Week 3 - Cardiovascular System PDF

HCAP 1210   The circulatory system has many functions:  Blood carries nutrients, oxygen, and other substances to the cells  Help stop bleeding and promote healing  During exercise, increased dem...

HCAP 1210   The circulatory system has many functions:  Blood carries nutrients, oxygen, and other substances to the cells  Help stop bleeding and promote healing  During exercise, increased demands are met through increased blood flow Circulatory  Blood removes waste products from cells System  Blood and blood vessels help regulate body temperature  The system produces and carries cells that defend the body from microbes that cause disease  The circulatory system is made up of the blood, heart, and blood vessels. Circulatory System  The blood  Consists of blood cells and plasma  Plasma is mostly (90%) water  Red blood cells (RBCs) are called erythrocytes  They give blood its red colour because of a substance in the cell called hemoglobin  White blood cells (WBCs) are called leukocytes  They protect the body against infection  Platelets (thrombocytes) are needed for blood clotting Circulatory System  The Heart  It pumps blood through the blood vessels to the tissues and cells.  It lies in the middle to lower part of the chest cavity, toward the left side. Circulatory System  The blood vessels  Arteries carry blood away from the heart  The aorta is the largest artery  The smallest branch of an artery is an arteriole  Capillaries are very tiny blood vessels  The capillaries pick up waste products from the cells  Veins return blood to the heart  The two main veins are the inferior vena cava and the superior vena cava Critical Thinking!  Name three functions of the heart  What is RBC and its function  What is WBC and its function  What is a blood vessel   The circulatory system Physical  The heart muscle weakens. Changes as we  Arteries narrow and are less elastic.  Sometimes circulatory changes are severe: Change  Rest is needed during the day.  Overexertion is avoided.  This system involves the heart and blood vessels Cardiovascular Disorders Cardiovascular disorders are the leading cause of death in Canada Hypertension  A condition in which the blood pressure is abnormally high  Systolic pressure of 140 mm Hg or higher  Diastolic pressure of 90 mm Hg or higher  Must be a consistent high reading  Box 37-5: Risk Factors for Hypertension (p. 863) Causes of Hypertension NARROWED KIDNEY HEAD INJURIES COMPLICATIONS TUMOURS BLOOD VESSELS DISORDERS OF PREGNANCY Signs and Symptoms of Hypertension HEADACHE BLURRED VISION DIZZINESS MAY NOT CAUSE ANY SIGNS AND SYMPTOMS— OFTEN PERSON DOES NOT KNOW THAT HE HAS HIGH BLOOD PRESSURE Complications of Hypertension STROKE— HEART ATTACK— KIDNEY (RENAL) BLINDNESS CEREBROVASCULAR MYOCARDIAL FAILURE ACCIDENT INFARCTION (MI) Treatment for Hypertension DRUGS THAT LOWER EXERCISE REST SMOKING CESSATION SODIUM-RESTRICTED BLOOD PRESSURE DIET LOW-CALORIE DIET Critical Thinking!  Mr. Dean has been living with HTN for his entire older adult life. His HTN is usually managed with medication, exercise and a good diet. When caring for him this morning he was voicing C/O of a headache and dizziness when waking up in bed.  What is your immediate response as nurse?  While doing your assessment and waiting for nursing staff to arrive Mr. Dean voices he is now having trouble seeing and his vision has become blurry, and dimmed. His arm has also fallen limp and he is slurring his speech. What is happening to Mr. Dean? Critical Thinking!  Mr. Lovely is a 96yr old lovely gentlemen who lives next door to Mrs. Bieber. He often checks on Mrs. Bieber to ensure she is ok and will on occasion pick up some groceries for her. Mr. Lovely drives and attends the legion every Sunday for brunch. Mr. Lovely is a relatively health man who has never been diagnosed with any health concerns in his life, he has never had surgery. However, lately he has not been feeling quite right, he has been complaining of dizzy spells. He was recently seen by his family doctor who diagnosed Mr. Lovely with Hypertension and gave him medication which he was instructed to take one tab every morning and to follow up with his doctor in 2 weeks. Mr. Lovely unfortunately fell while getting into the bathtub and it was determined that he would require standby assist with showers.  You are the HCA assigned to look after Mr. Lovely. Develop a care plan that will best meet Mr. Lovely’s needs. Think about his diagnosis. Hypotension  Hypotension is the medical term for low blood pressure  Systolic pressure of 90 mm Hg or lower  Diastolic pressure of 60 mm Hg or lower  Chronic low blood pressure with no symptoms is almost never serious.  But health problems can occur when blood pressure drops suddenly and the brain is deprived of an adequate blood supply. This can lead to dizziness or lightheadedness.  Sudden drops in blood pressure most commonly occur in someone who's rising from a lying down or sitting position to standing.  Sometimes referred to as postural hypotension or orthostatic hypotension Causes of Hypotension HORMONAL OTC HEART FAILURE HEART HEAT PROBLEMS MEDICATION ARRHYTHMIAS EXHAUSTION LOSS OF BLOOD LOW BODY DEHYDARTION FROM BLEEDING TEMPERATURE Signs & Symptoms of Hypotension DIZZINESS LIGHT UNSTEADINESS WEAKNESS FATIGUE HEADEDNESS COLD, CLAMMY FAINTING PALE SKIN SKIN Complications of Hypotension FALLS!!! Treatment of Hypotension Eat a diet higher in Drink lots of fluids salt Be careful sitting and Get regular exercise standing (pump your to promote blood ankles before flow standing) Avoid prolonger Avoid straining on exposure to hot toilet showers/bath Critical Thinking!  You are caring for Mrs. Cooper, she has a diagnosis of postural hypotension. You come to her bedside @0700 at the start of your shift. She is independent in all care and ambulatory on own. How will you assist her with morning care?  As you are helping her roommate get dressed you hear a large thud in the bathroom. You see Mrs. Cooper on the floor by the toilet, unconscious. What is your immediate action as a HCA?  What is postural hypotension, what did Mrs. Cooper most likely to do to bring on the unwanted effects of her postural hypotension  Mrs Cooper was easy to arouse when you arrived, she however looks pale, cool and clammy to touch, and appears disoriented. What will you do?  What patient education can you provide Mrs. Cooper? Coronary Artery Disease (CAD)  Coronary arteries narrow and thicken; called atherosclerosis  One or all of the arteries may be affected  Heart muscle gets less blood  Fatty material collects on the arterial wall  Walls narrow and obstruct blood flow  If arteries blocked, permanent damage to heart occurs  GENDER (MORE AGE (MORE COMMON LIFESTYLE FACTORS HIGH BLOOD HYPERTENSION FAMILY HISTORY OF UNCONTROLLED COMMON IN MEN) IN OLDER ADULTS) (LACK OF EXERCISE, CHOLESTEROL CAD DIABETES OBESITY, SMOKING, EXCESSIVE ALCOHOL, STRESS) Risk Factors for Coronary Artery Disease Critical Thinking  M.J. was recently released from the hospital for chest pain and discomfort, she has come back to her residential facility; you are her HCA for the day. She is 70 years old and has a hx of noninsulin dependent diabetes, is 5’2, weighs 220lbs, she states she is active but on observations from staff she does not participate in any programs, her father died of a heart attack at the age of 66, and her brother at age 67, she has said she never really worried about her heart disease because “its an old mans disease”  What are the risk factors for coronary artery disease (CAD) that M.J. has in he pt hx?  What is the common pathophysiology of CAD?  Is heart disease just an “Old mans disease”? Explain  The cardiac rehabilitation center she left has strongly indicated she requires major lifestyle changes if she does not oblige there could be serve negative health outcomes. What patient education would you provide, implement a plan of care. Angina Pectoris  Chest pain from reduced blood flow to a part of the heart muscle caused by CAD  Occurs when the heart muscle needs more oxygen  Physical exertion is the common trigger  Emotional stress, extreme cold or heat, heavy meals, alcohol, and smoking can also trigger  Chest pain, tightness, heaviness, or pressure in the left side of the chest Signs and Pain may radiate to other sites Fig 37-14 (p. 864) shows location of pain sites Symptoms of May be pale, feel faint, and perspire Angina Dyspnea is common Pectoris Rest often relieves symptoms in 3 to15 minutes, as it reduces the need for oxygen Treatment for Angina Pectoris  Nitroglycerin is given to relieve angina (tablet, ointment, patch, or spray form)  If client has taken maximum amount and still has no pain relief, call 9-1-1 and your supervisor Critical Thinking!  Is Angina Pectoris mean someone is having a Myocardial Infarction?  Tell me all the locations where Angina Pectoris can occur, make an mnemonic for yourself to remember these.  What is the treatment for someone experiencing Angina Pectoris? Myocardial Infarction  Myocardial infarction (MI) caused by lack of blood supply to the heart muscle (ischemia)  Atherosclerosis or a thrombus obstructs blood flow through an artery  Area damaged may be small or large  Sudden cardiac death can occur  One or more signs  Box 37-6: Signs and Symptoms of MI (p. 865)  Emergency care immediately Efforts to relieve pain, stabilize vitals, give Treatment oxygen, and calm the person for After MI—activities are increased gradually Myocardial Infarction Cardiac rehabilitation program Lifestyle changes Critical Thinking!  Mr. Stanley is a 90-year-old resident who resides in Hoag 2. He is a very social man who enjoys being around other residents. He takes part in most activities offered by the recreation therapist. He mobilizes using a 4ww. Two weeks ago, Mr. Stanley had an MI, CPR was initiated by staff and he was transferred to PAH. Mr. Stanley had suffered a Myocardial Infarction and had coronary artery bypass surgery. He was transferred back to Hoag 2 after a 3 week stay in the Cardiac unit at PAH.  Based on your knowledge of an MI, develop a care plan that will best meet Mr. Stanley’s needs. Think of his diagnosis. Sudden Cardiac Arrest  Sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness.  The condition usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to your body.  If not treated immediately, sudden cardiac arrest can lead to death. With fast, appropriate medical care, survival is possible.  Giving cardiopulmonary resuscitation (CPR), using a defibrillator — or even just giving compressions to the chest — can improve the chances of survival until emergency workers arrive. Signs & Symptoms of Cardiac Arrest Sudden collapse No pulse No breathing Loss of consciousness Causes of Cardiac Arrest  Arrhythmia  Coronary artery disease  Myocardial Infarction  Congenital heart disease Critical Thinking!  Explain the difference between a heart attack and cardiac arrest?  What part of the heaty is effected?  Signs & symptoms? How long do they last?  What action do you take? Congestive Heart Failure  Congestive heart failure (CHF) occurs when the heart cannot pump blood normally—blood backs up and causes congestion of tissues Congestive Heart Failure Right-sided failure—blood backs up Left-sided heart failure—blood backs into the vena cava and into the veins up into the lungs Feet, ankles swell (edema), neck veins bulge, and Respiratory congestion—difficulty breathing abdomen is congested with fluid (dyspnea), increased sputum, cough, gurgling sounds Liver congestion decreases liver function in lungs Severe left-side failure = pulmonary edema and death can occur Organs do not get enough blood Treatment for Congestive Heart Failure SODIUM-RESTRICTED OXYGEN—SEMI- WEIGH DAILY— INTAKE AND OUTPUT GOOD SKIN CARE; DIET FOWLER’S OR INDICATES FLUID (I&O); RESTRICTED ROM EXERCISES FOWLER’S POSITION BUILDUP FLUIDS ASSISTANCE WITH ELASTIC STOCKINGS TRANSFERS, AMBULATION Arrhythmias  Abnormal heart rhythms—may skip a beat or have extra beats  Usually not life-threatening, but can be serious  Pacemakers—medical devices implanted in the body to monitor heart rate and give small electric shocks to stimulate the heart  People with pacemakers should avoid electric or magnetic fields Critical Thinking!  Can you remove someone's pacemaker when doing care for them?  What is the purpose of a pacemaker?  What are complications of a pace maker?  Explain precautions with a pace maker and the following:  Cell phone  Airport security  Electrical blanket  Power tools or gardening tools  Microwave  How would a pace maker play a factor in end of life care? Phlebitis  Is an inflammation of the vein  Occurs most often in the leg  Can be caused by bacterial infection, a chemical irritation, trauma, lupus, or a genetic condition  Signs include redness and warmth in the area, pain, burning, swelling Thrombus  Is a blood clot  If it occurs in a large blood vessel, it will decrease blood flow through the blood vessel  If it occurs in a small blood vessel, it may stop the blood flow  Can form as the result of a stroke, heart attack, deficiencies in bloods clotting ability, or extended periods of inactivity  A travelling blood clot is called an embolus Critical Thinking!  What assessments are you doing for your resident if they have an IV line?  What clothing do you give someone who has a history of DVT?  What is the difference between an embolus and pulmonary embolus?