Transcript Chapter 15

Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 21
Cardiovascular System Function,
Assessment, and Therapeutic
Measures
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
The Heart
 In Mediastinum
 Pericardial Sac: Three Layers
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Fibrous Pericardium
Parietal Pericardium
Visceral Pericardium (Epicardium)
Serous Fluid Between Inner Layers
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Anterior Heart View
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Understanding Medical Surgical Nursing, 4th Edition
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Frontal Heart View
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Understanding Medical Surgical Nursing, 4th Edition
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Cardiac Structure and Vessels
 Four Chambers
 Right/Left Atrium, Right/Left Ventricle
 Cardiac Layers
 Epicardium, Myocardium, Endocardium
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Understanding Medical Surgical Nursing, 4th Edition
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Cardiac Structure and Vessels
(cont’d)
 Coronary Arteries
 Valves
 Tricuspid, Pulmonic, Mitral, Aortic
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Blood Flow
Vena Cava » Right Atrium» Tricuspid »
Right Ventricle» Pulmonic » Pulmonary
Artery » Lungs » Pulmonary Veins» Left
Atrium » Mitral » Left Ventricle» Aortic
Valve » Aorta
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Understanding Medical Surgical Nursing, 4th Edition
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Cardiac Conduction
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SA Node
AV Node
Bundle of His
Right and Left Bundle Branches
Purkinje Fibers
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Cardiac Output
 Amount of Blood Ejected from the Left
Ventricle in 1 Minute
 Stroke Volume x Heart Rate = CO
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nervous System Regulation of
the Heart
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Hormones and the Heart
 Epinephrine
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Increases Heart Rate
Force of Contraction
Cardiac Output
Systolic BP
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Understanding Medical Surgical Nursing, 4th Edition
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Hormones and the Heart (cont’d)
 Aldosterone
 Regulates Sodium/Potassium
 Atrial Natriuretic Peptide
 Excretes Sodium
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Understanding Medical Surgical Nursing, 4th Edition
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Blood Vessels
 Arteries
 Veins
 Capillaries
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Structure of Blood Vessels
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Understanding Medical Surgical Nursing, 4th Edition
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Blood Pressure
 Blood Force Against Blood Vessel Walls
 Normal
 Systolic <120 mm Hg
 Diastolic <80 mm Hg
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Renin-Angiotensin-Aldosterone
Mechanism
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Pathways of Circulation
 Pulmonary
 Systemic
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Aging and the Cardiovascular
System
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging and the Cardiovascular
System (cont’d)
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Atherosclerosis
Arteriosclerosis
Blood Pressure Increases
Vein Valves More Incompetent
Heart Muscle Less Efficient
Dysrhythmias Common
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Understanding Medical Surgical Nursing, 4th Edition
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Cardiovascular Disease
 Number 1 Killer
 Healthy Lifestyle
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Smoking Cessation
Dietary Fat Reduction
Two Servings of Fish Weekly
Exercise
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiovascular Disease
(cont’d)
 Go Red for Women
 American Heart Association’s Nationwide
Movement to Celebrate the Power Women
Have to Band Together to Wipe Out Heart
Disease
 Color Red and Red Dress Linked with This
Ability
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiovascular Assessment
 Health History
 Physical Assessment
 Diagnostic Studies
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Understanding Medical Surgical Nursing, 4th Edition
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Health History
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Symptoms – WHAT’S UP?
Allergies
Past Medical History
Medications
Family History
Health Promotion Methods
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Understanding Medical Surgical Nursing, 4th Edition
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Physical Assessment
 Vital Signs
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Blood Pressure
Pulse
Respirations
Temperature
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Understanding Medical Surgical Nursing, 4th Edition
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Physical Assessment (cont’d)
 Inspection
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Oxygenation, Skin Color
Extremities: Hair , Skin, Nails, Edema, Color
JVD
Capillary Refill
Clubbing
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Clubbing
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Physical Assessment (cont’d)
 Palpation
 Point of Maximum Impulse
 Extremity Temperature
 Poikilothermy
 Edema
 Homans’ Sign
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Understanding Medical Surgical Nursing, 4th Edition
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Edema
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Understanding Medical Surgical Nursing, 4th Edition
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Homans’ Sign
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Understanding Medical Surgical Nursing, 4th Edition
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Physical Assessment (cont’d)
 Auscultation
 Heart Sounds
 S1
 S2
 S3
 S4
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Understanding Medical Surgical Nursing, 4th Edition
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Heart Sounds
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Understanding Medical Surgical Nursing, 4th Edition
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Physical Assessment (cont’d)
 Auscultation (cont’d)
 Murmurs
 Pericardial Friction Rub
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Studies
Joint Commission
National Patient Safety Goal
 Improve Accuracy of Patient Identification
 Use at Least Two Patient Identifiers (Neither
Patient's Location) Whenever Collecting
Laboratory Samples or Administering
Medications or Blood Products
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Studies
Joint Commission National
Patient Safety Goal (cont’d)
 Use Two Identifiers to Label Sample Collection
Containers in Presence of Patient
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Understanding Medical Surgical Nursing, 4th Edition
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Diagnostic Studies
Joint Commission
National Patient Safety Goal
(cont’d)
 Immediately Prior to Any Invasive Procedure,
Conduct Final Verification Process to Confirm
Correct Patient, Procedure, Site, and Availability
of Appropriate Documents
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Understanding Medical Surgical Nursing, 4th Edition
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Noninvasive Diagnostic
Studies
 Chest X-Ray
 CT Scan
 Magnetic Resonance Imaging
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Electrocardiogram
 Records Cardiac Electrical Activity
 Signal-averaged ECG
 Risk for Ventricular Dysrhythmias
 Ambulatory Electrocardiogram Monitoring
 Holter Monitoring
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Echocardiogram
 Ultrasound
 Records Motion
 Heart Structures
 Valves
 Heart Size, Shape, Position
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Understanding Medical Surgical Nursing, 4th Edition
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Transesophageal
Echocardiogram
 Probe in Esophagus
 Clearer Picture
 NPO Until Gag Reflex Returns
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Exercise StressTest
 Cardiac Stress Test
 Cardiac Response to Exercise and Increased
Oxygen Needs
 Peripheral Vascular Stress Test
 Vascular Response to Walking
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Stress Test
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Noninvasive Diagnostic
Studies
 Plethysmography
 Diagnoses Deep Vein Thrombosis/Pulmonary
Emboli/Peripheral Vascular Disease
 Pressure Measurement
 BP Readings Along Extremity
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Noninvasive Diagnostic
Studies (cont’d)
 Arterial Stiffness Index
 Atherosclerosis/Cardiovascular Disease
 Tilt Table Test
 Lying to Standing BP and HR
 Doppler Ultrasound
 Impaired Blood Flow Reduces Sound Waves
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Radioisotope Imaging
 Radioisotopes IV, Gamma Camera Scan
 Detects Cardiac Ischemia/ Damage/
Perfusion
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Thallium Imaging
Technetium Pyrophosphate Scan
Technetium 99m Sestamibi
MUGA Scan
Positron Emission Tomography
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Blood Studies
 Blood Lipids
 Triglycerides, Cholesterol, Phospholipids
 hs-CRP
 Homocysteine
 Cardiac Biomarkers
 Creatine Kinase, Troponin, Myoglobin
 Magnesium
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Studies
Joint Commission
National Patient Safety Goal
 Improve Effectiveness of Communication
Among Caregivers
 For Orders/Telephonic Reporting of Critical
Test Results, Verify Complete Order/Test
Result by Reading Back Complete Order/
Test Result to Person Giving it
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Invasive Studies
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Angiography
Cardiac Catheterization
Hemodynamic Monitoring
Electrophysiology Study
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Catheterization
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Pulmonary Artery Catheter
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Therapeutic Interventions
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Exercise: Walking Program
Cardiac Rehab
Smoking Cessation
Balanced Diet, Weight Loss
Oxygen
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
(cont’d)
 Antiembolism Devices
 Elastic Stockings
 Intermittent Pneumatic Compression
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
(cont’d)
 Medications
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Cardiac Glycosides
Vasodilators
Antihypertensives
Antidysrhythmics
Antianginals
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
(cont’d)
 Medications (cont’d)
 Anticoagulants
 Thrombolytics
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Lifestyle and Cardiac Care
 Risk Factors
 Support Groups
 Sexual Activity
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Surgery
 Preparation for Surgery
 Cardiopulmonary Bypass
 Video-assisted Thoracoscope
 General Procedure for Cardiac Surgery
 Minimally Invasive Cardiac Surgery
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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiopulmonary Bypass Pump
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Cardiopulmonary Bypass Pump
in Use
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