1-Unit 1 & 2 Cardiac nursing, Heart Anatomy (4).pdf

INTRODUCTION TO CARDIAC NURSING CVN 831 BY MUNAZZA AHMED, APN REFERENCE BOOK Cardiac Nursing: The Red Reference Book for Cardiac Nurses Perpetua 7th Edition ISBN 10: 1975106326  LEARNING OBJECTIVES Understand and discuss the Standards of A Cardiac Nurse Review An...

INTRODUCTION TO CARDIAC NURSING CVN 831 BY MUNAZZA AHMED, APN REFERENCE BOOK Cardiac Nursing: The Red Reference Book for Cardiac Nurses Perpetua 7th Edition ISBN 10: 1975106326  LEARNING OBJECTIVES Understand and discuss the Standards of A Cardiac Nurse Review Anatomy of the Heart , including coronary arteries and veins  STANDARDS OF CARDIOVASCULAR NURSING: ASSESSMENT The cardiovascular registered nurse collects comprehensive data pertinent to the patient’s health or the situation. DIAGNOSIS The cardiovascular registered nurse analyzes the assessment data to determine the nursing diagnoses or the issues. OUTCOMES IDENTIFICATION The cardiovascular registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. PLANNING The cardiovascular registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. IMPLEMENTATION The cardiovascular registered nurse implements the identified plan.  STANDARDS OF CARDIOVASCULAR NURSING: COORDINATION OF CARE The cardiovascular registered nurse coordinates care delivery. HEALTH TEACHING AND HEALTH PROMOTION The cardiovascular registered nurse employs strategies to promote health and a safe environment. CONSULTATION The advanced practice registered nurse (APRN) provides consultation to influence the identified plan, enhance the abilities of others, and effect change. PRESCRIPTIVE AUTHORITY AND TREATMENT The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies based on education, certification, credentialing, and APRN scope of practice in accordance with state and federal laws and regulations. EVALUATION The cardiovascular registered nurse evaluates progress toward attainment of outcomes.  STANDARDS OF CARDIOVASCULAR NURSING: ETHICS The cardiovascular registered nurse practices ethically. EDUCATION The cardiovascular registered nurse attains knowledge and competence that reflects current nursing practice. EVIDENCE-BASED PRACTICE AND RESEARCH The cardiovascular registered nurse integrates evidence and research findings into practice. QUALITY OF PRACTICE The cardiovascular registered nurse contributes to quality nursing practice. COMMUNICATION The cardiovascular registered nurse communicates effectively in a variety of formats in all areas of practice.  STANDARDS OF CARDIOVASCULAR NURSING: LEADERSHIP The cardiovascular registered nurse demonstrates leadership in the practice setting and the profession. 17.COLLABORATION The cardiovascular registered nurse collaborates with patient, family, and others in the conduct of nursing practice. PROFESSIONAL PRACTICE EVALUATION The cardiovascular registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. RESOURCE UTILIZATION The cardiovascular registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. STANDARD ENVIRONMENTAL HEALTH The cardiovascular registered nurse practices in an environmentally safe and healthy manner ANATOMY AND FUNCTION OF THE HEART  INTERESTING FACTS: If one assumes an average rate of contraction of 75 The heart is the strongest muscle of the body, and it can contractions per minute, a human heart contracts pump 2000 gallons every day approximately 108,000 times in one day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan.  CONCEPT OF HEART THE CARDIOVASCULAR SYSTEM IS A CLOSED SYSTEM OF THE HEART AND BLOOD VESSELS. THE HEART PUMPS BLOOD THROUGH A CLOSED SYSTEM OF BLOOD VESSELS. BLOOD VESSELS ALLOW BLOOD TO CIRCULATE TO ALL PARTS OF THE BODY LOCATION OF THE HEART: THE HUMAN HEART IS LOCATED WITHIN THE THORACIC CAVITY, MEDIALLY BETWEEN THE LUNGS IN THE SPACE KNOWN AS THE MEDIASTINUM. WITHIN THE MEDIASTINUM, THE HEART IS SEPARATED FROM THE OTHER MEDIASTINAL STRUCTURES BY A TOUGH MEMBRANE KNOWN AS THE PERICARDIUM, OR PERICARDIAL SAC, AND SITS IN ITS OWN SPACE CALLED THE PERICARDIAL CAVITY. The dorsal surface of the heart lies near the bodies of the vertebrae Its anterior surface sits deep to the sternum and costal cartilages. The right side of the heart is deflected anteriorly, and the left side is deflected posteriorly. The slight deviation of the apex to the left is reflected in a depression in the medial surface of the inferior lobe of the left lung, called the cardiac notch. SHAPE AND SIZE OF THE HEART: The shape of the heart is like a pinecone. A typical heart is approx. the size of your fist: 12 cm (5 in) in length, 8 cm (3.5 in) wide, and 6 cm (2.5 in) in thickness. The weight of a female heart is approximately 250–300 grams (9 to 11 ounces), and the weight of a male heart is approximately 300–350 grams (11 to 12 ounces). The heart of a well-trained athlete, especially one specializing in aerobic sports, can be considerably larger than this. Hearts of athletes can pump blood more effectively at lower rates than those of nonathletes.  FUNCTION OF HEART: To deliver oxygen and nutrients to the body tissues and remove carbon dioxide and wastes products. The organ works ceaselessly, beating 100,000 times a day, 40 million times Heart speeds up or slowdowns automatically in response to nerve  signals from the brain that tell it how much the body is being exerted  MEMBRANES OF HEART: The membrane that directly surrounds the heart and defines the pericardial cavity is called the pericardium or pericardial sac The pericardium, which literally translates as “around the heart,” consists of two distinct sublayers: the sturdy outer fibrous pericardium and the inner serous pericardium. The fibrous pericardium is made of tough, dense connective tissue that protects the heart and maintains its position in the thorax. The more delicate serous pericardium consists of two layers: the parietal pericardium, which is fused to the fibrous pericardium, and an inner visceral pericardium, or epicardium, which is fused to the heart and is part of the heart wall. The pericardial cavity, filled with lubricating serous fluid, lies between the epicardium and the pericardium. MEMBRANES OF HEART: Cardiac Tamponade It excess fluid builds within the pericardial space, it can lead to a condition called cardiac tamponade, or pericardial tamponade. LAYERS OF HEART: The wall of the heart is composed of three layers of unequal thickness. From superficial to deep, these are epicardium, myocardium, and endocardium. The outermost layer of the wall of the heart is also the innermost layer of the pericardium, the epicardium, or the visceral pericardium. The middle and thickest layer is the myocardium, made largely of cardiac muscle cells. Contraction of the myocardium results in pumping of blood through the heart. The innermost layer of the heart wall, is endocardium, is joined to the myocardium with a thin layer of connective tissue. The endocardium lines the chambers where the blood circulates and covers the heart valves. It is made of simple squamous epithelium called endothelium, which is continuous with the endothelial lining of the blood vessels. Recent evidence indicates that the endothelium of the endocardium and the coronary capillaries may play active roles in regulating the contraction of the muscle within the myocardium. SEPTA OF THE HEART: The word septum is derived from the Latin for “something that encloses;” in this case, a septum (plural = septa) refers to a wall or partition that divides the heart into chambers. The septa are physical extensions of the myocardium lined with endocardium. Interatrial Septum: located between the two atria Normally in an adult heart, the interatrial septum bears an oval-shaped depression known as the fossa ovalis, a remnant of an opening in the fetial heart known as the foramen ovule. Interventricular Septum: Between the two ventricles. It is thicker than the interatrial septum, since the ventricles generate far greater pressure when they contract. Atrioventricular Septum: Between the atria and ventricles.  CHAMBERS OF HEART: The human heart consists of four chambers: The left side and the right side each have one atrium and one ventricle. Each of the upper chambers acts as a receiving chamber and contracts to push blood into the lower chambers and The right ventricle and the left ventricle. The Lower Chambers serve as the primary pumping chambers of the heart, propelling blood to the lungs or to the rest of the body.  VALVES OF HEART: Located in each of these openings between the atria and ventricles is a valve, a specialized structure that ensures one-way flow of blood. The valves ensure uni-directional blood flow through the heart.  VALVES OF HEART: Atrioventricular or Tricuspid Valve: Between the right atrium and the right ventricle is the right atrioventricular valve, or tricuspid valve. It typically consists of three flaps, or leaflets, made of endocardium reinforced with additional connective tissue. The flaps are connected by chordae tendineae to the papillary muscles, which control the opening and closing of the valves. Pulmonary valve or semilunar valve: Emerging from the right ventricle at the base of the pulmonary trunk is the pulmonary semilunar valve, or the pulmonary valve; it is also known as the pulmonic valve or the right semilunar valve. The pulmonary valve is comprised of three small flaps of endothelium reinforced with connective tissue. When the ventricle relaxes, the pressure differential causes blood to flow back into the ventricle from the pulmonary trunk. This flow of blood fills the pocket-like flaps of the pulmonary valve, causing the valve to close and producing an audible sound. Unlike the atrioventricular valves, there are no papillary muscles or chordae tendineae associated with the pulmonary valve.  VALVES OF HEART: Mitral Valve or Bicuspid Valve or Atrioventricular Valve: Located at the opening between the left atrium and left ventricle is the mitral valve, also called the bicuspid valve or the left atrioventricular valve. Structurally, this valve consists of two cusps, known as the anterior medial cusp and the posterior medial cusp, compared to the three cusps of the tricuspid valve. In a clinical setting, the valve is referred to as the mitral valve, rather than the bicuspid valve. The two cusps of the mitral valve are attached by chordae tendineae to two papillary muscles that project from the wall of the ventricle.  VALVES OF HEART: Aortic Valve or Aortic Semilunar Valve: At the base of the aorta is the aortic semilunar valve, or the aortic valve, which prevents backflow from the aorta. It normally is composed of three flaps. When the ventricle relaxes and blood attempts to flow back into the ventricle from the aorta, blood will fill the cusps of the valve, causing it to close and producing an audible sound. The two atrioventricular valves are open, and the two semilunar valves are closed. This occurs when both atria and ventricles are relaxed and when the atria contract to pump blood into the ventricles.  CORONARY CIRCULATION: As heart is a remarkable pump composed largely of cardiac muscle cells that are incredibly active throughout life. Like all other cells, a cardiomyocyte requires a reliable supply of oxygen and nutrients, and a way to remove wastes, so it needs a dedicated, complex, and extensive coronary circulation. And because of the critical and nearly ceaseless activity of the heart throughout life, this need for a blood supply is even greater than for a typical cell. However, coronary circulation is not continuous; rather, it cycles, reaching a peak when the heart muscle is relaxed and nearly ceasing while it is contracting. Arteries usually coloured red because oxygen rich, carry blood away from the heart to capillaries within the tissues. Veins usually coloured blue because oxygen poor, carry blood to the heart from the capillaries.  CORONARY ARTERIES: Coronary arteries supply blood to the myocardium and other components of the heart. The first portion of the aorta after it arises from the left ventricle gives rise to the coronary arteries. There are three dilations in the wall of the aorta just superior to the aortic semilunar valve. Two of these, the left posterior aortic sinus and anterior aortic sinus, give rise to the left and right coronary arteries, respectively. The left coronary artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum. The right coronary artery proceeds along the coronary sulcus and distributes blood to the right atrium, portions of both ventricles, and the heart conduction system.  CORONARY VEINS: Coronary veins drain the heart and generally parallel the large surface arteries. The great cardiac vein can be seen initially on the surface of the heart. The small cardiac vein parallels the right coronary artery and drains the blood from the posterior surfaces of the right atrium and ventricle. The anterior cardiac veins parallel the small cardiac arteries and drain the anterior surface of the right ventricle. Unlike these other cardiac veins, it bypasses the coronary sinus and drains directly into the right atrium.  HEART CIRCULATION: There are two distinct but linked circuits in the human circulation called the pulmonary and systemic circuits. Although both circuits transport blood and everything it carries, we can initially view the circuits from the point of view of gases. The pulmonary circuit transports blood to and from the lungs, where it picks up oxygen and delivers carbon dioxide for exhalation. The systemic circuit transports oxygenated blood to virtually all of the tissues of the body and returns relatively deoxygenated blood and carbon dioxide to the heart to be sent back to the pulmonary circulation. The blood exiting the systemic capillaries is lower in oxygen concentration than when it entered. The capillaries will ultimately unite to form venules, joining to form ever-larger veins, eventually flowing into the two major systemic veins, the superior vena cava and the inferior vena cava, which return blood to the right atrium. The blood in the superior and inferior venae calvae flows into the right atrium, which pumps blood into the right ventricle. The right ventricle pumps deoxygenated blood into the pulmonary trunk, which leads toward the lungs and bifurcates into the left and right pulmonary arteries. These vessels in turn branch many times before reaching the pulmonary capillaries, where gas exchange occurs: Carbon dioxide exits the blood and oxygen enters.  HEART CIRCULATION: The pulmonary trunk arteries and their branches are the only arteries in the post-natal body that carry relatively deoxygenated blood. Highly oxygenated blood returning from the pulmonary capillaries in the lungs passes through a series of vessels that join together to form the pulmonary veins—the only post-natal veins in the body that carry highly oxygenated blood. The pulmonary veins conduct blood into the left atrium, which pumps the blood into the left ventricle, which in turn pumps oxygenated blood into the aorta and on to the many branches of the systemic circuit. Eventually, these vessels will lead to the systemic capillaries, where exchange with the tissue fluid and cells of the body occurs. In this case, oxygen and nutrients exit the systemic capillaries to be used by the cells in their metabolic processes, and carbon dioxide and waste products will enter the blood and then again the blood exiting the systemic capillaries into the two major systemic veins, the superior vena cava and the inferior vena cava, which return blood to the right atrium. This process of blood circulation continues as long as the individual remains alive. CONDUCTION SYSTEM OF HEART: A lifelong series of electrical impulses generated in the heart by its specialised cells cause the muscle fibres of atria and ventricles to contract and relax rhythmically and in a coordinated manner. These specialised cell constitute the conduction system of the Heart.  CONDUCTION SYSTEM OF HEART: The conduction system of heart includes the following structures:- The sinoatrial node (S.A.Node) which is in the right atrial wall near to the opening of the Superior Vena Cava. The atrioventricular node (A.V.Node) which lies along the lower part of the intra- atrial septum. The bundle of His which originates at the A.V.Node and extends down the inter- ventricular septum as right and left bundle branches. The purkinjee fibres that are distributed in the ventricles. CONDUCTION SYSTEM OF HEART:  IMPORTANT TO KNOW: The S.A. node is normally the dominant pacemaker of the heart that generates impulses for the contraction of the heart. If S.A.node fails to function, the impulse may arise in any one component of the conduction system lower down A.V.Node, bundle of His, bundle branches, or Purkinjee fibres (usually in that order). The site of origin of impulse in such circumstances is called “Secondary pacemaker”. The S.A. node normally send impulses at the rate of 60-100 times per minutes, the A.V.node fires 40-60 times per minutes and Purkinjee fibres 30 to 40 times per minute. The process by which the heart is stimulated to contract is called “ Depolarization” The process by which the heart recovers from the effects of previous contraction is called “repolarization”. The depolarization and repolarization activity of atria and ventricles is electrical energy that can be sensed on the surface of body by skin electrodes. A representation of heart’s electrical activity is known as Electrocardiogram(ECG).