5. OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Electrocardiography [ECG] – graphic record of the
electrical activity of the heart
nionoveno@yc Cardiovascular Diseases 5
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
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. 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
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. 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
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
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. ASSESSMENT OF PAIN
P rovoking/precipitating
Q uality
R adiation
S everity
T iming
nionoveno@yc Cardiovascular Diseases 33
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. 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. 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
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. 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. 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. 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
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. 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. 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. 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
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. 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. 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. 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. 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
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
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. 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
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. 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. 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
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
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. 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. 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
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. 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. 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. 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
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. 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
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. 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. 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. 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. 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. 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. 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. 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