Cardio Introduction PDF

nursingcaremngt112: oxygenation&perfusion mpesinable lecturer nursingcaremngt112: respiratorysystem 1: Introduction 2 LEARNING OBJECTIVES 1. Describe the relationship between the anatomic structures and the physiologic function...

nursingcaremngt112: oxygenation&perfusion mpesinable lecturer nursingcaremngt112: respiratorysystem 1: Introduction 2 LEARNING OBJECTIVES 1. Describe the relationship between the anatomic structures and the physiologic function of the cardiovascular system. 2. Incorporate assessment of cardiac risk factors into the health history and physical assessment of the patient with cardiovascular disease. 3. Discriminate between normal and abnormal assessment findings. CARDIOVASCULAR SYSTEM - The transportation system of the body CARDIOVASCULAR SYSTEM Comprises: 1. Heart 2. Blood 3. Blood vessels  Heart - a hollow, muscular, 4 chambered organ located in the Mediastinum Layers of the Heart  Chambers and Valves Chambers: Valves: 1. RA 1. Tricuspid 2. RV 2. Pulmonic 3. LA 3. Bicuspid 4. LV 4. Aortic Coronary arteries Cardiac Electrophysiology 3 physiologic characteristics of the nodal cells and the Purkinje cells: 1. Automaticity 2. Excitability 3. Conductivity Pacemakers of the Heart SA node: - 60-100 bpm intrinsic HR - dominant pacemaker AV node: 40-60 bpm intrinsic HR back-up pacemaker Ventricular cells: 20-45 bpm 30-40 bpm intrinsic HR Action potential Nodal and purkinje cells - generate and transmit impulses across the heart, stimulating the cardiac myocytes (working cells) to contract. depolarization repolarization PQRST  Action potential SA node Spreads through the walls of the atria Atria contracts - P wave Slowdown ( allows ventricle fill with blood) AV node Bundle of HIS Q wave Purkinje fiber Spreads to ventricle Ventricles contract RV - S wave LV - R wave Ventricles relax - T-wave  Cardiac output - the total amount of blood ejected by one of the ventricles in liters per minute Stroke volume - is the amount of blood ejected from one of the ventricles per heartbeat. Factors that determines the stroke volume: 1. Preload – the degree of stretch the ventricular cardiac muscle fibers at the end of the diastole 2. afterload - resistance to ejection of blood from the ventricle - the second determinant to stroke volume 3. contractility - the force generated by the contracting myocardium CARDIOVASCULAR SYSTEM Blood vessels: 1. Arteries 2. Veins 3. Capillaries Cardiovascular Assessment: SUBJECTIVE DATA GATHERING History: A. Biographic and Demographic Data - age, race, gender and heredity B. History of present illness Chief Complaint - reason the patient is seeking health care Cardiovascular Assessment: C. Presenting symptoms 1. Date and mode of onset - to find out when and how the symptoms first began Example: - has the shortness of breath been a problem For weeks, or a new occurrence ? COLD SPA C – character describe the sign & symptom O – Onset when did it begin. L – location: Where is it? Does it radiate? D – duration: how long does it last? Does it recur? COLD SPA how bad is it? S – severity: what makes it better/ worst? P – pattern: what are the other A – associated signs & symptoms that occurs with it? factors: Clinical Manifestation 1. Chest pain 2. Palpitation 3. Dyspnea 4. Orthopnea 5. Cough 6. Nocturia  PAIN ASSESSMENT PQRST P - precipitating/predisposing factors etiology or provoking factors Q – quality. “ explain the feeling of pain “ Crushing? burning ? Etc. R –Region/radiation “ where is the origin and how far does it radiate “ PAIN ASSESSMENT PQRST S – severity 0= no pain; 1-3= mild; 4-6 moderate; 7-10= severe in a range of 1-10, how painful it is ? T –timing ( onset of duration ) is it recurrent ? Persistent ? Intermittent ? Clinical Manifestation 2. Palpitation - a sensation of a racing heart beat, irregular or skipped beats. 3. Dyspnea - may indicate imbalance of arterial oxygen supply and demand 4. Orthopnea - presence of dyspnea when patient lies flat Clinical Manifestation 5. Cough - may suggest pulmonary congestion 6. Nocturia - a need to urinate often at night. Clinical Manifestation D. Past Medical History 1. Childhood illnesses and immunizations 2. Previous Illnesses and hospitalization Cardiovascular Assessment: 3. Diagnostic/ Interventional Cardiac procedures or surgeries Ex. Cardiac catheterization, 2d Echo, ECG, hospital admission, etc. Cardiovascular Assessment: 4. Medications 5. Cultural considerations 6. Allergies E. Family Health History Disease Maternal Paternal Hypertension x Myocardial x Infarction Coronary Artery x Disease x Diabetes mellitus Cardiovascular Assessment: F. Risk factors 1. Non Modifiable - not subject to interventions to decrease their significance ( gender, family History and race ) 2. Modifiable - cigarette smoking, hypertension, hypercholesterolemia, physical inactivity, DM, stress, and obesity Cardiovascular Assessment: G. Social History H. Occupation - job stress I. Culture J. Environment - exposure to pollutants and chemicals - secondhand smoke K. Habits Topics for questioning: Formula = packs smoked per day x years smoked K. Habits 2. Coping and Tolerance - anxiety, depression, - Stress ( sources, recent or ongoing stressors) K. Habits 3. alcohol consumption 4. eating habits 5. Activity and exercise K. Habits Exercise 1. Determine change in activity pattern for the past 6 months 2. Fatigue 3. Exercise - intensity/ duration / frequency  K. Habits - low level of physical activity - consumption of excess calories, - inherited genes = obesity K. Habits 6. Sexuality and reproduction - physical demands are greatest during orgasm - reproductive history - menopausal status  K. Habits 7. Rest and sleep When/ how patient sleeps or rests: - recent sleep changes - sleeping upright in a chair instead of bed - no. of pillows - awakening short of breath K. Habits 8. Nutrition Factors to consider: 1. Current height and weight - waist measurement - BP, Laboratory tests K. Habits 8. NUTRITION 2. How often the patient self monitors 3. Level of awareness 4. He normally eats and drinks 5. Eating habits K. Habits 9. Elimination - nocturia - straining during defecation/ Urination - bloating, diarrhea, constipation, - Heartburn, nausea and vomiting K. Habits 10. Self perception and self concept Make difficult lifestyle changes – quit smoking NON COMPLIANCE - patient who do not understand consequences fail to return to normal functioning K. Habits 10. Roles and relationships 1. Who is the primary caregiver? 2. with whom does the patient lives? 3. Are their adequate services in place to provide a safe home environment 4. significant effect of cardiac illness - roles in the family 5. Adequate finances and health consequences