New Curriculum Nursing Care of Patients With Cardiovascular Disorders PDF

New Curriculum Nursing Care of Patients With Cardiovascular Disorders Williams & Hopper (2023). Understanding Medical Surgical Nursing 7th Edition Chapter 21 2/2/2025...

New Curriculum Nursing Care of Patients With Cardiovascular Disorders Williams & Hopper (2023). Understanding Medical Surgical Nursing 7th Edition Chapter 21 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 1 Cardiac Function and Pathophysiology Heart: Three layers, four chambers, four valves Right side: deoxygenated blood Left side: oxygenated blood from the lungs Valves: Tricuspid (between right atrium and ventricle) Pulmonic (between right ventricle and pulmonary artery) Mitral [bicuspid] (between left atrium and ventricle) Aortic (between left ventricle and aorta) Ch 21; pp 317-318 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 2 Cardiac Output Amount of blood pumped by the left ventricle in one minute Cardiac output = stroke volume times heart rate Affected by preload, afterload, and contractility Ejection fraction = percentage of blood ejected from left ventricle with each beat (normally 55-70%) Venous return (preload) = amount of blood returning to the right atrium Contractility = how forcefully the heart contracts; influenced by hormones and venous return Afterload: force the left ventricle must overcome to eject blood Ch 21, p 318 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 3 Pathophysiology –Aging and the Cardiovascular System Atherosclerosis Narrowed arterial lumen increases afterload and blood pressure Rough surface increases risk of clot formation Decreased blood flow to organs Heart muscle becomes less efficient Heart rate, maximum cardiac output decrease Atypical symptoms of myocardial infarction Conduction cells less efficient Dysrhythmias common Valves thicken and calcify Murmurs Ch 21, p 323; gerontological issues p 323 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 4 Health Data Collection Health history Physical examination Subjective data Tables 21.1, 21.2, pp 324, 325 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 5 Measuring blood pressure Normal average: 120/80 Measure in both arms for baseline Report differences Use arm with higher pressure for future measurement Box 21.1, p 327 Ch 21, pp 325, 327 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 6 Orthostatic Blood Pressure Orthostatic blood pressure Lying, sitting, standing Decrease in systolic pressure more than 15 mm Hg and increase in pulse more than 20 beats per minute Common associated symptoms: light-headedness, syncope Common etiologies: fluid volume deficit, diuretics, pain Be Safe box p 327 Box 21.2 p 327 Ch 21, pp 325-327 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 7 Pulses Count apical for a full minute; document regular or irregular Normally 60-100; well-conditioned athletes may be slower Compare apical and radial pulses Compare quality of peripheral pulses 0=non-palpable 1+ = weak 2+ = normal 3+ = bounding Bruit, thrill Ch 21, pp 327-328 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 8 Respirations Rate, work of breathing Lung sounds Sputum – pink, frothy sputum = pulmonary edema (acute heart failure) Cough – dry cough may be a sign of heart failure Ch 21, p 328 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 9 Inspection Shortness of breath Color of skin, mucous membranes Findings indicating hypoxia Pale skinned – cyanosis Dark skinned – white or gray around mouth, blue tint to conjunctiva Sallow skinned – grayish green Pallor – anemia or decreased arterial blood flow Dependent rubor Brown/purple discoloration of lower extremities Ch 21, p 328 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 10 Inspection – Arterial and Venous Disorders Arterial: decreased hair on legs thick, brittle nails shiny, taut, dry skin Legs pale when elevated, dependent rubor (reddish purple) when down Venous: Stasis ulcers Varicose veins Scars around ankles Swelling, redness or hard, tender vein (thrombophlebitis) Ch 21, p 328 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 11 Inspection – Other Findings Jugular venous distention (volume overload, right sided heart failure) Capillary refill Clubbing (congenital heart disease, long-term smoking Ch 21, p 328 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 12 Palpation Point of maximum impulse (PMI) Temperature Edema Ch 21, pp 328-329 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 13 Auscultation S1, S2 (normal) S3, S4 (abnormal) Murmurs: turbulent blood flow through one or more valves Valve disorder Pericardial friction rub Ch 21, pp 329-330 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 14 Blood Tests-Cardiac Biomarkers Troponin, CK-MB Proteins and enzymes released into the blood by damaged cardiac cells Useful in diagnosing myocardial infarction Troponin: specific and sensitive to cardiac muscle damage Elevates in 2-6 hours, peaks in 15-20 hours, remains elevated 5-7 days CK-MB (creatine-kinase MB): isoenzyme found in heart muscle Elevates in 4-6 hours, peaks in 15-20 hours, remains elevated 24-36 hours Ch 21, p 334 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 15 Blood Tests – Lipids Measure of risk for coronary arterial disease (CAD) May need to fast for 6-12 hours, avoid alcohol for 24 hours before test Water is permitted High levels of LDL and triglycerides increase the risk of heart CAD Ch 21, p 334 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 16  Electrocardiogram Records Cardiac Electrical Activity Dysrhythmias, enlarged heart chambers, myocardial ischemia or infarction, electrolyte imbalances, pericarditis Ambulatory Electrocardiogram Monitoring Holter Monitoring Ch 21, p 335 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 17 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 18 Echocardiogram Ultrasound Trans-esophageal ultrasound Throat is anesthetized NPO for 6 hour before test Records Motion Heart Structures Valves Heart Size, Shape, Position Blood flow through heart Ch 21, p 335; Be Safe box p 335 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 19 Exercise Stress Test Evaluates heart’s ability to respond to increased oxygen demands or degree of peripheral vascular disease Cardiac stress test – treadmill, stairs, or stationary bicycle Peripheral vascular stress test – treadmill for 5 minutes at 1.5 MPH Stop if intermittent claudication develops Non-exercise stress test – administration of dipyridamole or adenosine to stress the heart for patients unable to exercise Ch 21, p 336 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 20 Doppler studies Use ultrasound to generate images of blood vessels. Used to detect occlusions, clots Non-invasive Arterial-peripheral arterial disease Venous-thrombosis Ch 21, p 336 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 21 Invasive Studies –Cardiac Catheterization Insertion of a flexible tube into artery or vein and threaded to the heart Indication – determine the extent of occlusions, open occluded arteries Measures pressure in chambers of the heart, oxygen saturation, cardiac output Insertion sites: wrist, groin, forearm, neck Ch 21, pp 335-336 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 22 Angiography and Cardiac Catheterization Pre-procedure Ask about prior reactions to contrast dye NPO (8 hours for cardiac catheterization); IV hydration may be given Patient teaching: Done under local anesthesia with sedation. Warm, flushed feeling when dye is injected Vital signs and EKG continuously monitored Ch 21, p 336 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 23 Cardiac Catheterization Post-procedure Pressure to site to prevent hematoma or retroperitoneal bleeding (groin) Monitor: vital signs, insertion site, pedal pulses If groin was used, patient is on bedrest, avoid flexion of leg for prescribed time Fluids encouraged to flush dye Ch 21, p 336 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 24 Medications for the Cardiovascular System Antihypertensives Antianginals Anticoagulants Cardiac glycosides Thrombolytics Vasodilators Grapefruit and certain other citrus fruits can inhibit an enzyme responsible for metabolizing many medications and lead to an increased risk of toxicity Ch 21, p 338 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 25 Evidence-based Therapeutic Measures Antiembolism devices Antiembolism stockings Medical graduated compression stockings Non-medical support hosiery Intermittent pneumatic compression devices Oxygen Medications Cardiac surgery Ch 21, pp 337-338, learning tip p 338 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 26 Health Teaching Healthy diet Limit saturated fats, sodium Increase fruits, vegetables, fish Exercise Smoking cessation Oxygen safety No smoking No open flames Application of antiembolism stockings Ch 21, pp 337-338 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 27  Cardiovascular Disease in the U.S. Estimated 121.5 million Americans have one or more types of cardiovascular disease (2019) Leading cause of death in men and women of most ethnic groups One death every 33 seconds Lifestyle choices have a major impact Other influences: Access to high quality healthcare Culturally competent health promotion/disease prevention education Ch 21, p 323; https://www.cdc.gov/heartdisease/facts. 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 28 Review Cardiac anatomy and physiology Health history Data collection Diagnostic tests Medications Evidence-based practice Health teaching Cardiac disease in the United States 2/2/2025 Nursing Care of Patients With Cardiovascular Disorders 29