Care of Client with Circulatory Disorders PDF

2/11/25 1 Care of Client With Circulatory Disorders Ms. Vernon RN MSN 2 Videos v How varicose veins form q https://youtu.be/Ce2TjGY-r1o v Treatment for Varicose Veins | Nucleus Health https://youtu.be/89xuyftWmyU – 3 Video...

2/11/25 1 Care of Client With Circulatory Disorders Ms. Vernon RN MSN 2 Videos v How varicose veins form q https://youtu.be/Ce2TjGY-r1o v Treatment for Varicose Veins | Nucleus Health https://youtu.be/89xuyftWmyU – 3 Video Links v Difference Between Raynaud’s Disease and Buerger’s Disease §https://youtu.be/w1xYv1Z_2Ek v Buerger's disease - Medical Meaning and Pronunciation § https://youtu.be/KH2VqA1qVw8 v Raynaud's Disease - an Osmosis Preview § https://youtu.be/RemDgeFeBt4 v Raynaud’s Phenomenon : What You Should Know | Johns Hopkins Medicine § https://youtu.be/Jv0kEFCYF5M – 4 Function of the Heart ØAn organ that pumps blood throughout the body via the circulatory system ØSupplies oxygen and nutrients to the tissues and remove carbon dioxide and other wastes 5 Diagnostic Tests 1 ØProteins and enzymes released into the blood by damaged cardiac cells known as cardiac biomarkers. ØCardiac Biomarkers help identify whether a patient is having or has had a recent Myocardial Infarction (MI) q Cardiac Biomarkers v Creatinine Kinase v Lactic Dehydrogenase 2 6 1  2/11/25 v Creatinine Kinase v Lactic Dehydrogenase vTroponins I and Troponin T vMyoglobin 2 Cardiac Enzymes 6 Diagnostic Tests Electrocardiogram (ECG/EKG) 7 Diagnostic Tests Electrocardiogram (ECG or EKG) Ø Electrocardiogram is a test that measures the graphic recording of electrical activity of the heartbeat ØEach beat an electrical impulse (or “wave”) travels through the heart 8 Diagnostic Tests Stress Test 9 Diagnostic Tests Stress Tests Ø Exercise Electrocardiography known as a stress test measures the heart’s electrical activity as the patient exercise on a treadmill or stationary bicycle. ØBlood oxygen level, blood pressure and heart rate are also monitored ØDuring the test, patient will exercise for 10 to 15 minutes. Ø 10 Diagnostic Tests Echocardiogram (ECHO) 2  2/11/25 10 Echocardiogram (ECHO) ØEchocardiogram uses sound waves to view the heart and blood flow ØProvides a graphic outline of the heart ØAn ECHO test, uses high-frequency sound waves (ultrasound) from an hand held-wand. ØThe hand-held wand provides pictures of the heart’s valves and chambers evaluating the pumping action of the heart 11 Diagnostic Tests Nuclear Scans Ø Nuclear Scans uses radioactive substances to see structures and function in the body ØUse to detect Myocardial Damage ØSpecial camera detects radioactivity ØBefore the test small amount of radioactive material is (injected or oral inhalation) administered 12 Diagnostic Tests Invasive Studies (Cardiac Catheterization) Ø Cardiac Catheterization is a long thin tube known as a catheter inserted in an artery or vein in the groin, neck or arm threaded through the blood vessel to the heart ØAngiocardiogram - xray study of the heart and major vessel ØArteriogram – xray study of the artery ØDone by injecting Contrast or Dye through the catheter into a blood vessel or chamber of the heart ØProvides structural abnormalities 13 Cardiac Catheterization Nursing Considerations Ø Allergy to Shellfish or Iodine – anaphylactic reaction Ø NPO prior to procedure ØInvasive Procedure – consent Ø Carry out other routine pre-op procedures Ø Maintain bedrest until fully awake ØLie flat up to 8hrs – prevent swelling bruising, bleeding at femoral site, if the catheter was inserted at the groin 3 14  2/11/25 ØLie flat up to 8hrs – prevent swelling bruising, bleeding at femoral site, if the catheter was inserted at the groin ØPressure may be applied to the incision to prevent bleeding and promote healing ØAvoid flexing hip or leg ØCheck for hemorrhage ØMonitor vital signs ex. Pedal pulses 14 Risk of Cardiac Catheterization ØBleeding around the point of puncture Ø Abnormal heart rhythms Ø Blood Clots ØInfection ØAllergic reaction to the dye ØStroke Ø Heart attack Ø Perforation of a blood vessel 15 Diagnostic Blood Studies ØComplete Blood Count (CBC) ex. Hematocrit, Hemoglobin, WBCs, RBCs and Platelets, Serum electrolytes ex. K, Na & Mg. Ø Coagulation Studies ex. PT/INR and PTT Ø Blood Cultures - blood drawn from two separate venipuncture sites (aerobic /anaerobic) ØErythrocyte Sedimentation Rate (ESR) inflammation ØLipid Profile ex. Cholesterol < 200mg/dl; HDL 30-75mg/dl; and LDL < 130mg/dl (Screening for increased risk for Coronary Artery Disease) 16 Data Collection for Cardiac Patients Ø Establish baseline for future comparison Ø Report any changes in baseline observation Ø Complete Cardiovascular Assessment begins on admission and includes : q Complete nursing history qPotential risk factors ex. Family history of CVD, smoking, lack of exercise and poor nutrition q Performance of ADLs – SOB and Fatigue q Edema in extremities q Auscultate heart sounds 17 4  2/11/25 q Edema in extremities q Auscultate heart sounds qMonitor vital signs q 17 Signs and Symptoms of Cardiovascular Disorders Ø Change in rate quality and rhythm of pulse Ø Rise and fall of BP or central venous pressure (noted by jugular venous distention) increase or decrease in blood pressure Ø Cyanosis ØEdema (Feet and Ankles) ØWeight gain Ø Clubbing of Fingers (result from chronic low blood-oxygen levels) Ø Difficulty breathing may have a cough as a result of pulmonary edema Ø Intermittent claudication (decrease blood to both legs and feet) Ø Chest Pain. Need to squat to breathe. ØFatigue for no apparent reason 18 Normal Blood Flow to the Heart ØDeoxygenated blood enters the heart from two large veins to the right atrium. ØThe blood then flows from the right atrium through the tricuspid valve to the right ventricle Ø The blood leaves the heart through the pulmonary valve via the pulmonary artery to the lungs for deoxygenation. ØPulmonary veins carries oxygenated blood to the left atrium ØBlood flows from the left atrium through mitral valve to the left ventricle 19 Congestive Heart Failure Ø CHF is a chronic progressive disorder affecting the muscles of the heart to pump effectively Common Causes Ø Coronary Artery Disease (CAD) Ø Hypertension Ø Longstanding alcohol abuse Ø Disorders of the heart valves Ø Idiopathic (unknown origin) such as recovery from myocarditis 20 Left Sided Heart Failure qOccurs when left side of the heart fails to pump blood properly out 5  2/11/25 20 Left Sided Heart Failure qOccurs when left side of the heart fails to pump blood properly out to the body. Ø Left side of the heart pumps oxygenated blood ØFailure of the left side to effectively pump oxygenated blood results in congestion leading to inability for gas exchange to take place in the lungs Ø The body compensates by holding fluids ØThe heart begin to work harder due to the congestion to move fluid along 21 Right Sided Heart Failure Occurs when there is difficulty of the right side of the heart to pump blood to the lungs. Ø Deoxygenated blood fails to get oxygenated Ø Congestion of fluid in the body occurs as it is not circulating to the heart Ø Gravity allows fluid to pool in upper and lower body 22 Signs and Symptoms of Left Sided and Right Sided Heart Failure 23 Signs and Symptoms of Left Sided and Right Sided Heart Failure 1 Left Sided Heart Failure 2 Øpalpitations Ødyspnea on exertion ØPink frothy sputum ØCrackles and wheezing ØOrthopnea ØCyanosis ØParoxysmal nocturnal dyspnea (SOB after lying flat) ØChest pain ØCheyne –Stokes respiration (shallow resp- deep breaths then periods of apnea ) Ø 3 Right Sided Heart Failure 4 Jugular vein distension Peripheral edema Ascites 6  2/11/25 3 4 Peripheral edema Ascites Weight gain Splenomegaly Hepatomegaly Anorexia/nausea Fatigue/weakness Tachycardia Shortness of breath during exercise or when lying flat. – 24 Causes of Right Sided Heart and Left Sided Heart Failure 1 Right Sided Heart Failure 2 ØIncreased Pulmonary Pressure ØLeft Sided Heart Failure ØPulmonary Hypertension ØPulmonary Valve Stenosis 3 Left Sided Heart Failure 4 Ø Weakened or Stenosis of Left Ventricles Ø Hypertension Ø Infection of the Heart Muscles ØMyocardial Infarction Ø Mitral regurgitation 25 Medical Treatment Ø Decrease Workload of the Heart Ø Rest/Sedation (Maintain bedrest) Ø Proper diet restrict sodium and fluid (Na intake not more than 2 grams/day, fluid restricted to no more than 1500ml in 24hrs Ø Daily weights – same time each day Ø Medications 26 Medications Ø Oxygen Ø Digoxin slows and regulate heart rate strengthen contractility of the heart. Nursing alert assess apical pulse for 1 full minute before administering Ø Angiotensin converting enzyme (ACE inhibitors) dilates blood vessel Ø Beta blockers (beta-adrenergic blocking agent cause heart to beat slowly and with less force 27 7  2/11/25 Ø Beta blockers (beta-adrenergic blocking agent cause heart to beat slowly and with less force Ø Diuretics water pills (Furosemide/Lasix) increases salt and water excretion in the urine. 27 Nursing Care of Patients With Heart Failure Ø Check SPO2 – Oxygen Therapy Ø Semifowlers position (HOB) Ø Check V/S Ø Monitor I & O Ø Lab values for Hypokalemia, Hypovolemia and Dehydration Ø Check lung sounds for crackles and Signs/Symptoms of pulmonary edema Ø Strict I &O Ø Monitor weight report to MD if gain more than 2lbs/day Ø Check abdominal girth Ø Administered meds as prescribed 28 Pulmonary Edema 29 Pulmonary Edema Ø An accumulation of extravascular fluid in lung and tissue Ø Pressure from venous blood containing red blood cells leaks into alveoli ØFluid backs up into lungs and the patient 30 Pulmonary Edema Signs and Symptoms q Restlessness q Severe Dyspnea/ Tachypnea q Tachycardia q Audible crackles q Pink Frothy Sputum q Pallor/Cyanosis q Diaphoresis – 31 Pulmonary Edema 8  2/11/25 31 Pulmonary Edema Nursing Management ØOxygen as prescribed Ø Elevate HOB - High Fowlers Ø Check Lung sounds ØCheck Vital signs Ø Administer Medication 32 Pulmonary Edema Drug Therapy qDiuretics ex. Furosemide q Vasodilators ex. Nitroglycerin q Inotropes ex. Digoxin q Narcotic ex. Morphine may be used to relieve shortness of breath and relieve anxiety – 33 Arteriosclerosis and Atherosclerosis 1 ARTERIOSCLEROSIS 2 ATHEROSCLEROSIS 34 Arteriosclerosis and Atherosclerosis Causes 1 Arteriosclerosis 2 Ø High Blood Pressure Ø Smoking and other sources of tobacco ØObesity or Diabetes 3 Atherosclerosis 4 Ø High Cholesterol Ø High Triglycerides Ø Obesity or diabetes Ø High Blood Pressure Ø Obesity or Diabetes Ø Smoking and other sources of tobacco 35 36 9 1  2/11/25 Ø Smoking and other sources of tobacco 35 Treatment of Arteriosclerosis and Atherosclerosis Surgical 36 Treatment of Arteriosclerosis and Atherosclerosis 1 vAngioplasty – a minimally invasive endovascular procedure to widen narrowed or obstructed arteries and veins v Atherectomy – a minimally invasive endovascular procedure to remove of plaque 2 Angioplasty and Atherectomy 37 Hypertension v Two Types of Hypertension Ø Essential or Primary Hypertension (Unknown Cause) Ø Malignant or Secondary Hypertension (Uncontrollable Hypertension) 38 Pathophysiology of Hypertension Ø Heart pumps harder result in hypertrophy of muscle Ø The heart pumps harder to deliver blood to the rest of the body result in enlarging and thickening of the muscle Ø High blood pressure may also enlarge the upper chamber of the heart Ø Resulting in necrosis of vital organs ex. heart, brain and kidneys 39 Pathophysiology of Hypertension 40 Hypertension 41 Hypertension Signs and Symptoms Ø Classified as “Silent Killer” (often none) Ø Elevated Blood Pressure Ø Headache Ø Bloody Nose Ø Shortness of Breath Ø Increased Anxiety 42 10  2/11/25 Ø Shortness of Breath Ø Increased Anxiety 42 Hypertension Nursing Diagnosis Ø Knowledge Deficit Ø Activity Intolerance Ø Increase/Decrease Cardiac Output Ø Pain/Alteration in Comfort Ø 43 Management of Hypertension Non Pharmacological Treatment 1 vLifestyle Changes to Reduce Risk Factors ØLose Weight ØLimit Alcohol ØStop Caffeine ØSmoking Cessation 2 ØLow Na Diet Ø Low Fat Diet Ø Exercise ØMonitor Blood Pressure ØMedication Regimen – 44 Management of Hypertension Drug Therapy v Diuretics, Beta Blockers, ACE Inhibitors q Angiotensin II Receptor Blockers (ARBs) ex. Losartan Øhelps to relax your blood vessels Ølower the blood pressure Øheart easier to pump the blood. ØAngiotensin a chemical in the body narrows blood vessels 45 Management of Hypertension Drug Therapy q Calcium Channel Blockers ex. Amlodipine Øreduce electrical conduction in the heart 46 11 45 2/11/25 q Calcium Channel Blockers ex. Amlodipine Øreduce electrical conduction in the heart Ødecrease the force of contraction of the muscle and dilate arteries. Dilation reduces blood pressure result in less exertion for the heart to pump – 46 Hypotension Causes v Also Known As Low Blood Pressure Ø Heart rate problems – heart rate to fast or too slow Ø Heart problems – cardiomyopathy, cardiac insufficiency, cardiac tamponade ( pressure on the heart occurring when blood or fluid builds up in the space between the heart muscle, preventing the ventricles from expanding fully ØVolume problems – large volume losses ex. hemorrhage, GI fluid losses, renal diseases and medications 47 Hypotension Treatment q Nursing Diagnosis – Decrease Cardiac Output v Treatment Ø Increase salt intake Ø Drink more fluids – fluids increase blood volume, help prevent dehydration 48 Introduction to Reading Cardiac Rhythms v EKG or ECG gives a snapshot of electrical conduction of the heart. vEach wave and dip represents the heart. v v v v v v v v 49 Electrical Activity of Myocardium qRepolarization - Relaxing or Filling 50 51 52 12  2/11/25 49 Electrical Activity of Myocardium qRepolarization - Relaxing or Filling qDepolarization – Contracting or Squeezing 50 Electrical Conduction of the Heart 51 Cardiac Rhythms 52 Normal Sinus Rhythm v Sinus rhythm= normal heartbeat (heart rate and rhythm) vHeart 60 and 100 beats per minute. – 53 Cardiac Arrhythmias 2 v v vHeart arrhythmias – irregular heartbeat or cardiac dysrhythmias qClassified as a group of conditions such as: Ø Slow Heartbeat – Bradycardia Ø Fast Heartbeat – Tachycardia ØIrregular Heartbeat – Flutter or Fibrillation 54 Cardiac Arrhythmias Causes 1 –Treatment : treat underlying cause – 2 v Coronary Artery Disease (CAD) v Electrolyte Imbalances such as Sodium and Potassium v Changes in the heart muscle vInjury from a heart attack vHigh Fever vExcessive fluid or blood loss vOveractive thyroid vStrenuous Exercise 55 Cardiac Arrhythmias 2 13  2/11/25 55 Cardiac Arrhythmias Sinus Bradycardia 2 v Rhythm with a resting heart rate of 60 beats per minute or less. Causes q Problems with the Sinoatrial (SA) node or administration of Digoxin q Athletes - due to exercise strengthens the muscle of the heart, allows for greater amount of blood with each heartbeat result in infrequently heartbeats 56 Cardiac Arrythmias Bradycardia Treatment v Atropine – an anticholinergic blocking agent given intravenously for extremely slow heart rate 57 Cardiac Arrhythmias Atrial Fibrillation (AfIB) vRhythm – (irregular wave ) P wave looks flatten cannot be identified, chaotic quiver wave. QRS complex evident q Heart rate – approximately 400 -600 beats per minute Causes q SA node rapidly firing electrical impulses q High blood pressure, heart attack qCoronary artery disease qAbnormal heart valves 58 Cardiac Arrhythmias Atrial Fibrillation Treatment v Reset the rhythm and control the rate vMedications qDigoxin q Beta Blockers q Calcium Channel Blockers (Anti-arrhythmic agents) q Coumadin (blood thinners) maybe prescribed (complication of AfIB – Blood Clots) Ø 59 Cardiac Arrythmias Atrial Flutter vRhythm – Rapid P waves appears as flutter, saw tooth pattern 14 60  2/11/25 59 Atrial Flutter vRhythm – Rapid P waves appears as flutter, saw tooth pattern qRate – 250-350 beats per min qSome impulses is conducted by the AV node to the ventricles Causes q Chaotic firing of the SA Node 60 Cardiac Arrhythmias Atrial Flutter Causes q Rheumatic or Ischemic Heart Diseases q Congestive Heart Failure q Hypertension q Pericarditis q Pulmonary Embolism q Postoperative Coronary Artery Bypass Surgery q Medications 61 Cardiac Arrhythmias Atrial Flutter Treatment v Cardioversion – electrical shock (patient is usually sedated ) v Medications q Calcium Channel Blockers q Antiarrhythmics - Amiodarone q Blood thinners 62 Cardiac Arrhythmias Ventricular Tachycardia (VT) v Rhythm – regular, may have some irregularity fast heart rate. P waves are absent v Rate – 150-300 beats per minute v Ventricles contracting too fast v Heart not filling with enough blood with each beat 63 Cardiac Arrhythmias Ventricular Tachycardia (VT) Causes & Treatment 1 2 15  2/11/25 63 Ventricular Tachycardia (VT) Causes & Treatment 1 Causes q Improper electrical activity in the Ventricles q Cardiomyopathy weakens heart muscle q Structural Heart Disease q Ischemic Heart Disease 2 Treatment v Medication q Antiarrhythmic Lidocaine q q Cardioversion q 64 Cardiac Arrhythmias Supraventricular Tachycardia (SVT) v Rhythm - regular, heart suddenly beats faster then slows down abruptly. v Rate - 150-250 beats per minute 65 Cardiac Arrhythmias Supraventricular Tachycardia (SVT) Causes & Treatment 1 Causes q Heart Disease q Heart Failure q Caffeine Intake q Chronic Lung Disease q Drug Misuse ex. cocaine q 2 Treatment q Valsalva Maneuver q Cardioversion v Medication q IV Adenosine 66 Cardiac Arrhythmias 16  2/11/25 66 Cardiac Arrhythmias Ventricular Fibrillation (VFIB) vRhythm – Looks like an erratic QRS wave/complex Ø Quivering of the Ventricles (fireworks) or Chaotic pattern in the Ventricles v Rate – Unknown or Indistinguishable Ø 67 Cardiac Arrhythmias Ventricular Fibrillation (VFIB) q Deadly Rhythm – Ventricles will not fully empty or squeeze blood out because of the quiver. q No cardiac output results in decrease blood entering the lungs and no oxygen to vital organs 68 Cardiac Arrhythmias Ventricular Fibrillation (VFIB) Causes q Rapid Electrical Impulses q Ventricular Foci firing at the same time q Ventricular activity is chaotic q Hyperkalemia q Hypomagnesemia q Coronary Artery Disease q Myocardial Infarction ( MI) q 69 Cardiac Arrhythmias Ventricular Fibrillation (VFIB) Treatment q Defibrillation q Implantable Cardioverter Defibrillator (ICD) q Coronary Angioplasty and Stent Placement q Coronary Bypass Surgery 70 Cardiac Arrhythmias Asystole 2 17 71  2/11/25 70 Cardiac Arrhythmias Asystole 2 v Cardiac Standstill q No Electrical Activity in the heart q No pumping q No Cardiac Output q No Life 71 Cardiac Arrhythmias Asystole Treatment qCardiopulmonary Resuscitation (CPR) q Intubation qEpinephrine – to increase coronary and cerebral blood flow q Atropine 72 Cardiac Arrythmias First Degree AV Block v Heart block in Varying degree may result in Pacemaker Insertion v Abnormally slow conduction through the AV node v Changes include a PR Interval of greater than 0.20 secs without disruption of atrial to ventricular conduction v Generally asymptomatic discovered on routine ECG 73 Pacemakers v Delivers electrical impulses to the heart at specific intervals so the heart can beat vStimulates the myocardium Nursing Interventions q Provide post op care q After pacemaker insertion critical observation period is 3days. (Hemothorax, Pneumothorax, Atelectasis, Perforation) q Observe for neck vein distention or muffled heart sounds (cardiac tamponade – pressure on the heart from fluid around the heart) q Check patient vital signs q Provide passive ROM after 24hrs 74 Client and Family Teaching for Permanent Pacemakers vThe nurse instruct the client and family with permanent pacemaker as follows: 18  2/11/25 74 vThe nurse instruct the client and family with permanent pacemaker as follows: q Maintain follow up care. Avoid showering for 3 days. Do not wet incision site or apply lotion or powders. Report if the suture line becomes inflamed or sore. q Avoid injury to the area where the pacemaker is inserted. Instruct not to lift or push any heavy object. Should not lift more than 5lbs for 1-2 months. q Follow physician’s advice regarding, lifting, sports and exercise. (Do not raise arm to reach for object until insertion site is fully healed). q Palpate the pulse and count the rate for a full minute daily or when feeling ill. q Obtain and wear a MedicAlert bracelet or tag identifying that a pacemaker is implanted. q Be cautious of situations that can cause pacemaker malfunction such as: v Gravitational Force during airplane departures or landings, bumpy car rides v High tension wires, shortwave radio transmissions, telephone vTransformers, and nuclear magnetic resonance imaging q 75 Client and Family Teaching for Permanent Pacemaker (Cont’d) q Move to another location and check pulse rate if dizziness or palpitations occur. Check all electrical equipment for grounding. q Avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. q If patient begin feeling dizzy or light headedness instruct to move 6 feet away from source of electrical impulses. (Turn off equipment) q Request hand scanning during airport security checks, some pacemaker triggers alarms q Maintain at least 6 inches between a cellular phone and the pacemaker generator or 12 inches if the cellular phone generates over 3 watts q Check with the physician concerning transtelephonic pacemaker checks or when a pacemaker battery change will be necessary in the future (Pacemaker battery change needed every 10 years. 19  2/11/25 checks or when a pacemaker battery change will be necessary in the future (Pacemaker battery change needed every 10 years. q Inform MD or Dentist if you need other care such as: v Prophylactic antibiotics vMay or may not be able to have MRI testing q Patient may not be allowed to drive q 76 Defibrillators v Defibrillators are devices that restore normal heart beat by sending electrical pulse or shock to the heart v Used to prevent or correct an arrythmia v Restores the heart’s beating if the heart suddenly stops v v v v v 77 Coronary Artery Disease 78 Coronary Artery Disease 2 v Coronary Artery Disease – narrowing or blocking of the coronary arteries Ø Fatty plaque obstructs the blood flow in the coronary arteries ØAngina and Myocardial Infarction are common disease arising from CAD q Cause: Atherosclerosis q Symptoms : Chest Pain, Heart Attack q Treatment Ø Lifestyle changes Ø Medications ØAngioplasty Ø Surgery 79 2 20  2/11/25 ØAngioplasty Ø Surgery 79 Diagnostic Tests 2 Ø ECG, CBC ØXray examination Ø Patient medical history Ø Oxygen saturation Ø Serum Magnesium and Potassium ØEchocardiogram location of damage can be identified Ø Blood test ex. Cardiac enzymes (Isoenzymes : CK, CK-MB iso- enzymes) Serum myoglobin (damage to the heart) Troponin I or T (accurate cardiac marker) Ø Sedimentation rate 80 Percutaneous Transluminal Coronary Angioplasty (PTCA) 2 vPTCA a minimally invasive procedure to open up blocked arteries allowing blood to circulate unobstructed to the heart muscle v v v 81 Client and Family Teaching Self-Care Following Percutaneous Transluminal Angioplasty qThe nurse provides the following instructions before the client is discharged: ØAvoid lifting more than 10 lbs for at least 3 days if the groin was used for catheter insertion. Avoid lifting more than 1 lb for at least 3 days if a site in the upper extremity was used. ØRefrain from riding a bicycle, driving a vehicle, or mowing the lawn for at least 3 days. ØRefrain from sexual activity for 1 week. ØShower rather than bathe until the cutaneous catheterization site heals. 21  2/11/25 ØShower rather than bathe until the cutaneous catheterization site heals. ØClean the site with soap and water; eliminate any dressing. ØRelieve discomfort at the site with a mild analgesic such as acetaminophen (Tylenol); numbness at the site is temporary and not unusual. ØExpect to see a bruise, which may last 1–3 weeks, at the catheter insertion site. ØReport any signs of bleeding, infection, or impaired circulation: fever, swelling, redness, bloody or purulent drainage, acute pain in the extremity, and cold or pale skin. ØNotify the cardiologist immediately if there is pain or tightness in the chest, which could indicate obstructed blood flow through the coronary artery. 82 CORONARY ARTERY BYPASS GRAFT (CABG) 83 Angina Pectoris severe pain in the chest Causes Inadequate blood supply to the heart. Triggered by cold, exercise & stress Signs and Symptoms Øsevere and crushing ØFeeling of pressure and suffocation just behind the breastbone. ØMay spread to shoulder arm neck jaw and back. Øpain often stops in less than 5min but it is intense while It last. 84 Management of Angina Pectoris 1 Medical Treatment for Angina Medications: vNitroglycerin Sublingual (SL) during attack Ø Long acting Nitroglycerin to prevent attacks v Beta blockers (propranolol/inderal & atenolol/tenormin) v Calcium channel blockers (diltiazem/Cardizem & nifedipine/Procardia) v Aspirin, anticoagulants, anti-lipidemics 2 Nursing Interventions 22  2/11/25 2 Nursing Interventions vAssess chest pains, V/S, vSemi Fowlers vGive oxygen vInstruct pt. about disease and prevention ØAvoid stress ØQuit smoking vGive prescribed nitroglycerine ØIf nitroglycerine fails a percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery may be necessary qNursing interventions for a patient with angina pectoris include: Treating angina. The nurse should instruct the patient to stop all activities and sit or rest in bed in a semi-Fowler's position when they experience angina, and administer nitroglycerin sublingually. ØReducing anxiety 85 Myocardial Infarction vAKA - Heart Attack qBlockage of 1 or more coronary arteries qHeart loses blood supply resulting in necrosis and scarring qMI usually affects the left ventricle – 86 Myocardial Infarction Signs and Symptoms q Pain is similar to angina…. Crushing pain lasts longer & more severe q Not relieved by rest q Nitroglycerine does not help q Sense of impending death, q Signs may imitate indigestion or gallbladder attack q Dyspnea, cyanosis q Rapid irregular thready pulse decrease in BP and body temp. q Cold and clammy skin q Nausea and vomiting – 87 23  2/11/25 – 87 Diagnostic Tests Ø Imaging Ø Echocardiogram - location of damage can be identified Ø Blood test assess duration and severity Ø Sedimentation rate Ø Isoenzymes q CK, CK-MB iso-enzyme, q Serum myoglobin (damage to the heart) q Troponin I or T (accurate cardiac marker) – 88 Changes in Cardiac Markers 89 Management for Myocardial Infarction (MI) MONA – Morphine, Oxygen, Nitroglycerin and Aspirin vAdminister medication ØNitroglycerin to decrease cardiac workload ØAspirin for its antiplatelet ability to prevent blood clot ØAntidysrhythmic drugs like lidocaine to suppress dysrhythmia ØMorphine to relieve chest pain, anxiety and fear of death ØBeta blocker, calcium channel blocker to control heart rate and dysthymia ØRestore blood flow to myocardium by causing vasodilation qOther medications : vThrombolytic, beta-Blockers, anticoagulant , ACE inhibitors , valium ØCABG (Increase cardiac perfusion ) ØPrevent further damage 90 Nursing Interventions ØFrequent Vital signs ØCardiac monitoring ØI &O: daily weights , Notify MD MD of gain ↑ 2 lbs. weekly ØAssess lung sounds ex. Adventitious lung sounds ØAssess skin color ; pallor cyanosis ØAdminister prescribed medications ØProvide emotional support and stress reduction ØIsometric exercise, Antiemboli stocking as prescribed ØMonitor urine output 24  2/11/25 ØIsometric exercise, Antiemboli stocking as prescribed ØMonitor urine output ØAssess peripheral pulses and edema ØDiet as tolerated ↓ caffeine intake ØMonitor for constipation need prophylactic stool softener – use of bedside commode if able better than bedpan vTherapeutic measures Cardiac catheterization followed by administration of thrombolytic drug (clot buster) if chest pain less than 6 hours ago qCardiac catheterization allows performing percutaneous coronary interventions (PCI) qStent placement qCoronary artery bypass surgery (CABG) may be done 91 Infectious and Inflammatory Disorders – – – – – q The layers of the heart are endocardium, pericardium and myocardium. They can become inflamed or infected resulting in endocarditis, pericarditis and myocarditis. 92 Rheumatic Heart Disease vAutoimmune disorder ØResults from severe cardiac pathologies Ex. Myocarditis, endocarditis and pancarditis ØComplication of Upper Respiratory Infection (URI) (rheumatic fever ) ØRheumatic fever is an inflammatory disease that begins with strep throat. ØHeart valves are damaged Causes valve necrosis ØAffects connective tissue ( heart, joints, brain and skin) 93 Signs and Symptoms ØPolyarthritis (5 or more joints are affected with joint pain) ØChorea (brief rapid uncontrolled movements) 25  2/11/25 93 ØPolyarthritis (5 or more joints are affected with joint pain) ØChorea (brief rapid uncontrolled movements) ØCarditis (inflammation of the heart) ØFever ØArthralgia ØChest pain ØShortness of breath expectoration of blood ØHepatomegaly ØAscites swollen, tender, red and extremely painful joints — particularly the knees and ankles. ØNodules (lumps under the skin) ØRed, raised, lattice-like rash, usually on the chest, back, and abdomen. ØShortness of breath and chest discomfort. 94 Treatment ØAvoid exposures to cold and Strep infections ØAdequate rest and sleep ØBalanced diet avoid smoking Ø Prophylaxis Penicillin G ØHeart valve replacement if necessary ØJoint pains( tx with Non steroidal anti inflammatory drugs) (NSAIDS) – 95 Myocarditis vInflammation of the myocardium ØHeart may enlarge in response to the damaged muscle fibers. ØMost often due to a viral infection or caused by rheumatic heart disease vOther causes are q Bacteria, fungi, medications q Parasites human deficiency virus, qSystemic Lupus Erythematosus q Cardiac transplant rejection 96 Signs and Symptoms of Myocarditis ØFatigue ØFever 26  2/11/25 96 ØFatigue ØFever ØPharyngitis ØMalaise ØDyspnea ØPalpitations ØMuscle ache ØGastrointestinal discomfort ØEnlarged lymph nodes 97 Nursing Care Myocarditis 1 vNursing Care Aimed At: Ø Maintaining normal cardiac function ØMonitoring Vital Signs ØAdministering Medications as Prescribed vInterventions to reduce fatigue q Provide assistance as needed q Allow for frequent rest periods q Teach energy conserving measures q Determine diversional activities when activities are restricted to reduce further anxiety 2 Ø Reduce the workload of heart -Bed rest and limit activity ØAvoid alcohol and tobacco ØMonitor V/S ØOxygen ØSymptoms of HF: Give prescribed meds such as Beta blockers ACE inhibitors, diuretics and digoxin ØMonitor pt for Digitalis toxicity (N/V bradycardia, malaise, dysrhythmias) – 98 Endocarditis v Inflammation of the heart’s inner lining particularly the heart valves q Infection of the endocardium q Bacteria attaches to eroded endocardium q Causes damage to the valve leaflet q As blood flows through the heart, these vegetations may break off and become emboli. 99 27  2/11/25 and become emboli. 99 Signs and Symptoms of Endocarditis ØFever ØChills ØAching muscles and joints ØDyspnea and cough ØEdema and hematuria ØPetechiae ØSplinter hemorrhages ØOsler’s nodes (small painful nodes on fingers and toes) 100 Nursing Treatment Endocarditis ØMonitor and record vital signs ØAuscultate lung sounds ØProvide IV antibiotics ØGood skin care ØMonitor and report circulatory impairment ØGoal: Support cardiac function & prevent complications – i.e. heart failure, emboli – 101 Pericarditis vInflammation of the pericardium results in the heart unable to expand and fill resulting in decreased cardiac output and blood pressure. Signs and Symptoms Ø Chest pains may radiate to clavicle, neck and epigastric region Ø Dyspnea, orthopnea Ø Low grade fever Ø Cough ØPericardial rub (** sign of inflammation) A pericardial friction rub is a grating, scratchy, high-pitched sound that is the result of friction from the inflamed pericardial and epicardial layers rubbing together as the heart fills and contracts. ØEdema 102 28  2/11/25 102 Pericarditis Therapeutic measures ØAntibiotics for bacterial infections ØBedrest ØNSAIDs ØCorticosteroids Ø Pericardiocentesis (pericardial tap), is an invasive procedure that involves using a needle and catheter to remove fluid (called pericardial effusion) from the sac around the heart (the pericardium). The fluid may then be sent to a laboratory for tests to look for signs of infection or cancer. Pericardial window - (is a procedure done on the sac around the heart. Surgically removing a small part of the sac lets doctors drain excess fluid from the sac. 103 Pericarditis Nursing Care Ø Relieve chest pain Ø Relieve anxiety Ø Maintain normal cardiac functioning Ø Monitor v/s esp. fever, tachycardia ØTeaching about disease Complications q Pericardial effusion - is excess fluid between the heart and the sac surrounding the heart (a tough and layered sac-) q Cardiac tamponade - is a clinical syndrome caused by the accumulation of fluid in the pericardial space (resulting in reduced ventricular filling and subsequent hemodynamic compromise). The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death. 104 Valvular Disorders of the Heart v Two types of Valvular disorders are: q Narrowing (i.e., stenosis) of the valve opening and q Failure of a valve to close completely (ie, insufficiency or regurgitation). Cause Ø Valvular heart disorders result from congenital defects, trauma, ischemic 29  2/11/25 Ø Valvular heart disorders result from congenital defects, trauma, ischemic Ø Damage, degenerative changes, and inflammation. Rheumatic endocarditis is the most common cause. q When valves are unable to open and close at the appropriate time in the cardiac cycle it causes blood to leak or back up which can impede blood flow. 105 Valvular Disorders of the Heart (Common Valves Affected) 1.Mitral valve prolapse prevents the mitral valve from closing completely; Resulting in Valvular regurgitation in which blood from the left ventricle seeps back Into the left atrium. ØS&S : may be asymptomatic and the first symptom may be an extra heart sound referred to as a mitral click. 2. Mitral stenosis results in progressive thickening and contracting of the mitral valve, which causes narrowing and obstruction of blood flow. This leads to low cardiac output and pulmonary venous hypertension. ØS&S progressive fatigue, hemoptysis, and Dyspnea on exertion. 3. Mitral insufficiency (i.e., regurgitation) results when the chordae tendineae shorten and prevents complete closure of the leaflets, causing backflow of blood from the left ventricle into the left atrium. The left atrium must dilate to accommodate the blood flow from lungs and backflow of blood from the left ventricle. ØS&S palpitation of the heart, dyspnea on exertion, and cough due to pulmonary congestion. 4. Aortic valve stenosis results when the leaflets fuse and partially close the opening between the heart and the aorta; the obstructed flow causes left ventricular Hypertrophy. ØS&S dyspnea, angina pectoris, and a loud, rough systolic murmur over the aortic area. 5. Aortic insufficiency (ie, regurgitation) results when the leaflets do not completely sealed, the aortic orifice and allows backflow of blood from the aorta into the left Ventricle. ØS&S increased force of the heartbeat, an arterial pulsation in the neck, exertional dyspnea, and breathing difficulties 106 Valvular Disorders of the Heart Treatment and Nursing Care q Educate the client on the need of prophylactic antibiotics before 30  2/11/25 106 Treatment and Nursing Care q Educate the client on the need of prophylactic antibiotics before any invasive procedure to include dental work, genitourinary or gastrointestinal procedures, and intravenous therapy. q Implement nursing care for the client undergoing valve repair or replacement, Which in most instances is the treatment of choice. q Educate client about lifelong anticoagulant therapy. – 107 Peripheral Vascular Disease vDisease of arterial or venous circulation that leads to narrowing and hardening of the arteries in the extremities. Cause q The hardening and narrowing of arteries is caused by arteriosclerosis. qThe narrowing causes decreased blood flow which can injure nerves and other tissues. q Fatty plaques building up in wall of arterial blood vessels are also contributing factors. 108 Peripheral Vascular Disease 1 Risk Factors ØAbnormal cholesterol ØDiabetes ØObesity ØHeart disease (coronary artery disease) ØHigh blood pressure (hypertension) ØKidney disease involving hemodialysis ØSmoking ØStroke (cerebrovascular disease) ØFamily history 2 Clinical Manifestations vIntermittent claudication is: q Classic symptoms of pain, fatigue, burning, or discomfort in the muscles of feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest. Ø Legs or feet may feel numb when at rest. 31  2 2/11/25 during walking or exercise and go away after several minutes of rest. Ø Legs or feet may feel numb when at rest. Ø Legs cool to the touch, Ø Skin may look pale, hair loss, legs, feet Pain and cramps at night Ø Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful Ø Skin that looks dark and blue or pale skin right or shiny, toe nails thick Ø Sores that do not heal, painful usually black. 109 Buerger Disease Signs and Symptoms of Buerger Disease q Intermittent pain with activity (Cramps in the calf muscles disappear with rest) q Tingling q Burning q Numbness q Edema 110 Treatment of Buerger Disease q Avoid smoking and chilling of hands and feet q Mild exercise q Antibiotics q Anti-inflammatory q Analgesics q Avoid external heat– wear extra loose fitting clothing q Encourage fluid intake 111 Raynaud Disease 2 q Periodic narrowing or spasmodic constriction q Chronic hypoxia results in skin ulcers and organ failure q Especially (fingers, toes, ears and nose) – caused by exposure to cold/ emotional stress – 112 Signs and Symptoms of Raynaud Disease q Blanched and cold extremities q Cyanosis q Ulcers are slow to heal 113 32  2/11/25 112 q Cyanosis q Ulcers are slow to heal q Skin looks tight and shinny q Gangrene fingertips 113 Nursing Care of Raynaud Disease q Avoid chilling (wear warm clothes in winter) q Avoid emotional upsets and tensions q Smoking is contraindicated q Avoid electric blanket 114 Deep Venous Thrombosis (DVT) Blood clot formation in the deep veins of the lower extremities in legs or in the pelvic veins lead to venous insufficiency. q q Clot forms when platelets adhere to the vein lining begin the process of platelet aggregation, platelet plug, and clot formation as a clot enlarges, it may block blood flow through the vein and obstruct venous drainage from the area distal to the clot. q Within 24 to 48 hours after formation, the clot may dislodge and travel to the pulmonary artery (ie, pulmonary embolism), a life- threatening emergency. 115 Deep Venous Thrombosis (DVT) Cause q Thrombus formation occurs when there is: 1. Venous stasis. Conditions contributing to venous stasis include surgery, obesity, pregnancy, congestive heart failure, and immobility 2. Hypercoagulability. Conditions associated with hypercoagulability include malignant neoplasm, dehydration, blood dyscrasias, and oral contraceptive use 3. Venous wall injury. Constriction of the leg due to garters; straps, or trauma to lower extremities may cause injury to venous walls 116 Deep Venous Thrombosis (DVT) Clinical Manifestations Sometimes asymptomatic Symptomatic 33  2/11/25 116 Sometimes asymptomatic Symptomatic Ø Edema (usually unilateral) Ø Erythema, and warmth of calf or thigh associated with inflammation of phlebitis Ø Pain in calf muscle on dorsiflexion (Homans’ sign) due to stretching of inflamed vein Ø Tenderness in calf or thigh Ø Low-grade fever 117 Deep Venous Thrombosis (DVT) Treatment and Nursing Care ***Prevent progression Prevent the clot from breaking off in your vein and moving to your lungs Reduce the risk of another blood clot Medical Management: Antithrombic agents Surgical: Thrombectomy to remove clot possible stent placement Intervention Ø Elevate the client’s legs above the level of the heart and have the client avoid prolonged standing or sitting to promote venous return Ø Administer prescribed medication anticoagulant (Coumadin, Heparin, (Lovenox), Thrombocytes ) v Apply warm packs to the legs to reduce pain q Antiembolic stocking q BedRESt 118 Varicose Veins 1 v Weakening of the valves in the vein (dilation of the vessel) q Blood pools in the legs. Causes q Hereditary, prolong standing ,poor posture, repeated pregnancies, obesity, tumors, HTN, kidney and liver diseases. 119 34  2/11/25 obesity, tumors, HTN, kidney and liver diseases. 119 Varicose Veins Signs and Symptoms q Legs – dark protrusion q Torturous superficial veins q Pain fatigue q Muscle cramps q Feeling of heaviness 120 Nursing Management of Varicose Veins q Avoid long periods of standing q Avoid restricted clothing q Promote venous return ---- support hose q Aspirin Surgery q Surgical ligation ( surgical tying of veins through a small incision in the skin to prevent pooling of blood) q Stripping of the veins (remove or tie off a large vein in the leg called the superficial saphenous vein) q Post operative care 121 Videos v How varicose veins form § https://youtu.be/Ce2TjGY-r1o v Treatment for Varicose Veins | Nucleus Health §https://youtu.be/89xuyftWmyU 122 Video Links v Difference Between Raynaud’s Disease and Buerger’s Disease §https://youtu.be/w1xYv1Z_2Ek v Buerger's disease - Medical Meaning and Pronunciation §https://youtu.be/KH2VqA1qVw8 v Raynaud's Disease - an Osmosis Preview §https://youtu.be/RemDgeFeBt4 35  2/11/25 v Raynaud's Disease - an Osmosis Preview §https://youtu.be/RemDgeFeBt4 v Raynaud’s Phenomenon : What You Should Know | Johns Hopkins Medicine § https://youtu.be/Jv0kEFCYF5M – 36