081-PP02L020 ELO A_Cardiovascular Disorders _V 2.0_.pdf

DISORDERS OF THE CARDIOVASCULAR SYSTEM NP02L020 ELO A · Version 2.0 Cardiovascular Disorders Foundations and Adult Health Nursing, 8th ed., pp. 1526-1528; pp. 1534-1535 Introduction to Critical Care Nursing, 8th ed., pp. 220-230; pp. 241-244, pp. 303-307 TERMINAL LEARNING OBJECTIVE Determine a...

DISORDERS OF THE CARDIOVASCULAR SYSTEM NP02L020 ELO A · Version 2.0 Cardiovascular Disorders Foundations and Adult Health Nursing, 8th ed., pp. 1526-1528; pp. 1534-1535 Introduction to Critical Care Nursing, 8th ed., pp. 220-230; pp. 241-244, pp. 303-307 TERMINAL LEARNING OBJECTIVE Determine approaches to nursing care of patients requiring life-saving resuscitation and interventions. ENABLING LEARNING OBJECTIVE Determine approaches to nursing care for patients experiencing an emergent cardiovascular disorder. EFFECTS OF NORMAL AGING ON THE CARDIOVASCULAR SYSTEM CARDIOVASCULAR DISORDERS Decline on overall deaths Nurse’s role Awareness Implementing nursing interventions Patient teaching NORMAL AGING Physiologic changes reduce efficiency of heart Older adults with high cholesterol Stop smoking Increase activity level Blood pressure medications Decrease weight Control blood glucose levels RISK FACTORS Indicator for cardiovascular disease More than one – increased risk Classification: Non-modifiable Modifiable RISK FACTORS Non-modifiable Modifiable Age Smoking Hyperlipidemia Genetics Hypertension Gender Diabetes mellitus Obesity Sedentary lifestyle Stress Type D personality MODIFIABLE RISK FACTORS Smoking Hyperlipidemia Release of catecholamines Ratio of HDL to LDL best Tachycardia indicator Hypertension VLDL (triglycerides) Vasoconstriction LDL (low density lipids) Increased workload HDL (high density lipids) Tar and carbon monoxide Saturated fat, cholesterol, Interventions calories Stop smoking Interventions Diet Weight reduction Exercise Cholesterol lowering drugs MODIFIABLE RISK FACTORS Diabetes Obesity Glucose damages the Increases workload on vessels and contributes to heart atherosclerosis Increases development Alters lipid metabolism Diabetes Interventions Cardiovascular events Control blood glucose Stroke Control blood pressure Intervention Decrease BMI MODIFIABLE RISK FACTORS Sedentary lifestyle Stress Aerobic exercise Releases catecholamines Improves efficiency Vasoconstriction Lowers BG Interventions Improves ratio of HDL to Stress reduction LDL Reduce weight Feeling of well-being Regular physical exercise MODIFIABLE RISK FACTORS Type D personality Chronic negativity Pessimistic Socially inhibited CHECK ON LEARNING A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for heart problems? A) Hyperlipidemia B) Excessive alcohol intake C) A family history of hypertension D) Closer adherence to medical regimen ACUTE CORONARY SYNDROME ACUTE CORONARY SYNDROME Stable angina, unstable angina, and acute myocardial infarction Pathophysiology Imbalance between oxygen supply and demand Decreased perfusion Secondary atherosclerosis Reduces blood flow to myocardium Prolonged ischemic leads to infarction Intervention is thrombolytics ACUTE CORONARY SYNDROME MI Classification Type I Plaque rupture Type II Imbalance between myocardial oxygen supply and demand Infarct locations Left ventricle Right inferior infarct MI Severity ACUTE CORONARY SYNDROME Assessment Classic signs and symptoms Men vs. Women Silent infarction ACUTE CORONARY SYNDROME Diagnosis Symptoms 12-lead ECG Cardiac enzymes Emergency cardiac catheterization Complications ACUTE CORONARY SYNDROME Medical Management Treatment Goal for treatment Pain relief Reperfusion Oxygenation Reduce infarct size Prevention platelet Prevent and treat aggregation complications Medications Emotional support Restore blood flow Patient education ACUTE CORONARY SYNDROME Nursing Considerations Hemodynamic monitoring Bleeding after thrombolytics Dysrhythmias Re-occlusion Hemorrhagic stroke Patient Outcomes Adequate cardiac output Tolerate progressive activity Relief of pain or fear Positive coping mechanisms CHECK ON LEARNING A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to Type II MI. The nurse should inform the patient that angina is most often attributable to what cause? A) Occluded artery. B) Arrythmia. C) Hypertension. D) Pulmonary vasospasm. INTERVENTIONS FOR CARDIAC ARREST CODE MANAGEMENT Life-saving resuscitation Rapid Response Team Designed to improve recognition Codes Interventions before Cardiac cardiopulmonary arrest Respiratory arrest Goal Improve patient outcomes Code management Decrease hospital mortality Failure to rescue leads to death IN-HOSPITAL CARDIAC ARREST Physiological instability 24 hours prior RRT components Identify clinical deterioration Rapid intervention Ongoing evaluation Activation Deterioration Predictor of cardiac arrest and death Staff concern for changes in condition Identification of high-risk patients and allow early intervention ROLE OF CAREGIVERS Prompt recognition Code team members Work with primary nurse Code leader Code nurses Anesthesiologist Respiratory therapist Pharmacist ECG technician Chaplain Other personnel CHECK ON LEARNING The goal of the rapid response team is to: a. Prevent cardiac and respiratory arrest. b. Decrease critical care unit admissions. c. Increase hospital length of stay. d. Ensure that emergency equipment are working properly CHECK ON LEARNING Discussion: You are the second nurse to respond to a code. The first nurse is administering cardiopulmonary resuscitation (CPR). Describe your first actions and their rationales. CODE EQUIPMENT Code cart Back or cardiac board Monitor-defibrillator Face mask & oxygen IV supplies & solutions Emergency medications Other items Suction NG tubes BP cuffs Cart checked every shift or every 24 hours RESUSCITATION BLS ACLS Goal: restore effective Airway circulation, oxygenation Breathing and ventilation with ROSC Compressions Differential Diagnosis Steps of BLS Reversible causes Determine H’s & T’s responsiveness Assess circulation Rapid defibrillation RECOGNITION & TREATMENT OF DYSRHYTHMIAS Ventricular fibrillation Pulseless ventricular tachycardia Shockable rhythms RECOGNITION & TREATMENT OF DYSRHYTHMIAS Pulseless electrical activity Identify and treat underlying cause Asystole Poor prognosis RECOGNITION & TREATMENT OF DYSRHYTHMIAS Symptomatic bradycardia HR less than 60 BPM Signs Hypotension/Orthostatic hypotension Diaphoresis Pulmonary congestion/edema Symptoms Chest pain Shortness of breath Decreased LOC Weakness, fatigue Dizziness, syncope RECOGNITION & TREATMENT OF DYSRHYTHMIAS Unstable Tachycardia HR greater than 100 BPM Requires rapid recognition Treatment Synchronized cardioversion Antidysrhythmic therapy CHECK ON LEARNING The nurse has entered a patient’s room and found the patient unresponsive and not breathing. What is the nurses next appropriate action? A) Palpate the patient’s carotid pulse. B) Call the Rapid Response Team. C) Begin performing chest compressions. D) Call a code blue. RETURN OF SPONTANEOUS CIRCULATION (ROSC) GOALS OF POST-RESUSCITATION Optimize cardiopulmonary function and tissue perfusion Transport to critical care Identify and treat precipitating cause of arrest GOALS OF POST-RESUSCITATION Control dysrhythmias Advanced neurological monitoring Monitor for metabolic acidosis Monitor for hyperglycemia Provide emotional support TARGETED TEMPERATURE MANAGEMENT (TTM) High temperature results in poor neurologic recovery Hypothermia decreases metabolic rate and suppresses inflammatory reactions Cool to 32-36 C METHODS TO INDUCE HYPOTHERMIA Initiate as soon as possible Continuous monitoring Core temperature Adverse effects Blood glucose Rewarming after 24 hrs. CHECK ON LEARNING Following cardiac resuscitation, a patient has been placed in a state of mild hypothermia before being transferred to the cardiac intensive care unit. The nurse’s assessment reveals that the patient is experiencing neuromuscular paralysis. How should the nurse best respond? A) Administer hypertonic IV solution. B) Administer a bolus of warned normal saline. C) Reassess the patient in 15 minutes. D) Document this as an expected assessment finding. REVIEW OF MAIN POINTS Normal effects of aging on the cardiovascular system Risk factors for the development of cardiovascular disease Acute coronary syndrome Cardiac arrest Code management Care of the patient after resuscitation QUESTIONS?