smoking, alcoholand caffeine

8/8/2019 new heart


Post-test: instruct client to notify the

physician if any chest pain, dizzinessor shortness of breath

Instruct client to avoid taking a hot

shower for 10-12 hours after the test

8/8/2019 new heart


CARDIAC catheterization

Insertion of a catheter into theheart and surrounding vessels

Determines the structure and

performance of the heart valvesand surrounding vessels

Used to diagnose CAD, assesscoronary artery patency anddetermine extent of

atherosclerosis

8/8/2019 new heart


Intra-test: inf orm patient o f a f l uttery feel ing as the catheter

passes thr ough the heart ;- inf orm the patient that a

feel ing o f w armth and metall ic

taste may occur w hen dye isadministered

8/8/2019 new heart


Post-test: Monitor VS and cardiac rhythm

Monitor peripheral pulses, color andwarmth and sensation of the extremitydistal to insertion site

Maintain sandbag to the insertion site if required to maintain pressure

Monitor for bleeding and hematomaformation

8/8/2019 new heart


Maintain strict bed rest for 6-12 hours

Cl ient may turn fr om side t o side but bed

shoul d not be el evated more than 30

degrees and l egs al w ays straight

Encourage fluid intake to flush out the dye

Immobilize the arm if the antecubital vein isused

Monitor for dye allergy

8/8/2019 new heart


CARDIAC IMPLEMENTATION

1. Assess the cardio-pulmonary status

VS, BP, Cardiac assessment

2. Enhance cardiac output

Establish IV line to administer

fluids

8/8/2019 new heart



3. Promote gas exchange

Administer O2

Position client in SEMI -F ow l ers

Encourage coughing and deep

breathing exercises

8/8/2019 new heart



4. Increase client activity tolerance

Balance rest and activity periods

Assist in daily activities

Provide strict bed rest if indicated

Soft foods Assistance in self-care

8/8/2019 new heart



5. Promote client comfort

Assess the clients description of

pain and chest discomfort Administer medication as prescribed

Morphine for MI

Nitroglycerine for AnginaDiuretics to relieve congestion (CHF)

8/8/2019 new heart



6. Promote adequate sleep

7. Prevent infection

Monitor skin integrity of lowerextremities

Assess skin site for edema, rednessand warmth

Monitor for fever

Change position frequently

8/8/2019 new heart



8. Minimize patient anxiety

Encourage verbalization of feelings, fears and concerns

Answer client questions.

Provide information aboutprocedures and medications

8/8/2019 new heart


CARDIAC DISEASES

Coronary Artery Disease

Myocardial Infarction

Congestive Heart Failure

Infective Endocarditis

Cardiac TamponadeCardiogenic Shock

8/8/2019 new heart


VASCULAR DISEASES

Hypertension

Buergers disease

Aneurysm

Varicose veinsDeep vein thrombosis

8/8/2019 new heart


CORONARY ARTERY DSE

results from the focal narrowingof the large and medium-sized

coronary arteries due to

deposition of ather omat ous

pl aque in the vessel w all

8/8/2019 new heart


CAD: Pathophysiology

Fatty streak formation in the vascular intima

Atheroma

narrowing of the arterial lumen

reduced coronary blood flow

myocardial ischemia

8/8/2019 new heart


Angina Pectoris

Chest pain resulting from

coronary atherosclerosis or

myocardial ischemia

8/8/2019 new heart


Angina Pectoris: Clinical Syndromes

THREE COMMON TYPES OF ANGINA1. STABLE ANGINA

The typical angina that occurs

during exertion, relieved byrest and drugs and the severity d oes not change

8/8/2019 new heart


2. Unstable angina

Occurs unpredictably duringexertion and emotion, severity increases w ith time and pain

may not be relieved by rest anddrug

8/8/2019 new heart


3. Variant angina

Prinzmetal angina, results fromcoronary artery VASOSPASMS,may occur at rest

8/8/2019 new heart


ASSESSMENT FINDINGS

1. Chest pain The most characteristic symptom

PAIN is described as mild to

severe retrosternal pain,squeezing, tightness or burningsensation

Radiates t o the jaw and left arm

8/8/2019 new heart


Angina Pectoris

Precipitated by E xercise, E ating heavy

meals, E motions like excitement and

anxiety and E xtremes of temperature

Relieved by REST and

Nitroglycerin

8/8/2019 new heart


2. Diaphoresis

3. Nausea and vomiting

4. Cold clammy skin

5. Sense of apprehension and

doom 6. Dizziness and syncope

8/8/2019 new heart


LABORATORY FINDINGS

1. ECG may show normal tracing if

patient is pain-free.- Ischemic changes may show ST

depression and T wave inversion

8/8/2019 new heart


8/8/2019 new heart


2. Cardiac catheterization

Provides the MOST DEFINITIVEsource of diagnosis by showing thepresence of the atheroscleroticlesions

8/8/2019 new heart


NURSING MANAGEMENT

1. Administer prescribed medications

N itrates- t o di l ate the venous vessel sdecreasing venous return and t o someextent di l ate the c or onary arteries

Aspirin- t o prevent thr ombus f ormati on Beta-blockers- t o reduce BP and H R

C al cium-channel blockers- t o di l ate

c or onary artery and reduce vasospasm

8/8/2019 new heart


2. Teach the patient management of anginalattacks

Advise patient to stop all activities Put one nitroglycerin tablet under the tongue

If unrelieved after THREE tablets seek medicalattention

3. Obtain a 12-lead ECG

8/8/2019 new heart


4. Promote myocardial perfusion

Instruct patient to maintain bed rest Administer O2 @ 3 lpm

Advise to av oid val sal va maneuvers

Provide laxatives or high fiber diet tolessen constipation

Encourage to avoid increased physical

activities

8/8/2019 new heart


5. Assist in possible treatment modalities

PTCA- percutaneous transluminal coronaryangioplasty

To compress the plaque against thevessel wall, increasing the arterial lumen

CABG- coronary artery bypass graft

To improve the blood flow to themyocardial tissue

8/8/2019 new heart


8/8/2019 new heart


6. Provide information to familymembers to minimize anxietyand promote family cooperation

7. Assist client to identify riskfactors that can be modified

8. Refer patient to properagencies

8/8/2019 new heart


Myocardial infarction

Death of myocardial tissue

in regions of the heart

with abrupt interrupti on

of coronary blood supply

8/8/2019 new heart


8/8/2019 new heart


ETIOLOGY and Risk factors

1. CAD 2. Coronary vasospasm

3. Coronary artery occlusion by

embolus and thrombus 4. Conditions that decrease

perfusion- hemorrhage, shock

8/8/2019 new heart


PATHOPHYSIOLOGY

Interrupted coronary blood flowmyocardial ischemia anaerobicmyocardial metabolism for severalhoursmy ocardial death

depressed cardiac function triggers autonomic nervous systemresponse further imbalance of

myocardial O2 demand and supply

8/8/2019 new heart


ASSESSMENT findings

1. CHEST PAIN Chest pain is described as

severe, persistent, crushing

substernal discomfort Radiates to the neck, arm, jaw

and back

8/8/2019 new heart


Occurs without cause, primarily early

morning NOT relieved by rest or nitroglycerin

Lasts 30 minutes or longer

8/8/2019 new heart


2. Dyspnea

3. Diaphoresis

4. Cold clammy skin

5. N/V

6. restlessness, sense of doom

7. tachycardia or bradycardia

8. hypotension

f

8/8/2019 new heart


Laboratory findings

1. ECG- the ST segment isELEVATED, T wave inversion,presence of Q wave

2. Myocardial enzymes- el evated CK -MB , LDH and T r o ponin l evel s

8/8/2019 new heart


Nursing Interventions

8/8/2019 new heart



1. Provide Oxygen at 2 lpm, Semi-fowlers

2. Administer medications Morphine to relieve pain

Nitrates, thrombolytics, aspirin and

anticoagulants Stool softener and hypolipidemics

8/8/2019 new heart


3. Minimize patient anxiety

Provide information as to proceduresand drug therapy

Allow verbalization of feelings

Morphine can be administered

8/8/2019 new heart


4. Provide adequate rest periods Bed rest during acute stage

5. Minimize metabolic demands

Provide soft diet

Provide a low-sodium, low cholesterol

and low fat diet

8/8/2019 new heart


6. Assist in treatment modalities suchas PTCA and CABG

7. Monitor for complications of MI-especially dysrhythmias, sinceventricular tachycardia can happenin the first few hours after MI

8. Provide client teaching

8/8/2019 new heart


Medical Management

1. ANALGESIC The choice is MORP H I N E

It reduces pain and anxiety

Relaxes bronchioles to enhance

oxygenation

2 ACE i hibit

8/8/2019 new heart


2. ACE inhibitors

Prevents formation of angiotensin II

Limits the area of infarction

3. Thrombolytic therapy

Streptokinase, Alteplase

Dissolve clots in the coronary artery

allowing blood to flow

NURSING INTERVENTIONS AFTER ACUTE

8/8/2019 new heart



EPISODE

1. Maintain bed rest for the first 3 days

2. Provide passive ROM exercises

3. Progress with dangling of the feet atside of bed

4. Proceed with sitting out of bed, on the

chair for 30 minutes TID 5. Proceed with ambulation in the room

toilet hallway TID

8/8/2019 new heart



EPISODE

Cardiac rehabilitation

To extend and improve quality of life

Physical conditioning

P atients w ho are abl e t o w al k 3-4 mph are

usuall y ready t o resume sexual activities

8/8/2019 new heart


Inf ective endocarditis

Infection of the heart valves

and the endothelial surface

of the heart

Can be acute, sub-acute or

chronic

8/8/2019 new heart


Etiologic factors

1. Bacteria- Organism

depends on several factors

2. Fungi

8/8/2019 new heart


Risk factors

1. Prosthetic valves

2. Congenital malformation

3. Cardiomyopathy 4. IV drug users

5

. Valvular dysfunctions

8/8/2019 new heart


Inf ective endocarditis

PathophysiologyDirect invasion of microbes

microbes adhere to damaged valve surface andproliferate

damage attracts platelets causing clot formation

erosion of valvular leaflets and the clot and vegetation

can embolize

8/8/2019 new heart


Assessment findings

1. Intermittent high grade fever

2. anorexia, weight loss

3. cough, back pain and joint pain

4. splinter hemorrhages under nails

5 Oslers nodes painful nodules

8/8/2019 new heart


5. Oslers nodes- painful nodules

on fingerpads6. Roths spots- pale

hemorrhages in the retina

7. Heart murmurs

8. Heart failure= usually acute

heart failure

8/8/2019 new heart


Prevention

Antibiotic prophylaxis if patient is

undergoing procedures like dentalextractions, bronchoscopy,

surgery, etc.

8/8/2019 new heart


Prevention

Any invasive procedure that is

associated with transientbacteremia may cause the

microrganism to lodge in thedamaged, irregular valves

8/8/2019 new heart


LABORATORY EXAM

Blood Cultures to determine the

exact organism

Usually, 3 culture specimens are

obtained and antibioticsensitivity done

Nursing management

8/8/2019 new heart


Nursing management

1. Regular monitoring of

temperature, heart sounds

2. Manage infection

3. Long-term antibiotic therapy isgiven to ensure eradication of bacteria

8/8/2019 new heart


Medical management

1. P harmac otherapy

IV antibiotic for 2-6 weeks

Antifungal agents are given amphotericin B

Medical management

2. Surgery

Valvular replacement

C ti H t F il (CHF)

8/8/2019 new heart


Congestive Heart Failure (CHF)

A syndrome of congestion of both pulmonary and systemic

circulation caused byinadequate cardiac functionand inadequate cardiac

output to meet the metabolicdemands of tissues

8/8/2019 new heart


Inability of the heart topump sufficiently

The heart is unable tomaintain adequatecirculation to meet the

metabolic needs of the body

8/8/2019 new heart


This can happen acutely orchronically

Acute in Myocardial infarction

Chronic cardiomyopathies

8/8/2019 new heart


Classified according to themajor ventricular

dysfunction:1. Left Ventricular failure

2. Right ventricular failure

8/8/2019 new heart


8/8/2019 new heart


Etiology of CHF1. CAD

2. Valvular heart diseases

3. Hypertension4. MI

5. Cardiomyopathy

6. Lung diseases

7. Post-partum

8. Pericarditis and cardiac tamponade

LABORATORY FINDINGS

8/8/2019 new heart


LABORATORY FINDINGS

1. CXR may reveal cardiomegaly 2. ECG may identify Cardiac

hypertrophy

3. Echocardiogram may show

hypokinetic heart

4. ABG and Pulse oximetry mayshow decreased O2 saturation

NURSING INTERVENTIONS

8/8/2019 new heart



1. Assess patient's cardio-pulmonary status

2. Weigh patient daily to

monitor fluid retention

8/8/2019 new heart


Administer medications- usuallycardiac glycosides are given- DIGOXIN

or DIGITOXIN, Diuretics, vasodilators

and hypolipidemics are prescribed

CHF

8/8/2019 new heart


CardiotonicsCardiotonics

Positive Positive inotropic inotropic agents agents

To increase cardiac To increase cardiac

contractilitycontractility

DiureticsDiuretics To decrease the To decrease the

intravascular volume in theintravascular volume in thecirculationcirculation

Low Sodium DietLow Sodium Diet To minimize water retention To minimize water retention

HypolipidemicsHypolipidemics To decrease the lipid levels To decrease the lipid levels

of high risk patientsof high risk patients

8/8/2019 new heart


NURSING INTERVENTIONSDigoxin Health teaching

Oral tablet usually once a day

Increases force of contraction

DECREASES heart rate

Assess: Apical pulse, ECG,hypokalemia

8/8/2019 new heart


Digoxin Health teaching Withhold the drug if apical pulse is

less than 60

Note for early signs of toxicity:

NAVDA

Provide potassium supplements

4. Provide a LOW sodium diet.i i fl id i k

8/8/2019 new heart


Limit fluid intake as necessary

5. Provide adequate rest periodsto prevent fatigue

6. Position on semi-fowlers to

fowlers for adequate chestexpansion

7. Prevent complications of

immobility

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK

Heart fails to pumpadequately resulting to a

decreased cardiac outputand decreased tissueperfusion

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK

ETIOLOGY

1. Massive MI

2. Severe CHF

3. Cardiomyopathy

4. Cardiac trauma

5. Cardiac tamponade

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK

ASSESSMENT FINDINGS 1. HY POT E N SI ON

2. Ol iguria ( l ess than 30 ml/ hour)

3. T achycardia

4. N arr ow pul se pressure

5. weak peripheral pulses

6. cold clammy skin

7. changes in sensorium/LOC

8. pulmonary congestion

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK

LABORATORY FINDINGS

Increased CVP due to pooling of

blood in the venous system Normal is 4-10 cmH2O

Metabolic acidosis

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK


1. Place patient in a modified

Trendelenburg (shock ) position

2. Administer IVF, vasopressors and

inotropics such as DOPAMINE andDOBUTAMINE

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK


3. Administer O2

4. Morphine is administered to

decreased pulmonary congestion

and to relieve pain, relieve anxiety

CARDIOGENIC SHOCK

8/8/2019 new heart


CARDIOGENIC SHOCK

5. Assist in intubation, mechanical

ventilation, PTCA, CABG, insertion of

Swan-Ganz cath and IABP

6. Monitor urinary output, BP and

pulses

7. cautiously administer diuretics andnitrates

HYPERTENSION

8/8/2019 new heart


HYPERTENSION

A systolic BP greater than 140

mmHg and a diastolic

pressure greater than 90mmHg over a sustained

period, based on two or more

BP measurements.

HYPERTENSION

8/8/2019 new heart


HYPERTENSION

Types of Hypertension1. Primary or ESSENTIAL

Most common type

2. Secondary

Due to other conditions like

Pheochromocytoma, renovascular

hypertension, Cushings, Conns ,

SIADH

HYPERTENSION

8/8/2019 new heart


HYPERTENSION

PATHOPHYSIOLOGY

Mul ti-fact orial eti ology

BP= CO (SV X HR) x TPR Any increase in the above parameters w i ll

increase BP

8/8/2019 new heart


Any increase in the above parameters will

increase BP

8/8/2019 new heart


increase BP

1. Increased sympathetic activity 2. Increased absorption of Sodium, and

water in the kidney

3. Increased activity of the RAA

4. Increased vasoconstriction of the

peripheral vessels 5. Insulin resistance

ASSESSMENT FINDINGS

8/8/2019 new heart


ASSESSMENT FINDINGS

1. Headache 2. Visual changes

3. chest pain

4. dizziness

5. N/V

DIAGNOSTIC STUDIES

8/8/2019 new heart


1. Health history and PE

2. Routine laboratory- urinalysis,

ECG, lipid profile, BUN, serum

creatinine , FBS

3. Other lab- CXR, creatinine

clearance, 24-huour urine protein

MEDICAL MANAGEMENT

8/8/2019 new heart


MEDICAL MANAGEMENT

1. Lifestyle modification2. Diet therapy

3. Drug therapy

MEDICAL MANAGEMENT

D th

8/8/2019 new heart


Drug therapy

Diuretics Beta blockers

Calcium channel blockers

ACE inhibitors

A2 Receptor blockers

Vasodilators

ANEURYSM

8/8/2019 new heart


ANEURYSM

Dilation involving an artery

formed at a weak point in

the vessel wall

ANEURYSM

8/8/2019 new heart


ANEURYSM

RISK FACTORS

1. Atherosclerosis

2. Infection= syphilis3. Connective tissue disorder

4. Genetic disorder= MarfansSyndrome

ANEURYSM

8/8/2019 new heart


ANEURYSM

PATHOPHYSIOLOGY

Damage to the intima and media

weakness outpouching of vessel

wall

Dissecting aneurysm

tear in theintima and media with dissection of

blood through the layers

ANEURYSM

8/8/2019 new heart


ANEURYSM

ASSESSMENT

1. Asymptomatic

2. Pulsatile sensation on the

abdomen

3. Palpable bruit

ANEURYSM

8/8/2019 new heart


ANEURYSM

LABORATORY: CT scan

Ultrasound

X-ray

Medical Management:

Anti-hypertensive

ANEURYSM

8/8/2019 new heart


ANEURYSM

Nursing Management:

Administer medications

Emphasize the need to avoidincreased abdominal pressure

No deep abdominal palpation

Remind patient the need for serialultrasound to detect diameter

changes

PERIPHERAL ARTERIAL OCCLUSIVE

DISEASE

8/8/2019 new heart


DISEASE

Refers to arterial insufficiency of

the extremities usually secondary

to peripheral atherosclerosis.

Usually found in males age 50 and

above

The legs are most often affected

8/8/2019 new heart


ASSESSMENT FINDINGS

1. INTERMITTENT CLAUDICATION-

8/8/2019 new heart


1. I NT E RMI TT E NT C LAU DI C AT I ON the hallmark of PAOD

This is PAIN described as aching,cramping or fatiguing discomfortconsistently reproduced with thesame degree of exercise oractivity

This pain is RELIEVED by REST

This commonly affects the musclegroup below the arterial occlusion

8/8/2019 new heart


2. Progressive pain on theextremity as the diseaseadvances

3. Sensation of cold and

numbness of the extremities

ARTERIOSCLEROSIS OF THE EXTREMITIES

8/8/2019 new heart


4. Skin is pale when elevated andi d dd h l d

8/8/2019 new heart


cyanotic and ruddy when placed

on a dependent position

5. Muscle atrophy, leg ulcerationand gangrene

8/8/2019 new heart



8/8/2019 new heart


1. Maintain Circulation to the extremity

2. 2. Monitor and manage complications

BUERGERS DISEASE

8/8/2019 new heart


T hr omboangiitis obl iterans

A disease characterized by

recurring inflammation of themedium and small arteries and

veins of the lower extremities

Thromboangiitis obliterans

8/8/2019 new heart


T hr omboangiitis obl iterans

Occurs in MEN ages 20-35

RISK FACTOR: SMOKING!

8/8/2019 new heart


PATHOPHYSIOLOGY

Cause is UNKNOWN

Probably an Autoimmune disease Inflammation of the arteries and

veins thrombus formation

occlusion of the vessels

ASSESSMENT FINDINGS

8/8/2019 new heart


1. Leg PAIN

Foot cramps in the arch

(I N ST E P C LAU DI C AT I ON ) after exercise

Relieved by rest Aggravated by smoking, emotional

disturbance and cold chilling

2. Digital rest pain not changed by activityor rest

8/8/2019 new heart


3. Intense RUBOR (reddish-blue

discoloration), progresses to

CYANOSIS as disease advances

4. Paresthesias

RAYNAUDS DISEASE

8/8/2019 new heart


A form of intermittent arteriolar

VASOCONSTRICTION that results in

coldness, pain and pallor of the

fingertips or toes

8/8/2019 new heart


Cause : UNKNOWN

Most commonly affects WOMEN, 16-

40 years old

8/8/2019 new heart


ASSESSMENT FINDINGS

1. Raynauds phenomenon

A local ized episode o f vasoc onstricti on o f the small arteries o f the hands and feet

that causes c olor and temperature changes

8/8/2019 new heart


W -B-R is the acr onym f or the c olor change

Pallor- due to vasoconstriction, then

Blue- due to pooling of Deoxygenatedblood

Red- due to exaggerated reflow or

hyperemia

8/8/2019 new heart


ASSESSMENT FINDINGS

2. Tingling sensation

3. Burning pain on the hands andfeet

8/8/2019 new heart


Medical management

Drug therapy with the use of

CALCIUM channel blockers To prevent vasospasms

8/8/2019 new heart


Nursing Interventions 1. instruct patient to avoid situations that may

be stressful

2. instruct to avoid exposure to cold andremain indoors when the climate is cold

3. instruct to avoid all kinds of nicotine

4. instruct about safety. Careful handling of sharp objects

VARICOSE VEINS

8/8/2019 new heart


THESE are dilated veins

usually in the lower

extremities

8/8/2019 new heart


VARICOSE VEINS

8/8/2019 new heart


Predisposing Factors Pregnancy

Prolonged standing or sitting Incompetent venous valves

8/8/2019 new heart


Pathophysiology

Factors venous stasis

increased hydrostaticpressure edema

8/8/2019 new heart


Assessment findings

Tortuous superficial veins

on the legs

Leg pain and Heaviness

Dependent edema

8/8/2019 new heart


Medical management

Pharmacological therapy

Anti-embolic stockings

8/8/2019 new heart


Nursing management

1 Advise patient to elevate

8/8/2019 new heart


1. Advise patient to elevate

the legs with pillow toincrease venous return

2. Caution patient to avoidprolonged standing orsitting

Nursing management

8/8/2019 new heart


3. Provide high-fiber foodsto prevent constipation

4. Teach simple exercise to

promote venous return

5. Caution patient to avoid

constrictive clothing

8/8/2019 new heart


Nursing management

6. Apply anti-embolic

stockings as directed7. Av oid massage on the

affected area

DVT- Deep Vein Thrombosis

8/8/2019 new heart


Inflammation of the deep

veins of the lower

extremities and the pelvicveins

The inflammation results toformation of blood clots in

the area

Predisposing factors

P l d i bilit

8/8/2019 new heart


Prolonged immobility

Varicosities

Traumatic procedures

Increased age

Malignancy

Estrogen therapy

Smoking

Complication

8/8/2019 new heart


Complication

PULMONARY

thromboembolism

8/8/2019 new heart


Assessment findings

Leg tenderness

Leg pain and edema

Positive H OM AN s SIGN

8/8/2019 new heart


HOMANs SIGN The foot is FLEXED upward

(dorsiflexed) , there is a sharp painfelt in the calf of the leg indicative

of venous inflammation

8/8/2019 new heart


Medical management

Antiplatelets- aspirin

Anticoagulants

Vein stripping and grafting

Anti-embolic stockings

8/8/2019 new heart


Nursing management

1. Provide measures to avoid

prolonged immobility Repositioning Q2

Provide passive ROM Early ambulation

8/8/2019 new heart


2. Provide skin care to preventthe complication of legulcers

3. Provide anti-embolic

stockings

8/8/2019 new heart


4. Administer anticoagulants asprescribed

5. Monitor for signs of pulmonary embolism sudden

respiratory distress

8/8/2019 new heart


Thank

You!

new heart

Documents

Transcript of new heart