Download Chapter 81 Cardiovascular Disorders

Chapter 81
Cardiovascular Disorders
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Cardiovascular Disorders
• Cardiovascular disorders may
– Interfere with the heart’s ability to pump
– Disrupt blood flow within the coronary or cerebral
vessels
– Disrupt blood flow to a localized area
• Cardiac nurses
• Coronary care unit (CCU)
• Coronary intensive care unit (CICU)
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Laboratory Tests
• Serum enzymes
– Creatinine kinase, isoenzyme, lactic dehydrogenase,
aspartate aminotransferase, troponin, and
myoglobin
• Blood lipid (fat) studies
• Serum electrolytes
– Potassium, sodium, and magnesium
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X-ray Evaluations
• Angiocardiogram (angiogram)
• Arteriogram
• Test using radiopaque dye
– Ask clients if they are allergic to shellfish or iodine.
– This dye could cause a severe anaphylactic reaction.
• Study in which the femoral site is used
– Client should lie flat for up to 8 hours to prevent
swelling, bruising, and bleeding at the puncture site.
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Other Diagnostic Tests
• Electrocardiogram
• Stress test
• Echocardiogram
• Nuclear scan
• Electrophysiology study
• Cardiac catheterization
– Immediately report a client’s rapid or irregular pulse
after cardiac catheterization.
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Common Medical Treatments
• Pharmacologic therapy: Thrombolytics or fibrinolytics
• Clients for thrombolytic therapy
– History of chest pain within the past 6 hours
– Ischemia of the heart that persists even after the
administration of sublingual nitroglycerin
– No recent history of surgery, organ biopsy,
cardiopulmonary resuscitation, hemorrhagic CVA,
bleeding abnormalities, intracranial neoplasm,
recent head injury, pregnancy, or allergy to
streptokinase
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Common Surgical Treatments
• Percutaneous transluminal coronary angioplasty
– Atherectomy
– Laser angioplasty
• Cardiac surgery
– Coronary artery bypass grafting
– Heart valve repair and replacement
– Heart transplantation
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Nursing Considerations Before Surgery
• Preoperative teaching
• Discharge planning, plans for cardiac rehabilitation.
• Client’s nutrition and capacity for healing
• Supplemental oxygenation needs before and after
surgery
• Vitamin and mineral therapy
• Routine tests and procedures
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Nursing Considerations After Surgery
• Maintaining airway and ventilation
• Providing adequate tissue oxygenation
• Monitoring and maintaining cardiac function
• Maintaining fluid and electrolyte balance
• Controlling chest drainage with suction
• Monitoring body temperature
• Identifying signs and symptoms of complications
• Relieving pain
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Question
Which of the following is an indication for heart valve
surgery?
a. Chest pain, dyspnea, syncope
b. Headaches and migraines
c. Chest congestion
d. Heartburn and intense discomfort
e. Rapid heart rate
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Answer
a. Chest pain, dyspnea, syncope
Other indications for heart valve surgery are:
– Angina, heart failure
– Mitral or aortic valvular insufficiency
– Damage to valves
– Pulmonary valve stenosis
– Tricuspid regurgitation
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Nursing Process
• Data collection
• Planning and implementation
– Teaching about prevention
• Evaluation
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Abnormal Conditions That May Cause
Cardiovascular Disease
• Arteriosclerosis: Hardening of the arteries
• Atherosclerosis: Fatty deterioration of the arterial
smooth muscle walls
• Hypertension
– Leading cause of MI, cardiac damage, kidney
damage, congestive heart failure, and CVA
• Hypotension
– Heart rate problem, a heart muscle or pump
problem, or a volume problem
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Conditions Affecting the Heart’s Rhythm
• Cardiac dysrhythmias
– Sinus tachycardia
– Sinus bradycardia
– Premature ventricular contraction (PVC)
• Atrioventricular heart block
– Electronic pacemaker
• Fibrillation
– Defibrillation
– Implantable cardioverter–defibrillator
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Question
Is the following statement true or false?
During electrical defibrillation, ensure that those present
in the room do not touch the client or bed.
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Answer
True
During electrical defibrillation, everyone present must be
careful not to touch the client or the bed; doing so will lead
to shock and, possibly, injury.
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Conditions Affecting the Heart’s Pumping
Function
• Congestive heart failure
– Hemodynamic monitoring
– Measure intake and output (I&O) and weigh the
client daily.
• Cardiomyopathy
– Dilated or congestive cardiomyopathy
– Hypertropic cardiomyopathy
– Restrictive cardiomyopathy
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Infectious and Inflammatory Heart
Disorders
• Chronic rheumatic heart disease
• Bacterial endocarditis
– Make the person as comfortable as possible.
– Instruct client to conserve energy.
– Frequently note the pulse rate and quality.
– Observe closely for fluctuation in body temperature
and for any symptoms of complications.
• Pericarditis
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Coronary Artery Disease
• Angina pectoris
– Temporary loss of oxygen to the heart muscle
– Ischemia—if loss of oxygen supply continues
– Myocardial necrosis—death of heart tissue
• Myocardial infarction
– Acute coronary syndrome (ACS)
– Acute myocardial infarction (AMI)
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Question
Is the following statement true or false?
Thrombolytic therapy must be started as soon as
possible after the client develops symptoms.
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Answer
True
Thrombolytic therapy must be started as soon as possible
after the client develops symptoms. The sooner the
pharmacologic agent is administered, the less heart
muscle damage results.
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Inflammatory Disorders
• Thrombophlebitis
• Embolism
– Pulmonary embolism
– Coronary embolus
– Cerebral embolism
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Peripheral Vascular Disorders
• Symptoms
– Intermittent claudication
– Tingling and numbness
– Coldness and difference in size
– Lack of new tissue growth
• Buerger disease
• Raynaud phenomenon
• Varicose veins
• Telangiectasia (spider veins)
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Question
Is the following statement true or false?
For a client with peripheral vascular disorder, the bath
water should be hot—as hot the client can take.
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Answer
False
It is true that warm baths to help increase the circulation,
but the bath water should not be hot, as heat helps dilate
blood vessels.
This client is very susceptible to burns. Use a bath
thermometer; the maximum temperature is 100°F or
37.8°C.
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Aneurysms
• An aneurysm is an outpouching of a blood vessel.
• Forms of aneurysms
– Berry aneurysm in the circle of Willis
– Fusiform-type aneurysm of the abdominal aorta
– Dissecting aortic aneurysm
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Types of Cerebrovascular Accident
• Transient ischemic attack (TIA)
• Cerebral thrombosis
• Cerebral embolism
• Cerebral hemorrhage or aneurysm (hemorrhagic CVA)
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Results of Cerebrovascular Accident
• Hemiplegia
– Flaccid stage, spastic stage, recovery stage
• Aphasia and dysphasia
• Brain damage
• Hemianopsia (hemianopia)
• Pain
• Autonomic disturbances
• Personality changes
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Rehabilitation
• If contractures are prevented, the client can learn to walk
again much sooner.
• If the skin is kept intact, the client will not have to
contend with ulcers and infections.
• If bowel and bladder training have begun, the client will
be well on the way to independence.
• Teach adaptive ADL.
• Begin speech, physical, or occupational therapy as soon
as possible.
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End of Presentation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins