Class 8 - Cardiovascular System Flashcards
SA node is
the “pacemaker” of the heart (sets the heart rate).
The SA node sends electrical impulses that spread throughout the atria like ripples in a pond,
SA node impulses travel down to the AV node
AV node is
The AV node sends electrical impulses to the Bundles of His
- From the Bundles of His, impulses split and travel to the ventricles.
- These impulses are divided into 2 branches called the right and left bundle branch which allows the even spread of the electrical signal to both ventricles simultaneously.
information card only
The heart is divided by muscle and fibrous tissue into a right and left side. Each side has an upper chamber or atrium that collects blood returning to the heart and a muscular lower chamber or ventricle that pumps that blood away from the heart. The right atrium (RA) receives blood from you body and pumps it into the right ventricle (RV). The right ventricle then pumps it to your lungs. From the lungs, blood returns to your left atrium (LA) and then pumped into the left ventricle (LV). From the left ventricle it is pumped out to your body.
age-related changes to the heart
- valves become stiffer
- decreased contractility (slower HR)
- arteries thicken and stiffen
- baroreceptors become less sensitive
- heart may fill more slowly
What is an inflammatory disorder of the peripheral blood vessels
thrombophlebitis - inflammation of the wall of a vein with associated with a blood clot
Occlusive disorders of peripheral blood vessels are
Peripheral Vascular Disease (PVD)
□ Arterial Occlusive Disease
□ Venous Occlusive Disease
□ Venous Insufficiency
*Varicose Veins
*Valvular damageWhat is CAD
Coronary Artery Disease (CAD)
What are the characteristics of CAD (coronary artery disease)
- atherosclerosis (fatty substances form a deposit of plaque on the inner lining of arterial walls)
- ateriosclerosis (hardening of the arteries)
What is chronic stable angina
Chest pain that occurs intermittently over a long period with same pattern of onset, duration and intensity of symptoms
clinical manifestations of chronic stable angina
- Pain usually lasts 3 to 5 minutes
- Subsides when the precipitating factor is relieved
- Pain at rest is unusual
- May radiate
- “dull”, “tightness” , “burning sensation”
- Does not change with position or breathing
What is angina
marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, caused by an inadequate blood supply to the heart.
treatment of angina is aimed at
- decreasing O2 demand or increasing it depending on the situation
- emphasis on the reduction of risk factors
Collaborative ManagementChronic Stable Angina: drug therapy
What types of drugs can you use
- Short-acting nitrates: Sublingual nitro (first line of therapy for angina)
*promotes peripheral dilation
decreasing preload and
afterload- promotes coronary artery
vasodilation
- promotes coronary artery
- Long-acting nitrates: isosorbide dinitrate (Isordil)
- used to reduce the incidence
attacks
- used to reduce the incidence
- Transdermal controlled-release Nitrates
- used to deliver rate
controlled slow delivery
of medication over a 24 hour
period
- used to deliver rate
- β-adrenergic blockers
*inhibit SNS stimulation of the
heart
*reduce both heart rate and
contractility
*decrease after load - Calcium channel blockers
*systemic vasodilation with
decreased stroke volume
rate
*promote coronary
vasodilation
*reduce heart muscle
contractility - Angiotensin-converting enzyme inhibitors
*prevent conversion of
angiotensin I to angiotensin
II- decrease endothelial
dysfunction
- decrease endothelial
Strategies for the patient with chronic stable angina should address of these treatment elements in this pneumonic
A = antiplatelet agent, antianginal therapy, ACE inhibitor
B = B-Adrenergic blocker, blood pressure
C = cigarette smoking, cholesterol
D = diet, diabetes
E = education, exercise
F = flu vaccine
What diagnostic tools could you use
Health history/physical exam Laboratory studies 12-lead ECG Chest x-ray Echocardiogram Exercise stress test
What acute interventions could be used for an angina attack
- Administer of supplemental O2
- Vital signs
- 12-lead ECG
- Prompt pain relief with a nitrate followed by an opioid analgesic if needed
- Auscultation of heart sounds
- Comfortable positioning of the client
What can you teach someone who is ambulatory or at home about their angina
- watch for precipitating factors (ex: what triggers the attacks)
- risk factor reduction
- teaching around medications
heart failure means what
- an abnormal condition involving impaired cardiac pumping
- heart is unable to produce an adequate cardiac output (CO) to meet the metabolic needs
heart failure is characterized by what
- ventricular dysfunction
- reduced exercise intolerance
- diminished quality of life
- shortened life expectancy
Heart failure (HF) is not a disease but associated with long-standing what
hypertension, coronary artery disease & MI
common causes of HF
- CAD
- hypertension
- anemia
- pulmonary disease
- congenital heart disease
- acute MI
- pulmonary embolus
what leads to HF
- infection
- anemia
- pulmonary disease or embolus
- nutritional deficiencies
What are the 2 ways HF can be described
systolic and diastolic
Explain systolic HF
this is the most common type of HF which results from an inability of the heart to pump blood.
The hallmark of systolic HF is a decrease in the left ventricular ejection fraction (what is pumped out of the left ventricle with each contraction)
Causes of systolic HF
- Impaired contractile function (e.g., MI)
- Increased afterload (e.g., hypertension)
- Cardiomyopathy
- Mechanical abnormalities (e.g., valve disease)
Explain diastolic HF
Impaired ability of the ventricles to relax and fill during diastole resulting in decreased stroke volume and CO
How is diastolic HF diagnosed
based on the presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, normal ejection fraction (EF)
what are the 2 types of HF
Left-sided HF (most common)
- Backup of blood into the left atrium and pulmonary veins
- Manifested as pulmonary congestion and edema
Right-sided HF
- Causes backward blood flow to the right atrium and venous circulation
* Results in peripheral edema, hepatomegaly, splenomegaly, GI vascular congestion, jugular vein distension
Clinical manifestations of left and right sided HF are
Left-sided failure
-fatigue
-dyspnea
-orthopnea
-dry cough
-pulmonary edema**
-nocturia
-paroxysmal nocturnal dyspnea
(attacks of severe SOB)
Right-sided failure
- fatigue
- dependent edema (legs)
- right upper quadrant pain
- anorexia
- nausea
*Pulmonary edema, often life-threatening Early stage - Increase in the respiratory rate - Decrease in PaO2 Later stage - Tachypnea - Respiratory acidemia
What are some complications of HF
- pleural effusion
- dysrhytmias (afib being most common)
- left ventricular thrombus
- hepatomegaly
- renal failure
what diagnostics tools could be helpful in determining the underlying cause of HF
History and physical exam CXR ECG Lab studies (ex. cardiac enzymes, BNP) Hemodynamic assessment Echocardiogram Stress testing Cardiac catheterization Ejection fraction (EF)
Overall goal for acute HF and pulmonary edema is to improve what and how
Left ventricular function by
- Decrease intravascular volume
*loop diuretics
(ex: furosemide)
- Decrease venous return
(preload)
- reduce volume returned to
the left ventricle during
diastole
- high-Fowler’s position
- IV nitroglycerin
- Improve cardiac function
- for clients who do not
respond to conventional
pharmacotherapy
(ex: diuretics, vasodilators,
morphine sulphate), inotropic
therapy is used:
digitalis
hemodynamic monitoring
(in CCU or ICU) - Reduce anxiety
- distraction, imagery,
sedative medications
What are the main treatment goals
- Treat the underlying cause and contributing factors
- Provide treatment to alleviate symptoms
- Preserve target organ function
- Improve mortality and morbidity - - Oxygen administration
- Physical and emotional rest
- Non pharmacological therapies
What are the different types of drug therapy that can be used
- diuretics
* thiazides (hydrochlorothiazide)
* furosemide (Lasix)
* K+ sparing (spironolactone) - Angiotensin-converting enzyme (ACE) inhibitors {“prils’}
*Angiotensin II receptor
blockers in clients who can
not tolerate ACE inhibitors
{“sartans”} - B-Adrenergic blockers {“lols”}
- Inotropic drugs
*Sympathomimetic agents
(ex: dopamine)
*Phosphodiesterase inhibitors
(ex: milrinone)
*Digitalis preparations
(ex: digoxin)
*Vasodilator drugs
(ex: nitrates, nitroprusside)
In terms of nutritional therapy what are you going to do for the patient with HF
- Diet and weight reduction
- Dietary Approaches to Stop
Hypertension (DASH) diet is
recommended - Sodium is usually restricted to
2g per day; usually no fluid
restriction - Daily weights are important
- Weight gain of 2 kg over a 2 to 5
day period should be reported
to the physician
What ypes of health promotion should be provided
- treatment or control of
underlying disease
(ex: hypertension)
- antidysrhythmic agents or
pacemakers for more serious
situations
- vaccinations
- stop smokingWhat is Peripheral Vascular Disease
What is Peripheral Arterial Disease
PVD -
Term for disorders that affect blood vessels distant from the large central blood vessels supplying the myocardium or that circulate blood directly in and out of the heart
PAD - this is the thickening of artery walls, which results in a progressive narrowing of the arteries of the upper and lower extremities
what arteries are affected with PVD
Affects aortoiliac, femoral, popliteal, tibial or peroneal artery
what are the clinical manifestations of PVD
- severity depends upon the site - extent of obstruction
- amount of collateral circulation
Classic symptom is:
intermittent claudication.
This means when a muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.
Nursing Dx for PAD would be
Ineffective tissue perfusion Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen
Nursing implementation for PAD would be
Health promotion:
*Teach clients about risk factors, screening clinics, smoking cessation, diet modification
Acute Intervention:
*After surgical intervention, usual postop care with particular attention given to the affected extremity; avoid knee-flexed positions
Ambulatory & home care: * *Management of risk factors, meticulous foot care
Nursing planning for PAD would be (goals)
- Adequate tissue perfusion
- Relief of pain
- Increased exercise tolerance
- Intact, healthy skin on
extremities
What is acute arterial ischemic disorders
Acute arterial ischemia occurs suddenly, without warning
Can be caused by embolism, thrombosis or trauma
Clinical manifestations include the
What are the clinical manifestations of acute arterial ischemic disorders
They are the six Ps:
pain
pallor
pulselessness
paresthesia (pins and needles)
paralysis
poikilothermia (the inability to
regulate core body
temperature)What is the collaborative care for acute ischemic disorders
- Early treatment is essential to
keep limb viable
- Anticoagulant therapy-
ie: Heparin to prevent
development of further clots
or the extension of those
already present
- Thrombolytics
- Bedrest to monitor dissolution of
the clot
- SurgeryWhat is Venous Thrombosis (DVT)
is a disorder involving a thrombus in a deep vein, most commonly the iliac and femoral veins
What are the 3 factors that cause venous thrombosis to occur (Virchow’s triad)
- venous stasis (blood pooling in the veins)
- endothelial damage (inner lining of the veins)
- hypercoaguability of the blood
Factors that contribute to venous thrombosis are
- inactivity
- compromised circulation
- compression of veins in the pelvis or leg
- smoking
What are some of the sing and symptoms of venous thrombosis
- discomfort of affected extremity
- heat
- redness
- edema
- cap refill (less than 2 secs)
- fever
- malaise
- fatigue
- anorexia
What are some of the nursing Dx you could use for venous thrombosis
Acute pain Ineffective health maintenance Risk for impaired skin integrity Potential complication: Bleeding Potential complication: Pulmonary embolism
What are some of the planning goals that could be used for venous thrombosis
relieve pain
decrease edema
no skin ulcerations
no complications from drug
therapy
no pulmonary emboliWhat collaborative care measures would you put in place
- Complete bed rest (prevent
embolus)
- Anticoagulant therapy
- heparin/coumadin
/LMWH/Platelet inhibitors
- Fibrinolytic agents (emergent
situations)
- Surgery (if large vein involved or
danger of PE)
*thrombectomy
What is venous insufficiency
-flow of blodd is impaired through deep or superficial veins. this is a chronic condition that ususally affects the lower extremities (normally around the ankle)
What are some of the signs and symptoms of venous insufficiency
- non pitting edema
- superficial veins are dilated and
obvious - non uniform skin color
- shiny appearance to feet and
ankles - delicate, easily damaged skin
- possible weeping dermatitis
- moderate pain
- pedal and tibial pulses difficult
to palpate
What is the goal for venous insufficiency and how can we achieve this goal
to promote venous circulation
by:
- using elastic compression
stockings
- mild analgesics
- elevate legs periodically (raise
foot of bed)
- walk or isometric calf exercises
- avoid hot showers (dilates
vessels = congestion)
- avoid constricting clothingWhat is superficial thrombophlebitis
the formation of a thrombus in a superficial vein
Clinical manifestations of superficial throwbophlebitis include what
palpable, firm, subcutaneous cordlike vein with the surrounding area tender, reddened and warm
What can be done to help with superficial thrombophlebitis
- elevation of the affected limb
- warm, moist heat
- analgesics
- NSAIDs
What are varicose veins
dilated, tortuous subcutaneous veins most commonly found in the saphenous leg veins
What causes varicose veins
Familial tendency DVT Congenital venous malformations Multiple pregnancies Prolong standing Increased intraabdominal pressure obesity
What are some of the clinical manifestations for varicose veins
Legs heavy and tired
Activity or elevation of legs relieves discomfort
Feet, ankles and legs may appear swollen
Leg veins appear distended and tortuous,
-Dark blue or purple, snakelike
elevations
-Abnormal capillary refillWhat can be done to manage varicose veins
Focus on ↑ venous flow
*walking, swimming
/isometric exercises
*compression stockings
*occupational modifications
Preventing tissue injury
*avoid restrictive clothing
Sclerotherapy
Vein ligation /Vein stripping
