Nursing Care of Patients with Occlusive Cardiovascular Disorders Chapter 24 PDF

Nursing Care of Patients with Occlusive Cardiovascular Disorders Williams & Hopper (2023). Understanding Medical- Surgical Nursing 7th edition Chapter 24 02/08/2025 Nursing care of Patients with...

Nursing Care of Patients with Occlusive Cardiovascular Disorders Williams & Hopper (2023). Understanding Medical- Surgical Nursing 7th edition Chapter 24 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 1 ular Disorders Objectives Pathophysiology, health data collection, medications, evidence-based therapy, health teaching for: Arterio/atherosclerosis Acute coronary syndrome Unstable angina Myocardial infarction Peripheral arterial disease Varicose veins/venous insufficiency Aneurysms 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 2 ular Disorders Arterio/atherosclerosis Arteriosclerosis: thickening, rigidity of arterial walls that occurs with aging Atherosclerosis: buildup of plaque within the artery walls Coronary artery disease (CAD) atherosclerosis of coronary arteries Ch 24, p 378 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 3 ular Disorders Atherosclerosis/CAD Risk Factors Modifiable Non-Modifiable Diabetes mellitus Age Hypertension High cholesterol Ethnicity High LDL High homocysteine Gender Excessive alcohol Genetics Stress Obesity Sedentary lifestyle Tobacco use Exposure to 2nd, 3rd hand smoke Ch 24, table 24.1, p 378 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 4 ular Disorders Atherosclerosis/CAD Data Collection Serum lipid levels Total cholesterol Low density lipoproteins Cardiac angiography Signs and symptoms Angina Dyspnea on exertion Ch 24, pp 378, 379 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 5 ular Disorders Atherosclerosis/CAD-Evidence Based Therapeutic Measures Lifestyle modification Diet Smoking cessation Exercise Medications May take 4-6 weeks to have any noticeable effect Injectable monoclonal antibodies for chromosomal deficiency Ch 24, p 379 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 6 ular Disorders Atherosclerosis/CAD-Medications Statins (HMGOA reductase inhibitors) First line agent to lower cholesterol Decreases cholesterol production by the liver Monitor liver function tests Monitor for rhabdomyolysis Teach: take in evening; report unexplained muscle pain Others: Niacin Fibrates Cholesterol absorption inhibitors Ch 24, table 24.3, p 379 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 7 ular Disorders Health Teaching Prevention Tobacco use and exposure Second-hand, third hand smoke Resources: American Cancer Society Control cholesterol and blood pressure Monitor blood pressure Cardiac rehab Ch 24, p 379 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 8 ular Disorders Angina Chest pain caused by hypoxia to heart muscle Squeezing, pressure, burning or heaviness May radiate to neck, arms, shoulders, jaw or back May also occur without chest pain (just radiation) Women may have nausea, fatigue, less severe symptoms Other symptoms: Dyspnea Pallor Diaphoresis Sense of impending doom Heaviness in the arm Ch 24, p 380 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 9 ular Disorders Nitroglycerin Sublingual, buccal sprays, intravenous infusion for acute angina If pain is unrelieved or worsening after five minutes, take second NTG and call 911 If pain is not totally relieved but not worsening, take one tablet every five minutes for three doses. Call 911 if pain still not relieved. Nitroglycerine patches, pastes For prevention of anginal attacks Remove for 10-12 hours a day Wear gloves when applying; dispose of properly Ch 24, p 381 02/08/2025 Nitrates are contraindicated Nursing care of Patients withwith Occlusive erectile Cardiovasc dysfunction 10 ular Disorders Nitroglycerin teaching Keep in original brown bottle Protect from light, heat, moisture Replace every six months to maintain potency Use before activities known to cause chest pain May cause lightheadedness, hypotension, headache Sit or lie down if possible before taking Monitor blood pressure before and after administration Ch 24, tables 24.4, 24.5, p 381 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 11 ular Disorders Angina – Other medications Antiplatelets (aspirin, clopidogrel, tricaglor) Beta blockers (for exertional angina) Consult MD if BP below 90 systolic or pulse below 60 before administering Calcium channel blockers Hold for systolic BP below 90 or pulse below 60 Antianginal agent (ranolazine) May not be effective in women Statins Ch 24, table 24.4, p 381 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 12 ular Disorders Acute coronary syndrome Unstable angina Any change from previously stable anginal episodes Myocardial infarction Ischemia – injury to heart muscle Silent ischemia- occurs without pain. More common in women, geriatrics Infarction – death of heart muscle Ch 24, p 384 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 13 ular Disorders Unstable Angina Any Change in Previous Pattern of Anginal Pain Takes Longer To Resolve Occurs With Less Activity Occurs More Often Increased Severity Occurs At Rest Requires More Nitroglycerin to Relieve Also Referred to as Pre-Infarction Angina 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 14 ular Disorders Myocardial Infarction (Heart Attack) Sudden Partial or Complete Blockage Leads to Death of Myocardial Tissue Two Types: ST-Elevation MI (STEMI) Non-ST Elevation MI (non-STEMI) Bing Videos 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 15 ular Disorders  Myocardial Infarction (MI) (cont’d) 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 16 ular Disorders  Signs and Symptoms Crushing, Viselike Pain Radiates to Arm/Shoulder/Neck/Jaw Shortness of Breath Restlessness Dizziness, Fainting Nausea Sweating Ch 24, table 24.6, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 17 ular Disorders  Myocardial Infarction-Diagnosis Consider patient history Serial ECG Cardiac troponin I or T CK-MB Potassium, magnesium Vital signs, O2 saturation Ch 24, table 24.6, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 18 ular Disorders Myocardial Infarction-Therapeutic Interventions Antiplatelets Oxygen Nitrates Anticoagulants Beta blockers Statins 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 19 ular Disorders Myocardial Infarction- Revascularization Therapy Percutaneous coronary intervention (PCI) with stents Thrombolytics Ch 24, p 387 Nursing care of Patients with Occlusive Cardiovascular 02/08/2025 Disorders Myocardial Infarction-Additional Interventions Daily weights Bedrest with bedside commode or bathroom privileges Low sodium diet, no caffeine Cardiac rehabilitation Ch 24, table 24.6, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 21 ular Disorders Myocardial Infarction-Complications Arrhythmias Heart failure Cardiogenic shock Valvular insufficiency Ch 24, table 24.6, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 22 ular Disorders Women and Heart Disease Leading cause of death Myocardial infarctions (compared to men) Older age Higher mortality rate More complications Possibly due to delay in seeking treatment Ch 24, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 23 ular Disorders Women and Heart Disease-Atypical Symptoms Extreme fatigue Epigastric pain Lower jaw pain Nausea, vomiting, dyspnea Prodromal symptoms: Unusual fatigue Shortness of breath Sleep disturbances Ch 24, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 24 ular Disorders Gerontologic Issues May not have chest pain May experience: Shortness of breath Syncope Falls Restlessness Fewer complications compared to younger infarction survivors Ch 24, Gerontologic Issues, p 386 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 25 ular Disorders Client Education Disease Diet Medications Lifestyle modifications Myocardial infarctions affect all aspects of client’s life May be anxious about resuming sexual activity Can take nitroglycerin before intercourse to prevent chest pain Usually safe to resume after 1-2 months or when able to climb two flights of stairs without chest pain Ch 24, p 390 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 26 ular Disorders Cardiac Rehab Begins once acute symptoms subside Gradual increase in activity according to protocols (phase 1) Outpatient rehab continues for 4-6 weeks (phase 2) Focus on returning to previous level of function Clients encouraged to continue lifestyle modifications, exercise and weight loss (phase 3) Ch 24, p 390 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 27 ular Disorders Peripheral Arterial Disease Chronic, progressive narrowing of arterial lumen Usually caused by atherosclerosis Ischemia develops Ch 24, p 394 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 28 ular Disorders Peripheral Arterial Disease – Signs and Symptoms Pain: intermittent claudication progressing to rest pain Intermittent claudication – cramping pain in calves during activity, relieved by rest Pallor when elevated above heart level Dependent rubor (res-purple or cyanotic skin in dependent position) Pulses diminished, progressing to pulselessness Paresthesia: altered sensations (numbness, tingling, burning) Poikilothermy: cold extremities Ch 24, p 394 02/08/2025 Paralysis (late finding) Nursing care of Patients with Occlusive Cardiovasc 29 ular Disorders Peripheral Arterial Disease- Additional Symptoms Taut, shiny skin Thick, brittle nails Hair loss on feet, ankles, calves Loss of muscle mass in legs Ch 24, p 394 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 30 ular Disorders Peripheral Arterial Disease- Diagnostic Tests Ankle-brachial index test Pressures in thigh and calf are normally higher than in arm Lower pressure in legs indicates peripheral arterial disease Arterial duplex ultrasound Exercise stress test Ch 24, p 394 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 31 ular Disorders Peripheral Arterial Disease- Therapeutic Measures Lifestyle modifications Smoking cessation Exercise Statins Cilostazol Invasive procedures Angioplasty, stenting Arthrectomy Femoral aortic bypass graft Ch 24, p 394 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 32 ular Disorders Peripheral Arterial Disease-Nursing Interventions Monitor quality of peripheral pulses, capillary refill time, color, presence of edema Maintain extremities lower than the heart Avoid bending knees, pillows under knees, prolonged standing or crossing the legs Ch 24, p 395 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 33 ular Disorders Raynaud’s Phenomenon Excessive vasospasm in response to stress or cold Occurs primarily in fingers Signs and symptoms: pain, pallor or cyanosis with vasospasms; tingling, burning, reddening of digits as circulation returns Episodes last about 15 minutes Interventions Keep hands warm (wear gloves when outside in cool/cold weather or when preparing cold foods) Avoid vasoconstricting substances: caffeine, nicotine, decongestants, alcohol,Ch 24, p 394 emotional stress 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 34 ular Disorders Raynaud’s Phenomenon Medications: if symptoms unrelieved Nitrates Calcium channel blockers Ch 24, p 394 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 35 ular Disorders Aneurysms Dilation of a weakened area in an artery wall Risk factors: Atherosclerosis Hypertension Smoking Trauma Congenital abnormalities Heredity Ch 24, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 36 ular Disorders Abdominal Aortic Aneurysm Incidence increases with age Men over 50 years have highest risk of death from bleeding or rupture Elective repair before rupture or dissection improves mortality Dissection: separation of layers of artery wall Blood enters between layers, expanding aneurysm and increasing risk of rupture Ch 24, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 37 ular Disorders Abdominal Aortic Aneurysm-Signs and Symptoms None Back, flank, or abdominal pain Nausea, feeling of fullness (may be relieved by position changes) Pulsating abdominal mass Bruit Thrill Do not palpate Ch 24, table 24.8, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 38 ular Disorders Abdominal Aortic Aneurysm- Diagnostic Tests Ultrasound CT scan Aortography Ch 24, Table 24.8, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 39 ular Disorders Abdominal Aortic Aneurysm- Therapeutic Measures Monitor aneurysm size Maintain normal blood pressure Beta blockers Surgical repair or graft Smoking cessation No heavy lifting Ch 24, table 24.8, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 40 ular Disorders Abdominal Aortic Aneurysm - Complications Rupture Surgical emergency Hemorrhage Shock Ch 24, table 24.8, p 396 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 41 ular Disorders Abdominal Aortic Aneurysm-Nursing Process Following Aneurysm Repair Ineffective tissue perfusion Monitor circulation, movement, and sensation in lower extremities every 1-4 hours Rationale: detect reduced blood flow, decrease risk of ischemia Measure abdominal girth every shift Rationale: increasing abdominal girth may indicate bleeding into abdomen Monitor CBC Rationale: detect slow bleed or hematoma formation Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 42 ular Disorders Varicose Veins Dilated, twisted, elongated veins Usually due to structural defect in veins, incompetent vein valves Etiologies: Obesity Prolonged standing Pregnancy Anything that increases pressure in lower extremities Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 43 ular Disorders Varicose Veins – Signs and Symptoms Superficial: telangiectasis (spider veins) Moderately severe: Dull pain, cramping Heaviness in legs (especially after prolonged standing) May be relieved by ambulation or elevation of extremities Edema Ulcerations Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 44 ular Disorders Vericose Veins-Therapeutic Interventions Compression stockings Elevation Exercise Measures to remove or decrease appearance of varicosities Injection sclerotherapy Laser or light therapy Laser ablation Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 45 ular Disorders Venous Insufficiency Chronic pooling of blood in lower extremities Signs and symptoms: Edema Brownish discoloration of lower extremities Venous stasis ulcers Dysfunctional valves impair venous return, increases venous pressure Ulcerations common at medial malleolus Difficult to cure and affect quality of life Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 46 ular Disorders Venous Insufficiency-Therapeutic Measures Compression Elevation Avoid prolonged standing or sitting Elevate foot of bed Exercise Do not cross legs Do not wear constricting clothing Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 47 ular Disorders Stasis Ulcers-Therapeutic Interventions Topical antibiotics Zinc oxide Compression dressings (Una boots) Skin grafts Ch 24, p 397 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 48 ular Disorders Vascular Surgery: Post-Operative Care Monitor neurovascular status (circulation, motion, sensitivity) every 1-4 hours Rationale: detect compromised circulation that can lead to ischemia, necrosis Avoid constriction of affected extremity (tight dressings, tape) Rationale: prevents further reduction in blood flow to extremity Assist with ambulation as ordered Rationale: decrease complications of immobility, increase blood flow to lower Ch extremity 24, p 400 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 49 ular Disorders Neurovascular vs Neurological Checks Neurovascular Neurological Neuro Level of consciousness Movement Glasgow coma score Sensation numbness/tingling Orientation Vascular Ability to follow Pulses commands Capillary refill Pupil response Color Ch 24, p 400 Temperature 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 50 ular Disorders Review Artherosclerosis Coronary artery disease Angina Myocardial infarction Peripheral arterial disease Aneurysms Varicose veins Venous insufficiency 02/08/2025 Nursing care of Patients with Occlusive Cardiovasc 51 ular Disorders