CARDIOVASCULAR Lecture 2.pdf

CARDIOVASCULAR SYSTEM DN 2114  LEARNING OUTCOMES At the end of the lecture, the student will be able to : 1. Describe the types of data to be collect when caring for a client with a disorder of the cardiovascular system 2. Disc...

CARDIOVASCULAR SYSTEM DN 2114  LEARNING OUTCOMES At the end of the lecture, the student will be able to : 1. Describe the types of data to be collect when caring for a client with a disorder of the cardiovascular system 2. Discuss the diagnostic tests commonly performed to diagnose disorders of the cardiovascular system 3. Discuss the nursing care that needs to be provided for clients undergoing diagnostic tests SEO 3113 S 3 Jan 2013  Nursing assessment Includes a patient health history and physical examination Acute problem focus on the most serious signs and symptoms and physical assessment data until the patient is stable Stable or chronic cardiac conditions a complete nursing assessment is done on admission.  Subjective Data Risk factors Increase serum lipids Smoking Sedentary lifestyle Obesity Stress  Health History Medical History Past and current symptoms History of childhood illness Other medical conditions Hypertension, Asthma, pulmonary disease, Diabetes Mellitus, kidney disease, cerebral vascular accident or brain attack, transient ischemic attack, renal disease, anemia, streptococcal sore throat, congenital heart disease, thrombophlebitis, and alcoholism Allergic to dye  Health History Medications Use of prescribed drugs over-the-counter medications such as aspirin - prolong clotting time patient’s understanding of the medication and the medication name, dosage, reason for taking, last dose, and length of use  Health History Family history Familial disorders - varicose veins, intermittent claudication, asthma, kidney disease, obesity Sudden death of family member prior to age of 60 years  Health History Other history Constipation – leads to staining - valsava - stimulate vagus nerve - reduce heart rate Exercise intolerance Dyspnoea Sexual problems – Erectile dysfunction - medication Hormonal therapy - blood clots  Objective data Physical assessment Blood pressure including orthostatic (correct size cuff) Pulse apical pulseis auscultated for 1 minute to assess rate and rhythm documented as regular or irregular. compared with the radial rate to assess equality Respiration The rate and ease of respirations are observed Breath sounds are auscultated. Sputum characteristics such as amount, color, and consistency are noted  Objective data Inspection shortness of breath when patient speaks or moves. skin is noted for oxygenation status Hair distribution on the extremities Venous blood return is assessed internal and external jugular neck veins are observed for distention Capillary refill time assesses arterial blood flow to the extremities Clubbing of the nailbed  Objective data Palpation palpate the arteries temperature of the extremities-A warm or hot extremity indicates a venous blood flow problem Edema is palpated in the extremities and dependent areas such as the sacrum for the supine patient  Objective data Percussion Percussion is performed by a physician to detect cardiac enlargement. Usually only the left border of the heart can be percussed. The heart is heard as dullness,which is in contrast to the resonance heard over the lungs  Objective data Auscultation heart sounds heard with a stethoscope placed on the wall of the chest The first heart sound (S1) is heard at the beginning of systole as“lubb” when the tricuspid and mitral (AV) valves close The second heart sound (S2) is heard at the start of diastole as “dupp” when the aortic and pulmonic semilunar valves close Normally no other sounds are heard between S1 and S2 Having patients lean forward or lie on their left side can make the heart sounds easier to hear by bringing the area of the heart where the sound may be heard closer to the chest wall.  Objective data Auscultation Murmurs are caused by turbulent blood flow through the heart and major blood vessels. A murmur is a prolonged sound caused by a narrowed valve opening or a valve that does not close tightly. A pericardial friction rub occurs from inflammation of the pericardium The intensity of a rub can range from soft and faint to loud enough to be audible without a stethoscope. A rub has a grating sound like sandpaper being rubbed together that occurs when the pericardial surfaces rub together during the cardiac cycle.  Diagnostic Studies Diagnostic test results combined with the health history and physical assessment to plan care for the patient.  NON-INVASIVE STUDIES Chest X-ray Examination. Cardiac Calcium Scan Magnetic Resonance Imaging Electrocardiogram. Holter Monitoring Pressure Measurement Tilt Table Test Exercise Tolerance Testing Cardiac Stress Test Echocardiogram Doppler Ultrasound.  NON-INVASIVE STUDIES Blood Studies C-reactive Protein (CRP) Cardiac Troponin Cardiac Enzymes Creatine Kinase Myoglobin Blood Lipids  INVASIVE STUDIES. Angiography. - Two types - Arteriography and venography Cardiac Catheterization Hemodynamic Monitoring. Electrophysiologic Study.  Cardiac Catheterization It is an invasive diagnostic procedure which involves the insertion of catheter into the heart and surrounding vessels to obtain detailed information about the structure and function of the heart  Purposes 1. Confirm a diagnosis of the heart disease and determine the extent. 2. Determine congenital abnormalities 3. Obtain pressures within the heart chambers and the great vessels. 4. Obtain a clear picture of cardiac anatomy before heart surgery. 5. Measure blood oxygen concentration, tension, and saturation within the heart chambers.  Purposes 6. Determine cardiac output 7. Perform angiography for better coronary artery visualization 8. Obtain endocardial biopsies 9. Allow infusion of fibrinolytic agents directly into an occluded coronary artery to restore blood flow  Angiography A technique in which a contrast agent is injected into the vascular system to outline the heart and blood vessel. When a specific heart chamber or blood vessel is singled out for study, the procedure is known as selective angiography.  Angiography It is usually performed during Cardiac catheterization Common sites: 1. Right heart catheterization 2. Left heart catheterization 3. Aortography 4. Coronary arteriography  Right Heart catheterization It involves the passage of a catheter from an antecubital or femoral vein into the right Atrium, right ventricle, pulmonary artery, and pulmonary arterioles.  Left Heart Catheterization Blue color indicates catheter insertion It involves insertion of the catheter into the right brachial artery or a femoral artery and advances it into the Aorta and left ventricle  Aortography Is a form of angiography that outlines the lumen of the aorta and the major arteries arising from it.  Coronary arteriography The catheter is introduced into the right or left brachial or femoral artery, then passes into the ascending aorta and manipulated into the right and left coronary arteries  https://www.youtube.com/watch?v=kY5gKdF WT3k  Nursing Care Pre procedure care The client must be physically and emotionally prepared. STEPS: Explain the procedure, purpose, and its hazards. Obtain informed consent for the procedure  Nursing Care Determine any history of allergies, particularly to iodine-containing substances or shellfish. Solid food must be withheld for 6 to 8 hours and liquids for at least 4 hours before the procedure to prevent vomiting & aspiration. Record the client’s height and weight for calculating the amount of dye. The peripheral pulses must be marked distal to the probable cannulation sites & recorded in the chart  Nursing Care Administer prescribed medications (sedative, antibiotic) The insertion site may be prepared by shaving and cleansing it with an antiseptic solution. An intravenous catheter must be inserted.  Post Procedure Nursing Care GOAL: Assessment, prevention, and early detection of complications. CARE: Vital signs must be assessed every 15 minutes for 1 hour, every 30 minutes for 2 hours, and then less frequently.  Post Procedure Nursing Care The extremity in which the catheter was inserted must be kept straight for 4 to 6 hours after the procedure, and it must be immobilized. The pressure dressing over the puncture site must be checked for intactness and for evidence of bleeding. Occasionally, a sandbag is applied to the insertion site for 4 to 6 hours.  Post Procedure Nursing Care The site must be monitor for hematoma formation and the client questioned about the presence of increasing pain or tenderness. The pulse, color, warmth, and sensation of the extremity distal to the insertion site must be checked and documented every 30 minutes during the first hour. Fluid intake should be encouraged if client condition allows.  Post Procedure Nursing Care 8. Observe for nausea, vomiting, rash, and other signs of hypersensitivity to the contrast medium. 9. Provide emotional support to the client and significant others  Complications 1. Vasospasm or clot formation 2. Arterial occlusion 3. Dysrhythmias 4. Anginal pain 5. Allergic reaction 6. Dehydration 7. Myocardial and Aortic perforations (rare)  Exercise Stress Test Stress testing or Exercise ECG involves using controlled and carefully supervised exercise to increase myocardial oxygen demands and evaluating the coronary arteries ability to meet the increased demands successfully.  Purposes Stress test helps to determine Presence of CAD Cause of chest pain Functional capacity of the heart after an MI & cardiac surgery Effectiveness of antianginal & antiarrhythmic drugs Dysarrhythmias that occur at physical exercise Specific goal for a physical fitness programme  Contraindications 1. Acute MI unstable angina pectoris, heart failure, pericarditis, myocarditis, endocarditis, life threatening dysrhythmias, thrombophlebitis, recent systemic embolus, dissecting or enlarging aneurysm 2. OTHERS: renal failure, severe pulmonary disruptions, neurological impairment (stroke)  Modes of Exercise Bicycle ergometry and Treadmill  Stages Single stage – exercise workload is constant throughout the test. Multiple stage – increasing the exercise workload in increments until a desired point is reached, may occur every 1 to 5 minutes.  Findings 1. A positive exercise test is one that must be terminated before the predicted maximal have been achieved owing to manifestations of cardiovascular intolerance. 2. Alterations in the ST segment and T wave on the ECG during exercise and recovery are often considered diagnostic of coronary artery disease.  Nursing Care 1. Inform the client regarding purposes, and risks of exercise testing. 2. Describe equipment used, sensations and experiences that the client may have during the test 3. Obtain informed consent sign 4. Instruct the client to be fast for 4 hours before the test & to avoid stimulant such as tobacco & caffeine 5. Detailed examination, & baseline, resting ECG.  Nursing Care 6. Monitor client’s BP during the test. 7. Observe for signs of client fatigue or claudication. 8. Monitor client condition for 10 to 15 minutes after the test  ECHOCARDIOGRAPHY The echocardiogram is a noninvasive diagnostic procedure based on the principles of ultrasound, used to evaluate structural and functional changes of the heart.  Purposes 1. To asses & diagnose pericardial effusion, cardiomyopathy, valvular disorders, myocardial ischemia. 2. To determine the chamber size, left ventricular function, ventricular aneurysms, and cardiac tumors. 3. It is useful during biopsies to view the heart on a monitor while taking tissue samples.  Procedure 1. It is performed by placing a transducer on several areas of the chest wall. 2. This transducer emits short pulses of high- frequency sound through the chest wall and heart. 3. Wave pulses bounce off tissues of varying density and are reflected back to the transducer as a series of echoes, thus creating an image via an oscilloscope graph 4. An ECG is recorded simultaneously to assist with interpreting the echocardiogram ECHOCARDIOGRAPHY  Nursing Care 1. Explanation about procedure 2. Reassurance 3. Positioning of the patient during procedure 4. Assist with cardiologist https://www.youtube.com/watch?v=yVZ7jvsg yU4 Which of the following is a modifiable cardiovascular risk factor that should be noted during patient data collection? A. Age B. Gender C. Ethnic origin D. Tobacco use Which of the following describes the purpose of the endocardium of the heart? A. Covers the heart muscle and prevents friction. B. Supports the coronary blood vessels. C. Lines the chambers of the heart and prevents abnormal clotting. D. Prevents backflow of blood from atria to ventricles. The mitral and tricuspid valves prevent backflow of blood from which of the following? A. Ventricles to atria when the ventricles contract B. Atria to ventricles when the ventricles relax C. Ventricles to atria when the atria contract D. Atria to ventricles when the atria contract The function of the coronary blood vessels is to do which of the following? A. Prevent abnormal clotting within the heart. B. Bring oxygenated blood to the myocardium. C. Carry deoxygenated blood to the lungs. D. Carry oxygenated blood to the lungs  If it takes longer than 3 seconds for the color to return when assessing capillary refill, it may indicate which of the following? A. Decreased arterial flow to the extremity B. Increased arterial flow to the extremity C. Decreased venous flow from the extremity D. Increased venous flow from the extremity In which area should the nurse assess a patient who is on bedrest for the presence of edema? A. Arms B. Ankles C. Sternum D. Sacrum  REFERENCES Waugh & Grant (2018) Ross and Wilson Anatomy and Physiology in Health and Illness International Edition, 13th Edition. Churchill Livingstone Hinkle, J.L., & Cheever, K.H. (2017). Brunner & Suddarth’s Textbook of Medical Surgical Nursing.14thed. Lippincott Williams & Wilkins, Philadelphia LeMone, p., Burke, K.M. & Bauldoff, G. (2013) Medical- Surgical Nursing: Pearson New International Edition 5th Edition, Pearson Labus, D. (2009) Assessment: An Incredibly Easy! Pocket Guide, 2nd Edition: Lippincott Williams n Wilkins Coviello, J.S.(2016) ECG Interpretation: An Incredibly Easy Pocket Guide. 3rd Edition. Wolter Kluwer THANK YOU