Nursing Care in CVS PDF

NURS 3013 Heart Disease- The Silent Killer Outlines Anatomic& physiologic overview of cardiovascular system Coronary atherosclerosis Angina Myocardial infarction Congestive heart failure A& P of Cardiovascular System What is Heart Disease? A general term that covers a number of diseases...

NURS 3013 Heart Disease- The Silent Killer Outlines Anatomic& physiologic overview of cardiovascular system Coronary atherosclerosis Angina Myocardial infarction Congestive heart failure A& P of Cardiovascular System What is Heart Disease? A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina. Heart Disease is the number one killer in the United States. What Causes Heart Disease? Atherosclerosis-fatty deposits of cholesterol Hypertension-. Risk factors Age and sex Family history for Metabolic syndrome Smoking Hypertension Hypercholesterolemia DM Hemostatic factors, platelets activation- thrombosis Sedentary lifestyle/ Obesity Alcohol Coronary Artery Disease Occurs when the coronary arteries that supply the heart muscle become blocked. Partially blocked it causes angina. Fully blocked it causes a myocardial infarction or a heart attack! Coronary heart disease: clinical manifestations and pathology Clinical problem Stable angina Unstable angina Myocardial infarction Heart failure Arrhythmia Sudden death Definitions hardening of the arteries Stable angina - ischemia due to fixed atheromatous stenosis of one or more coronary arteries Unstable angina - ischemia caused by dynamic obstruction of a coronary artery due to plaque rupture or erosion with imposed thrombosis Myocardial infraction necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with imposed thrombosis Heart failure -myocardial dysfunction due to ischemia or infarction Arrhythemia - Altered conduction due to ischemia or infarction  Myocardial Infarction or Heart Attack Symptoms: uncomfortable pressure, fullness, squeezing pain, pain spreading to the shoulders, neck and arms. Chest discomfort and light headedness Anxiety/nervousness Paleness or pallor Increased irregular heart rate Myocardial Infarction contd. Feeling of impending doom If you or someone you know is having these symptoms call 911! Congestive Heart Failure Fits under the description of heart disease. Does not mean the heart has failed, simply means the heart is not doing an efficient job. It results from an injury or a reduction of function of the heart muscle. Can be due to arteriosclerosis, hypertension, myocardial infarction, rheumatic fever or birth defect. Congestive Heart Failure The right side of the heart collects the blood returning from the body and sends it to the lungs. If it is failing, the blood backs up into the veins, and there are signs of edema. The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively.  Cerebrovascular Accident or Stroke Blood vessel in the brain becomes blocked by atherosclerosis- the tissue supplied by the artery dies. Embolus – which is a traveling blood clot. Symptoms of Stroke Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sudden confusion, trouble speaking, or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. Symptoms of Stroke Sudden severe headache with no known cause. If you have any of these symptoms you need immediate medical attention! Unchangeable Risk Factors Age- the older you get, the greater the chance. Sex- males have a greater rate even after women pass menopause. Race- minorities have a greater chance. Family history- if family members have had CHD, there is a greater chance. Unchangeable Risk Factors Personal Medical History- other diseases such as Diabetes Mellitus can increase chances. Changeable Risk Factors Hypertension Serum cholesterol Obesity Diabetes Mellitus Physical Inactivity Smoking Alcohol Intake Cholesterol Everybody needs cholesterol, it serves a vital function in the body. It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. Frequently measured to promote health and prevent disease. A major component of the plaque that clogs arteries. Types of Cholesterol Lipoproteins- 4 main classes Chylomicrons Very low density lipoproteins (VLDL) Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL) Good vs. BAD LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. LDL’s are a major component of the atherosclerotic plaque that clogs arteries. Levels should be 35. High levels of HDL >60 can actually negate one other risk factor. The Facts About Fat Certain fats are essential for good nutrition and health. Fats provide essential fatty acids which the body can’t manufacture. Act as insulators to maintain body temperature. Improve the palatability of food and promote digestion. The Facts About Fat Provide the greatest energy output per gram of any food source. ( 9 cals) Carry fat soluble vitamins- A,D,E, and K. The Facts About Fat Saturated fats- basically means the fat is saturated with hydrogen, they are solid at room temperature. Examples are lard and butter. Why are they bad for you? They increase levels of LDL , decrease HDL and increase total cholesterol. The Facts About Fat What are polyunsaturated fats? They are unsaturated fats which are liquid at room temperature and in the refrigerator. Why are they good for us? They help the body get rid of newly formed cholesterol. The Facts About Fat What are monounsaturated fats? They are liquid at room temperature but start to solidify in the refrigerator. Decrease total cholesterol and lower LDL levels. The Facts About Fat What are trans fatty acids? They are unsaturated fats but they tend to raise total and bad cholesterol. Where do you find them? In fast-food restaurants Commercial baked goods. Examples: doughnuts, potato chips, cupcakes. What about Omega 3? Type of polyunsaturated fat. Consistently lowers serum triglycerides and may also have an effect on lowering blood pressure. Found in oily fish such as salmon, tuna, and herring. Is available as a supplement. Obesity People who are obese have 2 to 6 times the risk of developing hypertension. Location of the body fat is significant. Pears of apples? Diabetes Mellitus At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of atherosclerosis! Insulin is required to maintain adequate levels of lipoprotein lipase, an enzyme needed to break down bad cholesterols. Physical Inactivity Increasing physical activity has been shown to decrease blood pressure. Moderate to intense physical activity for 30- 45 minutes on most days of the week is recommended. Smoking Causes an increase in blood pressure Usually have lower levels of HDL Within 1 year of quitting, CHD risk decreases, within 2 years it reaches the level of a nonsmoker. Alcohol Consumption In small amounts it acts as a vasodilator- Good! 1-2 drinks In large amounts it acts as a vasoconstrictor- BAD! 3-4 drinks This is a very fine line! Treatment Cardiac Catherization - Dr. inserts a plastic tube into an artery or vein and injects a dye, this can help to determine where the blockages are. Also a good method to determine the amount of blood and oxygen the heart is receiving. Treatment Coronary Artery Bypass Surgery (CABG) The most frequently performed major surgery in the United States. Surgery reroutes or bypasses blood around clogged arteries. Treatment Angioplasty It involves creating a space in a blocker artery by inserting a small balloon and then inflating it. Now includes the placement of a mesh stent to improve effectiveness. Nursing process Assessment The nurse should observe & ask the patient about: When do attack tend to occur? How does the patient describe the pain? Is the onset of pain gradual or sudden How long does it last? Is the pain is steady? Is the discomfort accompanied by other symptoms? How many minutes after taking the nitroglycerin does the pain last? Full history Physical examination & clinical manifestation Interpretation of the finding of the diagnostic tests Patient's goals: ( patient will) Report pain free or pain is decreased Report anxiety level is decreased Understand nature of the disease & capable to avoid complications Adhere to the therapeutic regimen Accept the necessary of life-style changes Nursing intervention Prevention of pain Control of pain Reduction of anxiety Understanding of illness & ways to avoid complications Adherence to the self care program Patient education Goal : to improve the quality of life and promotion of health Expected outcomes: Patient prevents an episode of anginal pain Patient cope with an attack of anginal pain Patient prevents an episode of angina pain Uses moderation in all activities of life Participates in normal daily program of activities that don't produce chest discomfort, shortness of breath& fatigue Avoid exercises requiring sudden bursts of activity Refrains from engaging in physical exercise for 2 hours after meals Avoid activities that require heavy effort Alternates activities with periods of rest Prevention of Angina Avoid situations that are emotionally stressful Maintain proper weight Avoid excessive caffeine intake which can increase the heart rate& produce angina Stop smoking, since smoking increase the heart rate, blood pressure & blood carbon monoxide levels Avoid cold weather if possible Walk more slowly in cold weather Avoid walking against the wind Coping with Angina Carries nitroglycerin at all times Places nitroglycerin sublingually at first sign chest discomfort. It relieves pain within 3 minutes. Doesn't swallow saliva until the tablet has dissolved Stops activities and be in rest until all pain subsides Coping with angina Keep the upright position to potential the effect of nitroglycerin Usually another nitroglycerin tablet may be taken in 3-5 minutes if pain persist If the angina discomfort is unrelieved or reoccurs visit emergency facility Takes nitroglycerin prophylactically to avoid pain known to occur with certain activities (stair- climbing- sexual intercourse) Be alert for the side effects of nitroglycerin, headache, flushing & dizziness. How can You Stop CVD? Diet and Nutrition, there are several guidelines listed by the American Heart Association: Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals) Eat a variety of grain products ( 6 a day) Diet and Prevention of CVD Choose nonfat or low-fat products. Use lean meats- choose chicken, fish, turkey and lean cuts of beef and pork. Switch to fat-free milk- gradually reduce the fat content of the milk you drink. Dietary Guidelines Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil. Balance the # of calories you eat with the number of calories you use each day. Maintain a level of physical activity that keeps you fit and matches the # of calories you eat. Dietary Guidelines Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy. Limit foods high in saturated fat, trans fat and cholesterol Eat less than 6 gms of salt a day Have no more than one alcoholic drink a day. Step I and II Diets The AHA and NCEP have developed these diets to treat high blood pressure and hypercholesterolemia They are designed to lower LDL levels, while at the same time promoting good nutrition. Step I Step II Total fat- 30% or less 30% or less Sat fat- 7-10% 7% Poly - up to 10% up to 10% Mono Up to 15% up to 15% Carb 55% or more 55% or more Pro Approx 15% Approx 15% Chol. less than 300mg less than 200 mg Exercise and CVD Serves several functions in preventing and treating those at high risk. Reduces incidence of obesity. Increases HDL Lowers LDL and total cholesterol Helps control diabetes and hypertension Those at high risk should take part in a specially supervised program. Conclusion Cardiovascular disease is the number one killer. It is highly preventable and controllable with diet and exercise. Good resource: www.americanheart.org 1-800-AHA-USA