Download Unit 6 Cardiac F07 - Madisonville Community College

MADISONVILLE COMMUNITY COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
NURSING 202
Unit VI. Managing Care for Clients with Risk for/Actual Dysfunctions Related to
Activity-Exercise Patterns
1. Correlate the anatomy and physiology of the cardiovascular system with the
appropriate nursing assessments.
2. Describe cardiovascular changes associated with aging.
3. Describe the diagnostic tests used to monitor cardiovascular risks and function.
4. Intervene appropriately for a client experiencing cardiac dysrhythmias.
5. Discuss the use of drug therapy in the treatment of cardiovascular dysfunction.
6. Describe how the various valvular abnormalities affect cardiac function.
7. Discuss the inflammations and infections that affect cardiac function.
8. Explain the surgical management of cardiac disease.
9. Describe the care of client with coronary artery disease.
10. Correlate problems with cardiovascular function to the Functional Health Patterns
of Activity-Exercise.
UNIT CONTENT:
Lectures:
Cardiac
Coronary
PRESENTATION AND ACTIVITIES:
Observational Experiences:
Critical Care
Computer Programs:
Peripheral Vascular, Cardiac, Phys. Whiz Cardiac, and Rhythm
Interpretation
CAMPUS LAB/ESSENTIAL SKILL
Campus Labs: EKG Lab, Code Lab, Virtual Clinical Excursion – Iggy.
Congestive Heart Failure.
LEARNING OBJECTIVES
Assessment of the
Cardiovascular System
1. Review the anatomy and
physiology of the
cardiovascular system
(CV).
2. Trace a drop of blood
through the heart.
3. State the function of
cardiac valves.
4. Describe the function
and structure of the
coronary arteries.
5. Define each of the
electrophysiological
properties of the heart.
6. Explain the conduction
system of the heart.
7. Correlate the
components of the ECG
with the cardiac
conduction system.
8. Explain the events in the
cardiac cycle.
9. Discuss the factors that
are related to cardiac
output.
10. Define preload and
afterload and explain
their significance to the
work of the heart.
I.
II.
III.
IV.
V.
CONTENT OUTLINE
Anatomy & Physiology
Review
A. Heart
1. Chambers
2. Valves
3. Arteries
4. Electrophysiology
5. Conduction system3.
6. Cardiac cycle
7. Mechanical
properties
Vascular System
A. Arterial
B. Venous
Changes With Aging
Assessment
A. History
B. Physical assessment
C. Heart sounds
D. Psychosocial
Diagnostic Assessment
A. Laboratory
1.Serum markers of
myocardial
damage
2. Serum lipids
3. Homocysteine
4. Blood coagulation
tests
5. ABG’s
6. Serum electrolytes
CLINICAL OBJECTIVES
Identify factors that place a
client at risk for cardiovascular
problems
Perform a cardiovascular
assessment on a client.
Interpret diagnostic test
findings for clients with
suspected or actual cardiac
disease.
Teach a client about
preparations for tests used to
examine cardiac function.
Plan for the post-procedure
care of a client undergoing
cardiac assessment.
Assess a client for clinical
manifestations of cardiac
dysrhythmias.
Interpret common cardiac
dysrhythmias.
Identify typical assessment
findings associated with
common dysrhythmias.
ASSIGNMENTS & ACTIVITIES
Lecture
Reading Assignments:
Iggy Chapter 36
Lehne Chapter 42 (Review of
Hemodynamics)
Internet Resources:
American Heart Association
http://www.americanheart.org/
American Red Cross
http://redcross.org/
Cardiovascular System
http://www.innerbody.com/image/c
ardov.html
LEARNING OBJECTIVES
CONTENT OUTLINE
11. Compare and contrast
7. CBC
the structure and
B. Radiographic
function of the arterial
1. Chest
and venous systems.
2. Fluoroscopy
12. Recall the factors that
3. Angiography
control blood pressure.
4. Cardiac
13. Describe the CV
catheterization
changes of aging.
5. Digital subtraction
14. Identify pertinent
Angiography
information necessary
C. Other
when gathering data for
1. ECG
a CV assessment.
2. Echocardiography
15. Compare and contrast
3. Dobutamine stress
modifiable and
echocardiogram
nonmodifiable risk
4. Transesophageal
factors.
echocardiography
16. Describe the major
5. Phonocardiography
symptoms related to CV
6. Myocardial
disease.
perfusion imaging
17. Describe a pertinent
7. MRI
physical assessment for
8. Hemodynamic
a client with CV disease.
monitoring
18. Compare and contrast
VI. Medical/Surgical
the serum markers used
Interventions
to detect myocardial
VII. Related Pharmacology
damage.
VIII. Nursing Care
19. Explain the role of
A. Acute
elevated serum lipids
B. Community Based
and homocysteine in the
development of CV
disease.
CLINICAL OBJECTIVES
Select appropriate nursing
diagnoses and/or collaborative
problems for clients
experiencing cardiac
dysrhythmias.
Identify the priority nursing
diagnoses for a client
experiencing dysrhythmias.
Plan care for a client
experiencing dysrhythmias.
Develop a teaching plan for
clients experiencing common
dysrhythmias.
Teach a client to reduce risk
factors for cardiovascular
disease.
Position limb and chest leads
correctly on a patient.
Analyze an ECG strip for
rhythm.
Plan the care of a client
experiencing decreased cardiac
output as the result of a
dysrhythmia.
Administer drugs safety to
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
20. Explain the use of
coagulation studies in
the management of CV
disease.
21. Explain the role that
serum electrolytes play
in cardiac function.
22. Describe each of the
radiographic procedures
used to evaluate a client
with heart disease and
include client
preparation and related
nursing care.
23. Differentiate between a
right-sided and leftsided cardiac
catheterization.
24. Explain the measures
used to evaluate the
electrical activity of the
heart.
25. Describe the ways that a
cardiac stress test may
be performed.
26. Explain the use of
hemodynamic
monitoring.
CONTENT OUTLINE
CLINICAL OBJECTIVES
control cardiac dysrhythmias.
Monitor the effectiveness of
internal and external pacing.
Teach a client to prevent
cardiac rhythm problems
Teach a client to take
antidysrhythmic medications
safely.
Evaluate client understanding
of pacemaker monitoring
instructions.
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
Interventions for Clients
with Dysrhythmias
1. Define dysrhythmias.
2. Recall definitions of
electrophysiological
terms.
3. Explain action potential
of cardiac cells.
4. Explain the conduction
system of the heart.
5. Describe an ECG.
6. Contrast limb and chest
leads used to obtain
ECG.
7. Describe the nurse’s role
in continuous
electrocardiographic
monitoring.
8. Describe the
electrocardiographic
paper and its markings
used for measurement.
9. Relate each of the
complexes that make up
a normal ECG to the
physiologic cardiac
events.
10. Explain how the heart
rate may be estimated
using ECG paper.
CONTENT OUTLINE
I. Review of Cardiac
Electrophysiology
A. Electrophysiological
Properties
1. Automaticity
2. Excitability
3. Conductivity
4. Contractility
B. Action Potential
II. Cardiac Conduction
System
A. SA node
B. AV Junction
C. Bundle Branch System
III. Electrocardiography
A. Lead systems
1. Limb
2. Chest
B. Continuous Monitoring
C. Electrocardiographic
paper
D. Complexes, segments,
and intervals
1. P wave
2. PR segment
3. PR interval
4. QRS complex
5. QRS duration
6. ST segment
7. T wave
8. U wave
9. QT interval
CLINICAL OBJECTIVES
Assess a client for risk factors
for heart failure.
ASSIGNMENTS & ACTIVITIES
Reading Assignments:
Iggy Chapter 37
Assess a client for clinical
manifestations of heart failure.
Lehne Chapter 48
(Antidysrhythmic Drugs)
Utilize the nursing process to
care for a client with heart
failure.
Prioritize common nursing
diagnoses and collaborative
problems for clients with heart
failure.
Evaluate the effects of
interventions for reducing
preload and afterload.
Plan community-based care for
a client after pacemaker or
implantable
cardioverter/defibrillator
insertion.
Internet Resources:
American Heart Association
http://americanheart.org
LEARNING OBJECTIVES
11. State the best practice
for ECG rhythm
analysis.
12. State the criteria for
determining a normal
sinus rhythm.
13. Describe sinus
arrhythmia.
14. Explain the common
dysrhythmias and their
significance to normal
cardiac function.
15. Identify the common
etiologies for an
alternation in the normal
heart rhythm.
16. Explain the meaning of
tachydysrhythmias and
bradydysrhythmias.
17. Explain the term
premature complexes in
relationship to an ECG.
18. Name and explain
repetitive rhythms.
19. Describe how escape
complexes develop.
20. Explain how
dysrhythmias are
classified.
21. Contrast sinus and atrial
dysrhythmias.
CONTENT OUTLINE
IV. Determination of Heart
Rate
V. ECG rhythm analysis
VI. Normal Rhythms
A. NSR
B. Sinus arrhythmia
VII. Dysrhythmias
A. Tachydysrhythias
B. Bradydysrhythmias
C. Premature complexes
D. Repetitive rhythms
E. Escape complexes and
rhythms
F. Classification of
dysrhythmias
1. Sinus dysrhythmias
2. Atrial dysrhythmias
3. Junctional
dysrhythmias
4. Ventricular
dysrhythmias
5. Atrioventricular
blocks
VIII. Collaborative
Management
A. Common nursing
diagnosis and
collaborative problems
B. Planning and
implementation
1. Cardiac care
2. Nonsurgical
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
CONTENT OUTLINE
22. Identify the pacemaker
a. Drugs
rates in the junctional
b. Vagal maneuvers
cells and in the
c. Temporary
ventricular cells.
pacing
23. Describe the various
d. Cardioversion
ventricular
e. CPR
dysrhythmias.
f. Defibrillation
24. Contrast the types of AV
g. Ablation
and bundle branch
3. Surgical
blocks.
management
25. Discuss the nonsurgical
a. Permanent
management of a client
pacing
with a dysrhythmia.
b. CABG
26. Explain the mechanisms
c. Aneurysmectomy
of action of each of the
d. Insertion of
antidysrhythmic drugs.
implantable
27. Explain the effects of
cardioverter-vagal maneuvers in
defibrillator
treating supraventricular
e. Open-chest
dysrhythmias.
cardiac massage
28. Identify the purpose of
IX. Community-Based Care
temporary pacing.
A. Health teaching
29. Explain the synchronous
B. Home care
and asynchronous
management
pacing.
30. Explain invasive
temporary pacing.
31. Discuss the use of the
universal pacemaker
code.
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
32. Explain the purpose and
mechanism of action for
cardioversion.
33. Contrast cardioversion
with defibrillation.
34. Outline the procedure
and precautions
associated with
defibrillation.
35. Recall steps in CPR.
36. Describe the use of
automatic external
defibrillators.
37. State the purpose of
radio-frequency catheter
ablation.
38. Describe the surgical
placement of permanent
pacemakers and
implantable
cardioverter/defibrillator
s.
39. Discuss open-chest
cardiac massage.
40. Describe the necessary
health teaching to
prevent recurrence of
dysrhythmias.
CONTENT OUTLINE
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
CONTENT OUTLINE
Interventions for Clients
I. Heart Failure (HF)
with Cardiac Problems
A. Compensatory
1. Explain the
mechanism
pathophysiology of heart
B. Classification of HF
failure. (HF)
C. Etiology
2. Discuss the
D. Incidence/Prevalence
compensatory
II. Collaborative Management
mechanisms in a client
A. Assessment
with heart failure.
1. History
3. Classify the types of
2. Physical assessment
heart failure.
3. Clinical
4. State the conditions that
manifestations
are associated with heart
4. Psychosocial
failure.
assessment
5. Discuss special
B. Laboratory Assessment
considerations for older
C. Radiographic
adults experiencing HF.
Assessment
6. Describe subjective and
D. Other
objective cues that result III. Analysis
from left-sided and
A. Common Nursing
right-sided heart failure.
Diagnoses and
7. State the rationale for
Collaborative Problems
assessing the client’s
1. Impaired gas
psychosocial status.
exchange
8. Discuss the laboratory
2. PC: decreased
tests used to assess for
cardiac output
and evaluate the therapy
a. Reducing preload
of heart failure.
b. Reducing
9. Describe the Beta
afterload
Naturietic Peptide
3. Activity intolerance
diagnostic test used to
4. PC: Pulmonary
diagnose heart failure.
edema
CLINICAL OBJECTIVES
Evaluate the therapy of a client
being treated for heart failure.
ASSIGNMENTS & ACTIVITIES
Reading Assignments:
Iggy Chapter 38
Assess a client for clinical
manifestations of valvular
heart disease.
Lehne Chapter 47 (Drugs for Heart
Failure)
Utilize the nursing process in
caring for an individual with
valvular heart disease.
Develop a teaching plan for a
client being treated for
valvular heart disease.
LEARNING OBJECTIVES
10. Identify the nursing
diagnoses, collaborative
problems, and related
nursing care necessary
for a client with heart
failure.
11. Discuss how reducing
preload and afterload is
helpful for a client with
heart failure.
12. Describe the necessary
health teaching for a
client with HF.
CONTENT OUTLINE
B. Additional nursing
problems
IV. Planning and
Implementation
V. Community-Based Care
VI. Case Management
VII. Health Teaching
VIII. Home Care Management
IX. Evaluation
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
CONTENT OUTLINE
1. Describe how stenosis
I. Valvular Heart Disease.
and regurgitation affect
A. Mitral Stenosis
the mitral and aortic
B. Mitral Regurgitation
valves.
C. Mitral Valve Prolapse
2. Discuss the common
D. Aortic Stenosis
etiologies for the various
E. Aortic Regurgitation
valvular disorders.
II. Collaborative Management
3. Compare and contrast
A. Assessment
the key features of the
B. Interventions
various valvular heart
1. Nonsurgical
disorders.
management
4. Describe the assessment
a. Drug therapy
of a client with valvular
b. Rest
heart disease.
c. Drug therapy
5. Discuss the nonsurgical
2. Surgical management
and surgical options
a. Balloon
available to a client with
valvuloplasty
valvular heart disease.
b. Commissurotomy
6. Describe preoperative
c. Reconstruction
care for a client
d. Replacement
undergoing valve
III. Community-Based Care
surgery.
A. Health teaching
7. Identify the necessary
B. Home care management
postoperative
interventions for a client
following valve surgery.
8. Discuss health teaching
and home care
management following
diagnosis or treatment of
a valvular heart
condition.
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
1. Discuss the
pathophysiology and
etiology of infective
endocarditis.
2. Identify the incidence
and prevalence of
infective endocarditis.
3. Describe the clinical
manifestations of
infective endocarditis.
4. Describe splinter
hemorrhages, Janeway’s
lesions, and Osler’s
nodes in the diagnosis of
infective endocarditis.
5. Discuss nonsurgical and
surgical management of
infective endocarditis.
6. Discuss antibiotic
prophylaxis for a client
susceptible at risk for
infective endocarditis.
7. Discuss pericarditis and
its etiologies.
8. Contrast the types of
pericarditis.
9. Describe the assessment
and interventions
necessary to manage a
client with pericarditis.
CONTENT OUTLINE
I. Inflammations and
Infections
A. Infective Endocarditis
1. Pathophysiology
2. Etiology
3. Incidence/Prevalence
B. Collaborative
Management
1. Assessment
2. Interventions
a. Nonsurgical
Management
b. Drugs
c. Surgical
management
C. Pericarditis
1. Acute pericarditis
2. Chronic constrictive
pericarditis
D. Collaborative
management
1. Assessment
2. Interventions
a. Medical therapy
b. Monitoring for
complications
c. Managing cardiac
tamponade
C. Rheumatic carditis
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
Reading Assignments:
Lehne Chapter 83 (Penicillins)
LEARNING OBJECTIVES
CONTENT OUTLINE
10. Explain the development II. Cardiomyopathy
and monitoring for
A. Dilated
complications of
Cardiomyopathy
pericarditis.
B. Hypertrophic
11. Identify ways to manage
Cardiomyopathy
acute cardiac
C. Restrictive
tamponade.
cardiomyopathy
12. Explain the development III. Collaborative management
and management of
A. Assessment
rheumatic carditis.
B. Interventions
13. Define cardiomyopathy.
1. Nonsurgical
14. State the prognosis for
management
clients with
2. Surgical
cardiomyopathy.
management
15. Contrast dilated
a. Excision of hyper
cardiomyopathy,
trophied septum
hypertrophic
b. Cardiomyoplasty
cardiomyopathy, and
c. Heart
restrictive
transplantation
cardiomyopathy.
16. Identify the nonsurgical
treatments of
cardiomyopathy.
17. Contrast the types of
surgical procedures used
to treat cardiomyopathy.
18. Discuss heart
transplantation as a
means of treating
cardiomyopathy.
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
19. Discuss the legal/ethical
issues involved with
heart transplantation.
20. State the life expectancy
following heart
transplant.
21. Identify measures to
increase the longevity of
the new heart and signs
of rejection.
CONTENT OUTLINE
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES
LEARNING OBJECTIVES
Interventions for Critically
Ill Clients with Coronary
Artery Syndromes
1. Explain the
pathophysiology of
coronary artery disease
(CAD).
2. Contrast stable angina,
unstable angina, and
myocardial infarction
(MI).
3. Define the term acute
coronary syndromes.
4. Describe the process of
a myocardial infarction.
5. Identify modifiable and
nonmodifiable risk
factors for CAD.
6. Describe the
psychosocial aspects of
CAD.
7. Discuss the necessary
assessment data for a
client experiencing a
MI.
8. Correlates the laboratory
and radiographic
assessment to the
client’s condition.
CONTENT OUTLINE
I. Coronary Artery Disease
A. Pathophysiology
B. Stable angina pectoris
C. Acute coronary
syndromes
D. Myocardial infarction
E. Nonmodifiable risk
factors
F. Modifiable risk factors
II. Assessment
A. History
B. Clinical manifestations
C. Psychosocial assessment
D. Laboratory assessment
E. Radiographic
assessment
III. Analysis
A. Nursing diagnoses
B. Collaborative problems
IV. Planning and
implementation
A. Pain management
B. Restoration of perfusion
C. Thrombolytic and other
drug therapy
D. Activity tolerance
E. Coping enhancement
F. Monitoring for
dysrhythmias
G. Preventing heart failure
H. PTCA
I. CABG
CLINICAL OBJECTIVES
Interpret physical and
diagnostic assessment findings
in clients with CAD.
Select appropriate nursing
diagnoses and/or collaborative
problems for a client
experiencing a MI.
Prioritize care for a client with
CAD.
Develop a discharge plan for a
client with CAD and/or one
who has had a MI.
ASSIGNMENTS & ACTIVITIES
Reading Assignments:
Iggy Chapter 41
Lehne
Chapter 49 (Prophylaxis, of CAD:
Drugs That Lower LDL Cholesterol
Levels)
Chapter 51 (Anticoagulants,
Antiplatelet, and Thrombolytic
Drugs)
Chapter 52 (Management of
Myocardial Infarction)
LEARNING OBJECTIVES
9. Explain the advantages
of thrombolytic therapy
for a client experiencing
a MI.
10. Identify the lifethreatening
complications of a MI.
11. Describe the
perioperative care of a
client undergoing a
coronary artery bypass
graft (CABG),
minimally invasive
direct coronary artery
bypass, and
transmyocardial laser
revascularization.
CONTENT OUTLINE
V. Community-Based Care
VI. Health Teaching
VII. Evaluation
CLINICAL OBJECTIVES
ASSIGNMENTS & ACTIVITIES