CARDIOVASCULAR SYSTEM CONDITIONS CORONARY ARTERY DISEASES Non Modifiable Risk Factors Age Gender Family History Modifiable

ble Risk Factors Smoking Hypertension Obesity Elevated ________________ Stress Angina Pectoris Pain in the chest from coronary insufficiency, in the absence of myocardial infarction Signs and symptoms: Pain Pallor Diaphoresis Faintness Palpitations Collaborative Management Medications: ________________ (drug of choice) Anticipate postural hypotension Take maximum of 3 doses at 5 min interval SL prep has burning or stinging sensation SL route has onset of 1-2 min, duration of 30 min Sips of H2O improves absorption SL Avoid ________________ Advise client to carry 3 tabs in his pocket Store nitroglycerine in a cool, dry, dark place; replace stock q 6 months Observe for side effects Nitropatch applied OD in AM, rotating sites Evaluate effectiveness B-adrenergic blocking agents propanolol, metoprolol, etc Ca-channel blocker verapamil, nifedipine, diltiazem Platelet-aggregating inhibitors ASA, dypiridamole, ticlopidine Anticoagulants heparin Na, Warfarin Na (Coumadin), dicumarol

Types: ________________ Predictable pattern 4 Es Relieved by rest ________________ ("pre-infarction", "crescendo", "acute coronary insufficiency") Attacks accelerate in frequency intensity and duration Relieved by NTG Leads to MI ________________ ("variant") is primarily attributable to vasospasm

Surgeries: Percutaneous Transluminal Coronary Angioplasty (PTCA) Compresses the plaque by using balloon tipped catheter under fluoroscopic guidance.
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Lecture Aid: Medical-Surgical Nursing

Ideal in ________________ vessel coronary artery disease Intravascular Stenting - done to prevent restenosis after PTCA

Coronary Artery Bypass Graft (CABG) Reduce angina and improve activity tolerance Recommended for ________________ or multivessel involvement Main purpose is myocardial revascularization Common source of graft are saphenous vein and internal mammary artery

Nursing Interventions Administer, as ordered: o Oxygen o Nitroglycerin Rest Diet o Low fat, low Na, low cholesterol diet o Avoid saturated fats o Read food labels Activity restriction within patients limitation Myocardial Infarction ischemic myocardial cell necrosis Caused by coronary artery obstruction due to: o progressive development of atherosclerosis o coronary artery spasm o embolism Occlusion leads to ________________ glycolysis
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Manifestations Dsypnea Changes in heart area Nausea and vomiting Increased WBC and ESR Diagnostic Studies Enzymes: _______________ elevates in 30 minutes _______________ elevates in 2 to 4 hours AST peaks in 24 to 36 hours LDH peaks in 48 to 72 hours.

o Oxygen o IVF to run KVO CBR Monitor: o vital signs every ________________ hours. o cardiac rhythm for dsyrhythmias o signs of congestive heart failure

ECG changes: o ST elevation = myocardial injury o ST depression = ischemia o T wave inversion = myocardial ischemia o large Q waves = necrosis

CONGESTIVE HEART FAILURE Is the inability of the heart to maintain an adequate output of blood from one or more ventricles resulting to an inadequate supply of blood to the vital parts of the body.

Collaborative Management: "O BATMAN!": ________________ Beta blocker ASA ________________ Morphine ACE Nitroglycerin Nursing Interventions Administer, as ordered: o Morphine sulfate
Lecture Aid: Medical-Surgical Nursing

Types: Left-sided CHF: usually pulmonary by nature Right-sided CHF: CHF: affects the periphery in general Pathway of Blood Oxygenation In The Heart

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Peripheral edema Ascites Rapid weight gain (fluid retention) Anorexia, N/V Lightheadedness, dizzy spells or fainting spells Difficulty concentrating or decreased alertness Irregular or rapid heartbeat

Diagnostic Procedures Chest X-ray ECG Echocardiogram Coronary Catheterization Blood Test

Causes Coronary Artery Disease Faulty Heart Valves Cardiomyopathy Congenital Heart Defects Heart Arrythmias Kidney Failure Hypertension (or related increase in BV) Signs and Symptoms Fatigue and weakness DOE Persistent wheezing or cough with white or pink blood-tinged phlegm Pronounced neck veins

Management DIGITALIS THERAPY The major therapy for CHF (+)________________, (-)________________ effects Nsg. Implication: check for HR below 60 and above 120 Monitor serum potassium (Normal 3.5-5.5 mEq/L) Examples: Lanoxin (Digoxin), Crystodigin (Digitoxin), Lanatoside (Cedilanid C), Deslanoside (Cedilanid D) Beware of Digitalis Toxicity!!! G.I. Manifestations: Anorexia, N & V

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Bradycardia ________________ (most dangerous) Yellow / green visions; halos around the light (elderly) In males: gynecomastia, decreased libido and impotence

Captopril (an antihypertensive agent with vasodilator effect)

DIURETIC THERAPY To decrease cardiac workload by ________________circulating BV Nsg. Implications: o Assess for s/sx of hypokalemia when giving thiazides and loop diuretics o Give potassium supplements Best given early AM or early PM If thiazides are ineffective, a potassium sparing diuretic may be given. Examples of Diuretics: Thiazides o Chlorthiazide (Diuril) o Hyrochlorthiazide (Esixdrix o Hyrdodiuril) Loop Diuretics o Furosemide (Lasix) o Bumetamide (Burmex) Potassim-sparing o Spironolactone (Aldactone) o Triamterene (Dyrenium)

Teaching Plan Diet: o Sodium-restricted o Limit fats and cholesterol o Limit alcohol and fluids Stop ________________ NURSING MANAGEMENT Provide ________________ Promote rest and activity Decrease anxiety Facilitate fluid balance Provide skin care Promote nutrition Promote elimination Facilitate learning

HYPERTENSION ________________ elevation of the arterial blood pressure CO x TPR Increased pressure may be the: o systolic o diastolic o both pressures A sustained pressure = hypertension: o systolic = 140 mmHg

VASODILATORS Decreases resistance to ventricular emptying, thereby decreasing ________________ Most commonly used as follows: o Nitroprusside (Nipride) o Hydralazine (Apresoline) o Nifedipine (a Calcium-channel blocker with vasodilator effect)

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o Types:

diastolic = 90 mmHg

Antihypertensive drug therapy

Nursing Interventions ________________ / Essential / Idiopathic Unknown etiology Predisposing factors o Heredity o Age o Stress Secondary / Non-essential Secondary to other diseases Alcoholism Prolonged use of oral contraceptives ________________ crisis sudden elevation in blood pressure life-threatening Isolated systolic hypertension an elevation in systole only (>140 mmHg) affects elderly persons Record baseline BP in 3 positions (lying, sitting, standing) and in both arms Continuously assess BP and report any erratic change Administer antihypertensive agents as ordered o monitor closely and assess for S/E Monitor I & O Client teaching and discharge planning: o risk factors o dietary instructions o compliance of antihypertensive medications o routine follow up physician Report symptoms of complications: o Visual disturbances o Decreased urine output o Chest pains o Weakness or paresthesia

Collaborative Management Diet and weight reduction o restricted sodium o low cholesterol Lifestyle changes o alcohol moderation o exercise regimen o cessation of smoking ANEURYSM ________________ of blood vessel wall Types: o ________________ - involving all three layers of the vessel wall o ________________ - one side only

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Collaborative Management Hypertension control Surgery o resection of the aneurysm and replacement with a Teflon/Dacron graft Nursing Interventions Prepare for surgery and implement postop care Watch out for signs of shock Advise client to prevent increased IAP RAYNAUDS DISEASE / RAYNAUDS PHENOMENON Characterized by intermittent ________________ with resultant ischemia in the extremities

Etiology and Incidence Commonly affected: ________________ ______________, 50-70 May be caused by: o Arteriosclerosis o Syphilis o Hypertension o Infection o Trauma to the BV

Manifestations Often asymptomatic Deep, diffuse chest pain Hoarseness Dysphagia Dyspnea Pallor Rupture = ________________

Etiology and Incidence Commonly affects digits of the hands ________________, 18 and 40 Risk factor: o Chemical pollutants o Cold environment o Cigarette smoking o Emotional stress Raynauds disease ____________ cause Hereditary 2 years history Raynauds phenomenon secondary to other disorders: o Occlusive arterial diseases o Connective tissue diseases

Diagnostic Test Aortography - exact location X-rays o chest film abnormal widening of aorta o abdominal film - calcification within walls of aneurysm

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o o o

Primary pulmonary hypertension Hypothyroidism Neurologic diseases

o need to maintain warmth o Protection of the hands (gloves) Administer vasodilators as ordered THROMBOANGITIIS OBLITERANS (BUERGERS DISEASE)

Characterized by inflammatory changes in both ____________ and veins resulting in destruction of small and medium vessels Usually affects the ___________ extremities

Etiology and Incidence Exact cause: Unknown Men ages 25-40 Cigarette smoking Manifestations Intermittent ________________ Sensitivity to cold (skin may at first be white, changing to blue then red) Pulselessness Ulceration and gangrene (advanced) Collaborative Management Drugs: o Vasodilators - improve arterial circulation o Analgesics - relieve ischemic pain o Anticoagulants - prevent thrombus formation o Lipid reducing drug: cholestyramine, colestipol HCl, lovastatin (Mevacor), atorvastatin

Manifestations Pain (secondary to ischemia) Paresthesia Coldness Tingling in one or more digits Intermittent color changes (pallor, cyanosis) Small ulcerations Gangrene tips of digits Nursing Interventions Client teaching o importance of stopping smoking

Surgery o bypass grafting

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o o

balloon catheter dilation amputation (if necessary)

Nursing Interventions Health teachings o stop smoking o Maintaining warmth Administer medications, as ordered. Prepare for surgery, if indicated. VENOUS THROMBOSIS (THROMBOPHLEBITIS) Refers to inflammation of a vein Precipitated by a thrombus formation Commonly occurs in the veins of the extremities: o Saphenous o Femoral o Popliteal

o o o o o o o o o o o o

Obesity CHF Immobility MI Pregnancy Oral contraceptives Trauma Sepsis Cigarette smoking Dehydration Severe anemias Complication of surgery

Types ______________________ o A stationary clot in deeper veins of the legs Superficial thrombophlebitis o inflammation of a vein closer to the surface o accompanied by formation of a stationary clot within the vein Phlebitis o inflammation of one or more veins without resultant clot formation.

Manifestations Pain in the affected extremity Superficial vein o Tenderness o Redness o Induration along course of the vein Deep vein o Swelling o Venous distension of limb o (+)____________ sign DVT and phlebitis may result in pulmonary embolism (when clot break off) o Sudden chest pain o Dyspnea o Decreased blood oxygen (Po2) o Agitation o Cyanosis o Tachycardia

Risk factors:

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Collaborative Management Anticoagulants: Heparin Warfarin (coumadin) Nursing Interventions Deep Vein Thrombosis Assess respiratory and circulatory functions Admister medications, as prescribed: o Anticoagulant therapy o Thrombolytic therapy Avoid manipulation (eg. massage) Elevate the extremity Observe the extremity for edema Superficial thrombophlebitis Apply warm compresses over the affected site. Elevate the extremity. Administer anti-inflammatory agents, as prescribed. Health Teaching Avoid: o Standing & sitting for long periods o Constrictive clothing o Crossing legs at the knees o Smoking o Oral contraceptives Importance of adequate hydration Use of elastic stockings when ambulatory Importance of: o planned rest with elevation of feet

o weight reduction and exercise Institute postop care

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