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Medical-Surgical Nursing
Critical Thinking in Patient Care
Fifth Edition
CHAPTER
31
Nursing Care of
Patients with Cardiac
Disorders
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Directory
• NCLEX-RN® REVIEW Test Questions
• Lecture Note Presentation
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
NCLEX-RN® REVIEW
Test Questions
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 1
1. In reviewing the physician’s admitting notes for
a patient with heart failure, the nurse notes that
the patient has an ejection fraction of 25%.
The nurse recognizes this as meaning which of
the following?
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 1 Choices
1. Ventricular function is severely impaired.
2. The amount of blood being ejected from the
ventricles is within normal limits.
3. Twenty-five percent of the blood entering the
ventricle remains in the ventricle after systole.
4. Cardiac output is greater than normal, overtaxing
the heart.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 1 Response
1. Ventricular function is severely impaired.
2. The amount of blood being ejected from the
ventricles is within normal limits.
3. Twenty-five percent of the blood entering the
ventricle remains in the ventricle after systole.
4. Cardiac output is greater than normal, overtaxing
the heart.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 1 Rationale
Normal ejection fraction is 60%; an ejection
fraction of 25% indicates severe impairment of
ventricular function.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 2
2. In assessing a patient admitted 24 hours
previously with heart failure, the nurse notes
that the patient has lost 2.5 lb (1 kg) of weight,
his heart rate is 88 (HR was 105 on
admission), and he now has crackles in the
bases of his lung fields only. The nurse
correctly interprets this data as indicating
which of the following?
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 2 Choices
1. The patient’s condition is unchanged from
admission.
2. More aggressive treatment is needed.
3. The treatment regimen is achieving the desired
effect.
4. No further treatment is required at this time as the
failure has resolved.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 2 Response
1. The patient’s condition is unchanged from
admission.
2. More aggressive treatment is needed.
3. The treatment regimen is achieving the desired
effect.
4. No further treatment is required at this time as the
failure has resolved.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 2 Rationale
Interdisciplinary treatment goals for the patient with
heart failure are to reduce the cardiac workload
and improve pump effectiveness. Loss of excess
fluid, as indicated by weight loss, reduces cardiac
work. The drop in heart rate and reduced
pulmonary vascular congestion are indicative of
improved cardiac pump.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 3
3. The nurse assessing a patient admitted with
left ventricular failure would recognize which of
the following findings as consistent with the
diagnosis? Select all that apply.
1. 5 cm jugular vein distention at 30°
2. complaints of shortness of breath with minimal
exertion
3. substernal chest pain during exercise
4. bilateral inspiratory crackles to midscapulae
5. fatigue
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 3 Response
3. The nurse assessing a patient admitted with
left ventricular failure would recognize which of
the following findings as consistent with the
diagnosis? Select all that apply.
1. 5 cm jugular vein distention at 30°
2. complaints of shortness of breath with minimal
exertion
3. substernal chest pain during exercise
4. bilateral inspiratory crackles to midscapulae
5. fatigue
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 3 Rationale
In left ventricular failure, the cardiac output falls
and pressure in the pulmonary vascular system
increases. This leads to fatigue, increasing
dyspnea, and crackles in the lung bases.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 4
4. The nurse caring for a patient undergoing
pulmonary artery pressure monitoring provides
appropriate care when he or she does which of
the following?
1. secures the intravenous line to the bed linens
2. maintains flush solution flow by gravity
3. reports waveform dampening during wedge
pressure measurements
4. calibrates and levels the system every shift
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 4 Response
4. The nurse caring for a patient undergoing
pulmonary artery pressure monitoring provides
appropriate care when he or she does which of
the following?
1. secures the intravenous line to the bed linens
2. maintains flush solution flow by gravity
3. reports waveform dampening during wedge
pressure measurements
4. calibrates and levels the system every shift
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 4 Rationale
Calibrating and leveling the system during each
shift ensures accuracy and consistency of
measurements.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 5
5. Morphine 2 to 5 mg IV as needed for pain and
dyspnea is ordered for a patient in acute
pulmonary edema. The nurse appropriately
does which of the following?
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 5 Choices
1. questions this order because no time intervals have
been specified
2. administers the drug as ordered, monitoring
respiratory status
3. withholds the drug until the patient’s respiratory
status improves
4. administers the drug only when the patient
complains of chest pain
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 5 Response
1. questions this order because no time intervals have
been specified
2. administers the drug as ordered, monitoring
respiratory status
3. withholds the drug until the patient’s respiratory
status improves
4. administers the drug only when the patient
complains of chest pain
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 5 Rationale
Morphine is given intravenously to relieve anxiety;
it also is a venous vasodilator, reducing venous
return and cardiac work.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 6
6. The nurse notes a grating heart sound when
auscultating the apical pulse of a patient with
pericarditis. The most appropriate response is
to do which of the following?
1.
2.
3.
4.
Note the finding in the patient’s medical record.
Obtain an electrocardiogram.
Immediately notify the physician.
Initiate resuscitation measures.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 6 Response
6. The nurse notes a grating heart sound when
auscultating the apical pulse of a patient with
pericarditis. The most appropriate response is
to do which of the following?
1.
2.
3.
4.
Note the finding in the patient’s medical record.
Obtain an electrocardiogram.
Immediately notify the physician.
Initiate resuscitation measures.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 6 Rationale
A pericardial friction rub, a grating sound, is a
characteristic sign of pericarditis so it is expected,
but should be documented in the patient’s record.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 7
7. An appropriate goal of nursing care for the
patient with acute infective endocarditis would
be which of the following?
1. “Will resume usual activities within 1 week of
treatment.”
2. “Will relate the benign and self-limiting nature of the
disease.”
3. “Will consider cardiac transplantation as a viable
treatment option.”
4. “Will state the importance of continuing intravenous
antibiotic therapy as ordered.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 7 Response
7. An appropriate goal of nursing care for the
patient with acute infective endocarditis would
be which of the following?
1. “Will resume usual activities within 1 week of
treatment.”
2. “Will relate the benign and self-limiting nature of the
disease.”
3. “Will consider cardiac transplantation as a viable
treatment option.”
4. “Will state the importance of continuing
intravenous antibiotic therapy as ordered.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 7 Rationale
Effective treatment for acute infective endocarditis
requires long-term intravenous antibiotic therapy to
eliminate the infecting organisms.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 8
8. An expected assessment finding in a patient
with mitral stenosis being admitted for a valve
replacement would be which of the following?
1.
2.
3.
4.
muffled heart sounds
S3 and S4 heart sounds
diastolic murmur heard at the apex
cardiac heave
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 8 Response
8. An expected assessment finding in a patient
with mitral stenosis being admitted for a valve
replacement would be which of the following?
1.
2.
3.
4.
muffled heart sounds
S3 and S4 heart sounds
diastolic murmur heard at the apex
cardiac heave
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 8 Rationale
The murmur of mitral valve stenosis would be
heard during diastole (when blood is flowing
through the stenotic valve from the atrium to the
ventricle) at the apex of the heart.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 9
9. A patient facing heart valve replacement asks
the nurse which type of valve is the best,
biologic or mechanical. An appropriate
response would be which of the following?
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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®
NCLEX-RN REVIEW
Test Question 9 Choices
1. The need to take drugs to prevent rejection of
biologic tissue is a major consideration.
2. Clotting is a risk with mechanical valves,
necessitating anticoagulant drug therapy after
insertion.
3. Biologic valves tend to be more durable than
mechanical valves.
4. Endocarditis is a risk following valve replacement; it
is more easily treated with mechanical valves.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 9 Response
1. The need to take drugs to prevent rejection of
biologic tissue is a major consideration.
2. Clotting is a risk with mechanical valves,
necessitating anticoagulant drug therapy after
insertion.
3. Biologic valves tend to be more durable than
mechanical valves.
4. Endocarditis is a risk following valve replacement; it
is more easily treated with mechanical valves.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 9 Rationale
Anticoagulant therapy to prevent clot formation is
necessary following insertion of a mechanical
valve.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 10
10. The parents of a young athlete who collapsed
and died due to hypertrophic cardiomyopathy
ask the nurse how it is possible that their son
had no symptoms of this disorder before
experiencing sudden cardiac death. The nurse
responds with which of the following?
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 10 Choices
1. “Exercise causes the heart to contract more
forcefully, and can lead to changes in the heart’s
rhythm or the outflow of blood from the heart in
people with hypertrophic cardiomyopathy.”
2. “It is likely that your son had symptoms of the
disorder before he died, but he may not have
thought them important enough to tell someone
about.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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®
NCLEX-RN REVIEW
Test Question 10 Choices
3. “In this type of cardiomyopathy, the ventricle does
not fill normally. During exercise, the heart may not
be able to meet the body’s needs for blood and
oxygen.”
4. “Cardiomyopathy results in destruction and scarring
of cardiac muscle cells. As a result, the ventricle
may rupture during strenuous exercise, leading to
sudden death.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 10 Response
1. “Exercise causes the heart to contract more
forcefully, and can lead to changes in the
heart’s rhythm or the outflow of blood from the
heart in people with hypertrophic
cardiomyopathy.”
2. “It is likely that your son had symptoms of the
disorder before he died, but he may not have
thought them important enough to tell someone
about.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 10 Response
3. “In this type of cardiomyopathy, the ventricle does
not fill normally. During exercise, the heart may not
be able to meet the body’s needs for blood and
oxygen.”
4. “Cardiomyopathy results in destruction and scarring
of cardiac muscle cells. As a result, the ventricle
may rupture during strenuous exercise, leading to
sudden death.”
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
®
NCLEX-RN REVIEW
Test Question 10 Rationale
In hypertrophic cardiomyopathy, manifestations
may not develop until the demand for oxygen
increases, such as with athletes during activity,
causing sudden death due to a ventricular
dysrhythmia. This type of cardiomyopathy is not a
filling problem but rather an obstruction to ejection
of blood to the body to meet oxygen demand.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Lecture Note
Presentation
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Learning Outcome 1
• Compare and contrast the etiology,
pathophysiology, and manifestations of
common cardiac disorders, including heart
failure, structural disorders, and
inflammatory disorders.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Heart Failure
• Etiology
• Pathophysiology
• Manifestations
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Heart Failure
• Systolic and diastolic failure
• Left-sided and right-sided heart failure
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Figure 31–1 The hemodynamic effects of left-sided heart failure.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–2 The hemodynamic effects of right-sided heart failure.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Heart Failure
• Low- versus high-output failure
• Acute versus chronic heart failure
• Pulmonary Edema
– Etiology, pathophysiology, and manifestations
• Rheumatic fever/rheumatic heart disease
– Etiology, pathophysiology, and manifestations
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Heart Failure
• Infective and inflammatory diseases of the
heart
• Etiology, pathophysiology, manifestations:
– Infective endocarditis
– Myocarditis
– Pericarditis
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–9 Constrictive pericarditis. Source: Custom Medical Stock Photo, Inc.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Copyright ©2011 by Pearson Education, Inc.
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Valvular Heart Disease
• Etiology
• Pathophysiology
• Manifestations
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Figure 31–10 Valvular heart disorders. A, Stenosis of a heart valve. B, An incompetent or regurgitant heart valve.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–11 Mitral stenosis. Narrowing of the mitral valve orifice (1) reduces blood volume to left ventricle (2), which
reduces cardiac output (3). Rising pressure in the left atrium (4) causes left atrial hypertrophy and pulmonary
congestion. Increased pressure in pulmonary vessels (5), causes hypertrophy of the right ventricle and right atrium.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–12 Mitral regurgitation. The mitral valve closes incompletely (1), allowing blood to regurgitate during systole
from the left ventricle to the left atrium (2). Cardiac output falls; to compensate, the left ventricle hypertrophies (3).
Rising left atrial pressure (4) causes left atrial hypertrophy and pulmonary congestion. Elevated pulmonary artery
pressure (5) causes slight enlargement of the right ventricle.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Figure 31–13 Mitral valve prolapse. Excess tissue in the valve leaflets (1) and elongated cordae tendineae (2) impair
mitral valve closure during systole. Some ventricular blood regurgitates into the left atrium (3).
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–14 Aortic stenosis. The narrowed aortic valve orifice (1) decreases the left ventricular ejection fraction
during systole (2) and cardiac output (3). The left ventricle hypertrophies (4). Incomplete emptying of the left atrium (5)
causes backward pressure through pulmonary veins and pulmonary hypertension. Elevated pulmonary artery pressure
(6) causes right ventricular strain.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
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Figure 31–15 Aortic regurgitation. The cusps of the aortic valve widen and fail to close during diastole (1). Blood
regurgitates from the aorta into the left ventricle (2) increasing left ventricular volume and decreasing cardiac output (3).
The left ventricle dilates and hypertrophies (4) in response to the increase in blood volume and workload.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Valvular Heart Disease
•
•
•
•
Tricuspid stenosis
Tricuspid regurgitation
Pulmonic stenosis
Pulmonic regurgitation
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Cardiomyopathy
• Etiology, pathophysiology, and
manifestations
• Primary and secondary
• Dilated
• Hypertrophic
• Restrictive
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Learning Outcome 2
• Explain risk factors and preventive
measures for cardiac disorders such as
heart failure, inflammatory disorders, and
valve disorders.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Heart failure: Risk factors
• Coronary artery disease
• Cardiomyopathies
• Hypertension
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Congenital and Valvular Heart
Disease Prevention
• Education: reduce risks
• Coronary artery disease and DM
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Rheumatic Fever and
Rheumatic Heart Disease
• Risk factors
– Crowded living conditions
– Malnutrition
– Immunodeficiency
– Poor access to health care
– Genetic factors
• Prevention
– Prompt identification, treatment
– Compliance: medications
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Infective Endocarditis
• Risk factors
– Congenital deformities
– Tissue damage due to ischemic disease
– Valve prosthesis
– Intravenous drug use
– Invasive catheters
– Dental health
– Recent heart surgery
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Infective Endocarditis
• Prevention
– Education
– Prophylactic antibiotics
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Myocarditis
• Risk factors:
– Alteration of immune response
– Advanced age
– Malnutrition
– Alcohol use
– Immunosuppression
– Exposure to radiation
– Stress
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
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Valvular Heart Disease
• Prevention of rheumatic fever
– Early and effective treatment of strep throat
– Completing the full prescription of antibiotic
• Prophylactic antibiotic therapy
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Learning Outcome 3
• Discuss indications for and management
of patients undergoing hemodynamic
monitoring.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Hemodynamics
• Study of forces involved in blood
circulation
• Main goals
– Evaluation of cardiac and circulatory function
– Evaluation of responses to interventions
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Hemodynamics
• Hemodynamic parameters
– Heart rate
– Arterial blood pressure
– Central venous or right atrial pressure
– Pulmonary pressure
– Cardiac output
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
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Hemodynamics
• Measurement
– Directly
– Indirectly
• Nursing Care Focus
– Safety
– Infection control
– Accuracy of measurement
– Knowledge of equipment being used
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Learning Outcome 4
• Discuss the effects and nursing
implications for medications commonly
prescribed for patients with cardiac
disorders.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Heart Failure
• Medications used to treat heart failure
– ACE inhibitors
– Angiotensin II receptor blockers
– Beta blockers
– Diuretics
– Inotropic medications
– Direct vasodilators
– Antidysrhythmic drug
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Heart Failure
• Nursing diagnoses
– Decreased Cardiac Output
– Excess Fluid Volume
– Activity Intolerance
– Deficient Knowledge: Low-Sodium Diet
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Pulmonary Edema
• Medications to treat pulmonary edema:
– Morphine sulfate
– Potent loop diuretics such as furosemide
– Vasodilators such as nitroprusside; dopamine
or dobutamine
– Aminophylline to reduce bronchospasm
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Pulmonary Edema
• Nursing diagnoses:
– Impaired Gas Exchange
– Decreased Cardiac Output
– Fear
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Rheumatic Fever
• Medications used to treat rheumatic fever:
– Antibiotics
– Penicillin
– Erythromycin, Clindamycin
– Anti-inflammatory drugs
• Nursing diagnoses
– Acute Pain
– Activity Intolerance
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Infective Endocarditis
• Medications used to treat infective
endocarditis:
– Prolonged course of antibiotics
• Nursing Diagnoses
– Risk for Imbalanced Body Temperature
– Risk for Ineffective Tissue Perfusion
– Ineffective Health Maintenance
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Myocarditis
• Medications used to treat myocarditis:
– Antibiotics and antiviral therapy, if infection
– Immunosuppressives to minimize the
inflammatory response
– ACE inhibitors and other drugs
– Digitalis used with caution
– Antidysrhythmic agents
– Anticoagulants
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Myocarditis
• Nursing diagnoses
– Activity Intolerance
– Decreased Cardiac Output
– Fatigue
– Anxiety
– Excess Fluid Volume
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Pericarditis
• Medications used to treat pericarditis:
– Determined by manifestations
– ASA and acetaminophen
– NSAIDs
– Corticosteroids
• Pericardiocentesis
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Pericarditis
• Nursing Diagnoses
– Acute Pain
– Ineffective Breathing Pattern
– Risk for Decreased Cardiac Output
– Activity Intolerance
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Valvular Heart Disease
• Medications used to treat valvular heart
disease:
– Diuretics, ACE inhibitors, vasodilators,
digitalis if heart failure
– Digitalis, small doses of beta blockers,
anticoagulant therapy if atrial fibrillation
– Prophylactic antibiotics prior to any dental
work or surgery
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Valvular Heart Disease
• Surgery and invasive procedures
– Percutaneous balloon valvuloplasty
– Valvuloplasty
– Open commissurotomy
– Annuloplasty
– Valve replacement
• Nursing diagnoses
• Decreased Cardiac Output
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Valvular Heart Disease
• Activity Intolerance
• Risk for Infection
• Ineffective Protection
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Cardiomyopathies
• Medications used to treat
cardiomyopathies
– Dilated and restrictive cardiomyopathies
 ACE inhibitors, vasodilators, and digitalis
 Beta blockers with caution in dilated
cardiomyopathy
 Anticoagulants and antidysrhythmics
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Cardiomyopathies
• Medications used to treat
cardiomyopathies
– Hypertrophic cardiomyopathy
 Beta blockers
 Vasodilators, digitalis, nitrates, and diuretics are
contraindicated
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Cardiomyopathies
• Surgery and invasive treatments
– Cardiac transplant
– Ventricular assist devices
– Removal of excess muscle
– Dual-chamber pacemakers
– Implantable cardioverter-defibrillators
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Cardiomyopathies
• Nursing diagnoses
– Decreased Cardiac Output
– Fatigue
– Ineffective Breathing Pattern
– Fear
– Ineffective Role Performance
– Anticipatory Grieving
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Learning Outcome 5
• Describe nursing care for the patient
undergoing cardiac surgery or cardiac
transplant.
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Placement of a Circulatory
Assistance Device
• Intra-aortic balloon pump
• Left-ventricular assist device
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Nursing Care of the Heart
Transplant Patient
• Similar to care of any cardiac surgery
patient
• Monitor chest tube drainage
• Monitor cardiac rate and rhythm
• Monitor cardiac output, pulmonary artery
pressures, and CVP
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Nursing Care
• Rewarming procedures
• Administration of IV medications
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Aggressive Nursing Care to
Prevent Infection
•
•
•
•
Limit visitors with communicable diseases
Pulmonary hygiene
Early ambulation
Strict aseptic technique
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition
Priscilla LeMone • Karen Burke • Gerene Bauldoff
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.