Download Cardiovascular and Peripheral Vascular Disorders (Heart)

NURSING OF ADULTS
WITH
MEDICAL & SURGICAL
CONDITIONS
Diseases and Disorders
of the
Heart
Angina Pectoris
• Etiology/Pathophysiology
– Cardiac muscle is deprived of oxygen
• Ischemia
– Increased workload on the heart
•
•
•
•
•
Exposure to cold
Exercise
Unusually heavy meals
Emotional stress
Other strenuous activity
Angina Pectoris
• Signs & Symptoms
– Pain (usually relieved by rest)
• heaviness or tightness in chest
• usually substernal or retrosternal
• may radiate
–
–
–
–
–
Dyspnea
Anxiety
Apprehension
Diaphoresis
Nausea
Ischemic Myocardial Pain
Angina Pectoris
• Treatment
– Correct cardiovascular risk factors
– Avoid precipitating factors
– Medications
• dilate coronary arteries and decrease workload of heart
• Nitroglycerin
– give SL, repeat q 5 min, up to three times
• Beta adrenergic blocking agents
– Inderal, Corgard, Lopressor
• Calcium channel blockers
– Procardia, Cardizem, Calan, Isoptin
Angina Pectoris
• Surgical Interventions
– Coronary Artery Bypass Graft (CABG)
• Saphenous vein used to bypass occluded arteries
– Percutaneous Transluminal Coronary Angioplasty (PTCA)
• Cardiac catheterization is done and a balloon inflated in
narrowed artery
– Stent Placement
• Expandable, meshlike structures designed
• to maintain vessel patency
Coronary Artery Bypass Graft
PTCA & Stent
Myocardial Infarction
• Etiology/Pathophyisiolgy
– Occlusion of a major coronary artery or one of
its branches with subsequent necrosis of
myocardium
• Most common cause is atherosclerosis
– Ability of the cardiac muscle to contract and
pump blood is impaired
Common Locations of MI
Myocardial Infarction
• Signs & Symptoms
–
–
–
–
–
–
–
–
–
–
Asymptomatic (silent MI)
Similar to Angina Pectoris, but are more severe and last longer
Pain (not relieved by rest, position, or nitroglycerine)
Nausea
SOB
Dizziness
Weakness
Diaphoresis
Pallor - ashen color
Sense of impending doom
Myocardial Infarction
• Treatment
– Oxygen
– Fibrinolytic agents
• Streptokinase
• Tissue plasma activator (TPA)
– Percutaneous Transluminal Coronary Angioplasty (PTCA)
– Coronary Artery Bypass Graft surgery
– Medications
Myocardial Infarction
Congestive Heart Failure
• Etiology/Pathophysiology
– Abnormal condition characterized by
circulatory congestion as a result of the heart’s
inability to act as an effective pump.
– Left ventricular failure
• Most common
– Right ventricular failure
• Usually caused by left ventricular failure
Congestive Heart Failure
• Signs & Symptoms
– Decreased cardiac output
•
•
•
•
•
•
•
•
fatigue
angina
anxiety
oliguria
decreased GI motility
pale, cool skin
weight gain
restlessness
Congestive Heart Failure
– Left Ventricular Failure
• Pulmonary congestion
–
–
–
–
–
–
–
dyspnea
paroxysmal nocturnal dyspnea
cough
frothy, blood-tinged sputum
orthopnea
pulmonary crackles
pleural effusion (x-ray)
Congestive Heart Failure
– Right Ventricular Failure
•
•
•
•
•
Distended jugular veins
Anorexia, nausea, and abdominal distention
Liver enlargement
Ascites
Edema in feet, ankles, sacrum; may progress up the
legs into thighs, external genitalia, and lower trunk
Congestive Heart Failure
• Treatment
– Increase cardiac efficiency
• Digitalis
• Vasodilators
– nitroglycerin
• ACE inhibitors (decrease B/P)
– Capoten, Vasotec, Altace, Lotnesin, Prinivil, Zestril, Accupril Monopril
– Lower oxygen requirements
– Bedrest, HOB elevated
– Oxygen
Congestive Heart Failure
– Treat edema and pulmonary congestion
– diuretics
– sodium restricted diet
– restriction of fluids
– Monitor fluid retention
– weigh daily
– strict I&O
Pulmonary Edema
• Etiology/Pathophysiology
– Accumulation of fluid in lung tissues and
alveoli
– Complication of CHF
Pulmonary Edema
• Signs & Symptoms
–
–
–
–
–
–
–
–
–
–
Restlessness
Agitation
Disorientation
Diaphoresis
Dyspnea & Tachypnea
Tachycardia
Pallor or cyanosis
Cough - large amounts of blood-tinged, frothy sputum
Wheezing, crackles
Cold extremities
Pulmonary Edema
• Treatment
–
–
–
–
–
High Fowler’s or Orthop. postion
Morphine sulfate
Oxygen
Nitroglycerin
Diuretics
• Lasix, Bumex
– Inotropic agents (increase myocard. Contraction & periph. dilation)
• Dobutrex, Inocor
– Vasodilators
• Nitropress
Valvular Heart Disease
• Etiology/Pathophysiology
– Heart valves are compromised and do not open
and close properly
• Stenosis
– thickening of the valve tissue, causing the balve to become
narrow
• Insufficiency
– valve is unable to close completely
– Congenital
– Rheumatic fever
Valvular Heart Disease
• Signs & Symptoms
–
–
–
–
–
–
–
–
Fatigue
Angina
Oliguria
Pale, cool skin
Weight gain
Restlessness
Abnormal breath sounds
Edema
Valvular Heart Disease
• Treatment
–
–
–
–
–
Restrict activities
Sodium restricted diet
Diuretics
Digoxin
Antidysrhythmics
• Pronestyl, Quinidine, Lidocaine, Norpace
– Surgery
• Open mitral commissurotomy
– splitting of the fused valve
• Valve replacement
– valve replaced with a bioprosthetic or mechanical valve
Rheumatic Heart Disease
• Etiology/Pathophysiology
– Rheumatic Fever
• inflammatory disease which is a delayed childhood
reaction to inadequately treated childhood upper
resp. tract infection of Beta hemolytic streptococci
• causes scar tissue in the heart
Rheumatic Heart Disease
• Signs & Symptoms
–
–
–
–
–
–
–
–
Elevated temperature
Elevated heart rate
Epistaxis
Anemia
Joint pain and stiffness
Nodules on the joints
Specific to valve affected
Heart murmur
Rheumatic Heart Disease
• Treatment
– Prevention
• Treat infections rapidly and completely
– Penicillin
–
–
–
–
–
–
Bedrest
NSAID’s
Application of heat
Well-balanced diet (supplement with Vit. B & C)
Encourage fluids
Commissurotomy or valve replacement
Pericarditis
• Etiology/Pathophysiology
– Inflammation of the membranous sac
surrounding the heart
– May be acute or chronic
– Bacterial, viral, or fungal
– Noninfectious conditions
• azotemia, MI, neoplasms, scleroderma, trauma,
SLE, radiation, drugs
Pericarditis
• Signs & Symptoms
– Debilitating pain
• aggravated by lying supine, deep breathing, coughing,
swallowing and moving the trunk
–
–
–
–
–
–
–
Dyspnea
Fever
Chills
Diaphoresis
Leukocytosis
Pericardial friction rub
Pericardial effusion (x-ray)
Pericarditis
• Treatment
– Analgesia
• morphine, Demerol
–
–
–
–
–
Oxygen
IV fluids
Salicylates
Antibiotics
Antiinflammatory agents
• Indocin
– Corticosteroids
– Surgery
• Pericardial window, pericardial tap
Endocarditis
• Etiology/pathophysiolgy
– Infection or inflammation of the inner
membranous lining of the heart
– Risk factors
•
•
•
•
•
rheumatic heart disease
CHF
Degenerative heart disease
Invasive procedures
“mainline” drug users
Endocarditis
• Signs & Symptoms
– Influenza-like symptoms
•
•
•
•
•
•
–
–
–
–
–
Fever
Fatigue
Chest pain
Headaches
Joint pain
Chills
Petechiae in the conjunctiva, mouth, and legs
Anemia
Splinter hemorrhages under nails
Weight loss
Heart murmur
Endocarditis
• Treatment
– Bedrest
– Antibiotics
• IV 1-2 months
– Prophylactic antibiotics for “high risk” patients
– Surgical repair of diseased valves or valve
replacement
Myocarditis
• Etiology/Pathophysiology
–
–
–
–
–
Inflammation of the myocardium
Rheumatic heart disease
Viral, bacterial, or fungal infection
Endocarditis
Pericarditis
Myocarditis
• Signs & Symptoms
–
–
–
–
–
Vary according to site of infection
Cardiac enlargement
Murmur
Gallop
Tachycardia
Myocarditis
• Treatment
–
–
–
–
–
Bedrest
Oxygen
Antibiotics
Antiinflammatory agents
Assessment and correction of dysrhythmias
Cardiomyopathy
• Etiology/Pathophysiology
– A group of heart muscle diseases that primarily affects the
structural or functional ability of the myocardium
– Not associated with CAD, hypertension, vascular disease, or
pulmonary disease
– Primary - unknown cause
– Secondary - Infective, metabolic, nutritional, alcohol,
peripartum, drugs, radiation, SLE, rheumatoid arthritis
Cardiomyopathy
• Signs & Symptoms
–
–
–
–
–
–
Angina
Syncope
Fatigue
Dyspnea on exertion
Severe exercise intolerance
S/S of left and right-sided CHF
• dyspnea, peripheral edema, ascites, hepatic
dysfunction
Cardiomyopathy
• Treatment
–
–
–
–
–
–
Treat underlying cause
Diuretics
ACE inhibitors
Beta-adrenergic blocking agents
Internal defibrillator
Cardiac transplant