Download Cardiovascular and Peripheral Vascular Disorders

Nursing of Adult Patients
with
Medical & Surgical Conditions
Cardiovascular
Disorders
Diagnostic Tests
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Diagnostic Imaging
– Radiographic exam to assess heart size,
shape and position and outline of shadows.
Diagnostic Tests
– Computed Axial Tomography
(CT/CAT Scan)
• Three dimensional view of the
structure
Diagnostic Tests
– Angiogram
• radiographs are taken after injection of dye into
an artery
– Aortogram
• visualizes the abdominal aorta and the major
leg arteries with injection of dye into the femoral
artery
Iliac Artery
Diagnostic Tests
–Fluoroscopy
•action-picture
Fluoroscopy Demo
Diagnostic Tests
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Cardiac Catherterization and Angiography
– Visualizes the heart’s chambers, valves, great
vessels, and coronary arteries
– Catheter is inserted into the heart chambers
to measure pressure, and blood-volume.
– Contrast dye may be used for better
visualization
– Post-procedure:
• supine, with sandbag over pressure dressing at
insertion site
Cardiac Catheterization
Cardiac Catheterization Lab
Cardiac Catheterization
with Contrast
Diagnostic Tests

Electrocardiogram
– Graphic study of the electrical activities of the
myocardium
Review of Cardiac Electrical Activity
Diagnostic Tests
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Electrocardiogram
– P-wave
• contraction (depolarization) of the
atria
– QRS complex
• contraction (depolarization) of the
ventricles
• relaxation (repolarization) of the atria
is covered by the QRS complex
– T-wave
• relaxation (repolarization) of the
ventricles
Relationship of EKG to cardiac
muscle activity
(SA Node fires)
Atrial Depolarization
(Impulse to AV node)
(Impulse moves through Bundle of
His & Perkinje fibers)
Ventricular Depolarization
Ventricular Repolarization
Electrocardiogram
Diagnostic Tests
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Cardiac Monitors
– Continual monitoring of the cardiac
electrical activity on a video monitor
– Telemetry
• electronic transmission of data to a distant
location
Diagnostic Tests

Thallium Scanning
– Thallium 201 is injected
and the patient
exercises on a treadmill
– Thallium is transported
into normal cells, but not
ischemic or infarcted
cells
Thallium Scanning
Diagnostic Tests

Echocardiography
– Ultrasound is used to record size, shape, and
position of cardiac structures
– Detects:
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pericardial effusion
ventricular function
cardiac chamber size and contents
ventricular muscle and septal motion and thickness
cardiac output
cardiac tumors
valvular function
congenital heart disorders.
Echocardiography
Echocardiogram Demo
Echocardiography
Diagnostic Tests

Positron Emission Tomography (PET)
– Computerized radiographic technique that
uses radioactive substances to examine
the metabolic activity of various body
structures
– Used to study dementia, stroke, epilepsy,
tumors, and cardiac tissue
PET Demonstration
Diagnostic Tests
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Laboratory Exams
– Blood cultures
• Culture and sensitivity
– Compete Blood Count (CBC)
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RBC (erythrocytes)
Hemoglobin
Hematocrit
WBC
Platelets
4-6 million/cu.mm
10-20 gm/100ml
40-50 percent
5,000-10,000/mm
150,000-400,000/mm
– Coagulation Studies
• Prothrombin Time (PT) 11-12.5 seconds
• Partial thromboplastin time (PTT) 60-70 seconds
– Erythrocyte sedimentation rate (ESR)
• Up to 20mm/minute
– Serum electrolyte tests
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sodium - maintains fluid balance (135-145mEq/L)
potassium - relaxes heart muscle (3-5 mEq/L)
calcium - contraction of cardiac muscle (9-11mg/dl)
magnesium - maintain level of electrical excitability in the
nerves and muscles (1-2 mEq/L)
– Serum lipids
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Total Cholesterol (140-200 mg/dl)
High Density Lipoprotein (HDL) (35-85 mg/dl)
Low Density Lipoprotein (LDL) (below 100mg/dl)
Triglycerides (35-135 mg/dl)
– Arterial blood gases
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pH
PaCO2
PaO2
HCO
SaO2
7.35-7.45
35-45 mm Hg
80-100 mm Hg
21-28 mEq/L
95-100%
Diagnostic Tests

Cardiac Enzyme Studies
– CPK isoemzyme II (MB)
• enzyme is released when the heart muscle is damaged
or necrosis occurs
• levels rise in 3-6 hours, peak in 12-18 hours, and may
remain elevated for 3-4 days
• Normal Value 40-170 U/L
– LDH
• Rises within the first 24-72 hours, peaks in 3-4 days, and
returns to normal in approx 14 days
• Normal Value 100-200 U/L
Risk Factors
for
Cardiovascular Disorders

Nonmodifiable Factors
– Family History
• Parent or sibling who has CV disorder before 50 yrs
– Age
• Normal physiological changes
• Approx 50% of all MI occur after 65 yrs
– Sex (Gender)
• Men are at greater risk than women
– Race
• African Amer. males are at higher risk of hypertension
Risk Factors
for
Cardiovascular Disorders
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Modifiable Factors
– Smoking
• 2-3 times greater risk
– Hyperlipidemia
• Diet high in saturated fat, cholesterol, and
calories
• Cholesterol levels above 200 mg/dl
– Hypertension
• B/P higher than 140/90
Risk Factors
for
Cardiovascular Disorders
– Diabetes Mellitus
• Damage to vessels due to high glucose levels
• High cholesterol levels (abnorm. lipid metabolism)
– Obesity
• Increases workload of the heart
– Sedentary Lifestyle
• Exercise improves the heart’s efficiency, lowers
glucose & cholesterol levels, lowers B/P, reduces
weight, and reduces stress levels
Risk Factors
for
Cardiovascular Disorders
– Stress
• Catecholamines are released which cause increased
heart rate and damage to myocardial cells
– Oral Contraceptives
• Not clearly defined
– Older high dose contraceptives made women at higher risk
for cardiovascular disorders – esp. smokers
– Newer low dose contraceptives don’t seem to cause that
risk
– Psychosocial Factors
• Type A personality
– aggressiveness, competitiveness, perfectionism, &
compulsiveness
Cardiac Dysrhythmias
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Normal Sinus Rhythm
– Originates in the SA node
– Rate: 60-100 beats/min
– Rhythm: regular
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Sinus Tachycardia
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Originates in the SA node
Rate: 100-150
Rhythm: regular
Causes:
• exercise, anxiety, fever, shock, medications,
hypothermia, heart failure, excessive caffeine, and
tobacco
• Not usually caused by cardiac problems
– Treatment:
• Directed at cause
Sinus
Bradycardia
–Originates: SA node
–Rate: less than 50-60 beats per min
–Rhythm: regular
–Cause:
•sleep, vomiting, intracranial tumors, MI, drugs, vagal stimulation,
endocrine disturbances, and hypothermia
–Treatment:
•Directed toward cause
•Atropine to increase heart rate
•Temporary or permanent pacemaker
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Supraventricular Tachycardia (SVT)
Premature Atrial Contraction (PAC)
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Originates: atria
Rate: 150-250 beats/min
Rhythm: regular
Causes:
• drugs, alcohol, mitral valve prolapse, emotional stress,
smoking, and hormone imbalance
• usually not caused by heart disease
– Treatment:
• Eliminate underlying cause
• Decrease heart rate
– carotid sinus pressure, ocular pressure, digitalis, calcium channel
blockers, propranolol, quinidine, and cardioversion
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Atrial Fibrillation
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Originates: atria
Rate: 350-600
Rhythm: irregular; may be unable to count
Causes:
• atherosclerosis, mitral valve disease, CHF,
cardiomyopathy, congenital abnormalities, COPD, and
thyrotoxicosis
– Treatment:
• digitalis, calcium channel blockers (verapamil),
antidysrhythmics (procainamide), quinidine,
anticoagulants (heparin, coumadin) and cardioversion
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Atrioventricular Block (1st, 2nd, & 3rd
degree)
– Originates: SA node; impulse is slowed at the AV junction
due to a defect
– Rate:
• 1st degree - 60-100 beats/min
• 2nd degree - 30-40 beats/min
• 3rd degree - may be no heart beat
– Cause:
• atherosclerotic heart disease, MI, CHF, digitalis toxicity, congenital
abnormality, drugs, and hypokalemia
– Treatment:
• directed at cause
• atropine and isoproterenol
• pacemaker for 3rd degree
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Premature Ventricular Contractions (PVC)
– Originates: ventricles
– Rate: 60-100 beats/min
– Rhythm:
• regular with an occasional extra beat
• may occur as a single event or may occur several times in a
minute, or in pairs or strings
– Cause:
• irritability of the ventricules, exercise, stress, electrolyte
imbalance, digitalis toxicity, hypoxia, and MI
– Treatment:
• Treat the cause
• antidysrhythmics (lidocaine, procainamide, or bretylium
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Ventricular Tachycardia
– Originates: ventricles; 3 or more successive
PVC’s
– Rate: 140-240 beats/min
– Rhythm: regular to slightly irregular
– Cause:
• hypoxemia, drug toxicity, electrolyte imbalance, and
bradycardia
– Treatment
• IV procainamide (decrease excitability of cardiac muscle)
• Lidocaine with MI
• Cardioversion
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Ventricular Fibrillation
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Originates: ventricles
Rate: none
Rhythm: none
Cause:
• untreated ventricular tachycardia, electrolyte imbalances,
digitalis or quinidine toxicity, and hypothermia
– Treatment:
• Emergency care
– CPR
– defibrillation (15-20 seconds of the onset)
– medications
» lidocaine, bretylium, or procainamide
Artificial Cardiac Pacemakers
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Pacemaker
– Battery-operated generators that initiate and control
the heart rate by delivering an electrical impulse to
the myocardium
– Temporary
• Used for cardiac support following some MI’s or open-heart
surg.
– Permanent
• Used when other measures have failed to convert the
dysrhythmia or conduction problem
• 2nd & 3rd degree AV block, bradydysrhythmias, &
tachydysrhythmias
Internal Pacemaker
Catheter-like electrode is placed in the area to
be paced and generator is embedded under the
skin
External Pacemaker
Electrode pad is placed on the chest wall and is
attached to a generator place in a pocket or pouch
Artificial Cardiac Pacemakers
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Nursing Interventions
– Post-op
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monitor heart rate and heart monitor
assess vital signs and level of consciousness
assess insertion site for erythema, edema, and tenderness
bed rest with arm immobilized for first few hours
– Patient Teaching
• continued medical care is very important
• medical-alert ID
• report signs & symptoms of pacemaker failure
– weakness, vertigo, chest pain, pulse changes
• avoid electrical equipment
– hairdryers, battery-operated toothbrushes, etc.
• avoid high-output electrical genterators and large magnets
(MRI)
• teach patient or family member to check pulse rate
• notify physician if heart rate drops below 70