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JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 37:
Circulation
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Objectives
• Describe basic functioning and structure of the cardiovascular
system
• Identify factors that influence circulation and perfusion
• Verbalize assessments & how to evaluate adequacy of
circulation and perfusion
• Develop nursing diagnosis related to circulation and perfusion
• Verbalize measures to promote peripheral circulation (venous
return)
• Recognize medications used to enhance cardiovascular
function
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Structures of the Cardiovascular System
Heart
• Cardiac cycle—
simultaneous contraction
of the two atria, followed a
fraction of a second later
by the simultaneous
contraction of the
ventricles
• Electrical conduction—
electrical activity that
initiates contraction of
the myocardium
<<insert Figure 38-2 –
from Treas1 PPT – use
the Treas1 PPT slide
image>>
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Structures of the
Cardiovascular System (cont’d)
Cardiac cycle
• Sinoatrial (SA) node—pacemaker of the heart
• Atrioventricular (AV) node—Electrical activity passes
through the AV node into the left and right bundles of
HIS and into Purkinje fibers to the ventricles.
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Structures of the
Cardiovascular System (cont’d)
Systemic and pulmonary
blood vessels
• Arteries
• Arterioles
• Capillaries
• Veins and venules
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Structures of the
Cardiovascular System (cont’d)
• Heart, blood vessels, red blood cells
• Hemoglobin: carries oxygen
• Arteries
– Oxygenated blood to tissues
• Veins
– Deoxygenated blood back to heart/lungs
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Structures of the
Cardiovascular System (cont’d)
Coronary Arteries
Blood supply for the heart
Fill during diastole
https://www.youtube.com/watch?v=tBQa8IBzP6I
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Regulating Cardiovascular Function
• Autonomic nervous
system—sympathetic
and parasympathetic
fibers
– Heart: regulate heart
rate and contractility
– Vascular system: maintain
vascular tone
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Regulating Cardiovascular Function (cont’d)
• Brain stem centers—regulate cardiac function and
blood pressure
– Baroreceptors—sensitive to pressure changes
– Vascular system—sensitive to blood pH, oxygen levels, and
CO2
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Factors That Influence Cardiac Function
• Developmental stage
– Infants—transition to life outside the uterus, congenital
heart
– Preschool/school-age—growth, diet, and obesity
– Adolescents—substance use/abuse, diet
and obesity
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Factors That Influence
Cardiac Function (cont’d)
• Developmental stage
– Adults—lifestyle, stress, heredity, diet,
exercise, obesity
– Older adults—thicker and more rigid valves, decreased
myocardial strength, lower exercise tolerance, other health
problems
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Factors That Influence
Cardiac Function (cont’d)
• Environment
• Stress
– Allergic reactions and air quality
– Heat and cold
• Medications
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Factors That Influence
Cardiac Function (cont’d)
• Lifestyle
– Pregnancy
– Nutrition
– Obesity
– Exercise
– Tobacco use
– Substance abuse
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Factors That Influence
Cardiac Function (pathophysiological) (cont’d)
• Cardiovascular abnormalities
– Heart failure
– Cardiomyopathy
– Cardiac ischemia
– Coronary artery disease
– Dysrhythmias
– Heart valve abnormalities-nice to know only in Block one
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Factors That Influence
Cardiac Function (cont’d)
• Environment
– Stress
• Allergic reactions and air quality
• Heat and cold
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Factors That Influence
Cardiac Function (cont’d)
• Peripheral vascular abnormalities
• Oxygen transport abnormalities
– Anemia
– Carbon monoxide
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Cardiovascular Assessment
• Assessing risk factors
• Physical exam
– Assess pain
– Assess fatigue
– Assess dyspnea
– Assess peripheral circulation
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Cardiovascular Assessment (cont’d)
• Tests of
blood oxygenation
• Lab testing
• Cardiac monitoring—
supraventricular,
junctional, ventricular
rhythms
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Cardiac Monitoring
• P wave
• QRS complex
• T wave
• U wave
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Cardiovascular Nursing Diagnosis
• Decreased cardiac output
• Ineffective tissue perfusion
• Risk for shock
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Cardiovascular Nursing Planning
and Interventions
• Manage anxiety
• Promote circulation (venous and arterial)
• Prevent clot formation
• Administer medication
• Perform CPR
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Cardiopulmonary Resuscitation
• In-hospital arrest
• Hands-Only™ CPR
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Think Like a Nurse
Why might it be more difficult to recognize a heart
attack in a woman than in a man?
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