Transcript CARDIAC - Vincent's

NUR-224
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Explain cardiac anatomy/physiology and the
conduction system of the heart.
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Incorporate assessment of cardiac risk factors
into the health history and physical assessment
of the patient with cardiovascular disease.
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Discuss clinical indications, patient preparation
and other elated nursing implications fro
common test and procedures used to assess and
diagnose cardiovascular diseases.
Three layers
 Endocardium
 Myocardium
 Epicardium
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Four chambers
Heart valves
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Surrounded by pericardium
Pericardial fluid 10-30 mL
Divided by septum
Left ventricular wall 2-3 x as thick as right
ventricle
Atrial wall thinner than ventricles
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Inferior and superior vena cava send
deoxygenated blood to right atrium
Blood passes through tricuspid valve to right
ventricle blood passes from right ventricle
through pulmonic valve via pulmonary artery to
lungs
Blood from lungs enters left atrium via pulmonary
veins
Passes through mitral valve to left ventricle
Blood ejected to body through aortic valve  aorta
 peripheral system
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Depolarization (contraction of heart)
Sinoatrial node – pacemaker of heart
Contraction of atria
AV node
Bundle of His
Right and left bundle branches
Purkinje fibers
Systole
 Contraction of myocardium
 Ejection of blood from ventricles
Diastole
 Relaxation of myocardium
 Filling of coronary arteries
 Atrium is emptying into the ventricles
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Number of times the ventricles contract each
minute
60-100
Regulated by: Autonomic Nervous System
Sympathetic
Parasympathetic
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Amount of blood pumped by each ventricle during
a given period
Amount of blood ejected from ventricle with each
beat (stroke volume) x heart rate
CO = SV x HR 4 – 7 L/min
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Stroke volume: amount of blood ejected with
each heartbeat
Cardiac output: amount of blood pumped by
ventricle in liters per minute
Preload: degree of cardiac muscle fiber tension
at end of diastole (prior to contraction)
Afterload: resistance that ventricles must
overcome to eject the blood
Contractility: ability of cardiac muscle to
shorten in response to electrical impulse
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Health history
Family/genetic history
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Chest pain
Dyspnea
Peripheral edema, weight gain
Palpitations
Fatigue
Dizziness, syncope, changes in level of
consciousness
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Medications
Nutrition
Elimination
Activity, exercise
Sleep, rest
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Self-concept
Roles, relationships
Sexuality
Risk factors
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Inspection
Palpation
Percussion
Auscultation
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Normal skin color
Capillary refill < 3 seconds
Thorax symmetrical
No jugular vein distention with patient at 45°
Absence of clubbing
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PMI palpable at 5th ICS mid-clavicular line
No thrills, heaves
Slight pulsation of abdominal aorta in epigastric
region
Carotid and extremity pulses equal bilaterally
No pedal edema
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Normal heart sounds
S1 and S2 heart sounds heard
Apical-radial rate equal and regular
No murmurs or extra heart sounds
No S3 or S4
Pericardial friction rub
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Extremities
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Lungs
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Abdomen
Laboratory test:
 Diagnose the cause of cardiac-related
signs/symptoms
 Determine baseline values before initiating
therapeutic interventions
 Ensure therapeutic levels of medication are
maintained
 Evaluate the patient’s response to the therapeutic
regimen
 Identify abnormalities
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Cholesterol - normal level <200mg/dL
Major sources – diet, liver
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Low density lipoproteins LDLs <160
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High-density lipoproteins HDLs
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Triglycerides <200
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CXR/Fluoroscopy
Electrocardiography
Cardiac stress testing
Echocardiography
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Coronary arteries dilate to 4x their normal in
response to increased metabolic demands for
oxygen.
Coronary arteries affected by atherosclerosis dilate
less, compromising blood flow to the myocardium
 ischemia
Noninvasive test
Abnormalities in CV function are more likely to be
detected during times of increased stress.
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Determine :
presence of CAD
cause of chest pain
functional capacity of the heart after MI/ heart
surgery
effective of antianginal/antiarrhythmic
dysrhythmias/ physical exercise
Pre-Test
 Physical and Baseline ECG
 Signed consent
 Patient teaching
 Report cardiac symptoms during test
 NPO 4 hours pre-test
 Withhold meds
 Emergency and resuscitation equipment
need to be at site of test at all times
Testing procedure
 Exercise equipment
 Increase HR to target rate for age and gender OR
c/o chest pain or fatigue
 Speed or incline increased every 2-3 minutes to
increase stress on patient
 ECG and BP monitored throughout the test
 Rest for 15 minutes post test while being
monitored
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Invasive procedure study used to measure cardiac
chamber pressures, assess patency of coronary
arteries
Requires ECG, emergency equipment must be
available
Assessment prior to test: allergies, blood work
Assessment of patient postprocedure: circulation,
potential for bleeding, potential for dysrhythmias
Activity restrictions
Patient education pre/postprocedure
Preparation
 √ allergies to shellfish
 Signed consent form
 D/C anticoagulants,
ASA, salicylates,
herbals affecting
coagulants
 Contraindicated;
patients with
bleeding disorders
Elderly, dehydrated
 Severe renal failure
Patient Teaching
 Palpitations as
catheter enters left
ventricle
 Heat/hot flash as
contrast medium
injected
 Sensation of need to
cough as medium
injected into right
side of heart
During Procedure
 nausea
 pain at insertion site
STAT Intervention
 chest pain
 dysrhythmias
 changes in peripheral
pulses
 neuro assessment
Post Procedure
 VS & Neuro checks
 insertion site
 pressure dressing
 bleeding/hematoma
Assessment
 extremities - s/s
ischemia r/t clots
 bed rest 4-6 hrs post
procedure
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CVP
Pulmonary artery pressure
Intra-arterial BP monitoring