CARE OF CLIENTS WITH

PROBLEMS IN OXYGENATION
(CARDIAC DISORDERS)
Judy F. Celiz, RN,MAN

CK-MB (CREATININE KINASE,

MYOCARDIAL MUSCLE)
An

elevation in value indicates myocardial

damage

An

elevation occurs within 4 to 6 hours

and peaks 18 to 24 hours following an
acute ischemic attack

Normal

value is 0% to 5% of total; total

CK is 26 to 174 units/L

LACTATE DEHYDROGENASE
(LDH)
Elevations

in LDH levels occur 24 hours

following myocardial infarction and peak in
48 to 72 hours

Normally,

LDH1 is lower than LDH2; when

the serum concentration of LDH1 is higher
than LDH2, the pattern is indicated as
flipped, signifying myocardial necrosis

140

to 280 IU/L

TROPONIN
Is

composed of troponin C, cardiac

troponin I, and cardiac troponin T

Has

a high affinity for myocardial injury;

it rises within 3 hours and persists for up
to 7 days

Troponin

I lower than 0.6ng/mL

Troponin T 0 to 0.2ng/mL

 Elevated

hematocrit level can result from

vascular volume depletion

Decreases

in hematocrit and hemoglobin

levels can indicate pneumonia

SERUM LIPIDS
The

lipid profile measures serum

cholesterol, triglyceride, and lipoprotein
levels

Is

used to assess the risk of developing

coronary artery disease

Serum

cholesterol lower than 200mg/dL

LDL lower than 130mg/dL
HDL 30 to 70 mg/dL

B-TYPE NATRIURETIC PEPTIDE

(BNP)
Is

released in response to atrial and

ventricular stretch; it serves as a marker
for congestive heart failure

Should
The

be lower than 100pg/mL

higher the level, the more severe the

congestive heart failure

ELECTROCARDIOGRAPHY
Noninvasive

test that records the

electrical activity of the heart and is
useful for detecting cardiac dysrhythmias,
location and extent of MI, and cardiac
hypertrophy and for evaluation of the
effectiveness of medications

INTERVENTIONS
Determine

the clients ability to lie still;

advise the client to lie still, breathe
normally, and refrain from talking during
the test

Reassure

the client that an electrical shock

will not occur

Document

any cardiac medications the

client is taking

ECHOCARDIOGRAPHY
Noninvasive

procedure based on the

principles of ultrasound and evaluates
structural and functional changes in the
heart

Heart

chamber size is measured, ejection

fraction is calculated, and flow gradient
across the valve is determined

EXERCISE TESTING (STRESS

TEST)
Noninvasive

test that studies the heart

during activity and detects and evaluates
coronary artery disease

Treadmill

testing is the most commonly

used mode of stress testing

INTERVENTIONS
Obtain

an informed consent if required

Provide

adequate rest the night before the

procedure

Instruct

the client to eat a light meal 1 to

2 hours before the procedure

Instruct

the client to avoid smoking,

alcohol and caffeine before the procedure

 Instruct

client to wear nonconstrictive,

comfortable clothing and supportive
rubber-soled shoes for the exercise stress
test

Instruct

the client to notify the physician

if any chest pain, dizziness, or shortness of
breath occurs during the procedure

Instruct

client to avoid taking a hot bath

or shower for at least 1 to 2 hours after
the procedure

DIGITAL SUBTRACTION
ANGIOGRAPHY
This

test combines x-ray techniques and a

computerized subtraction technique with
fluoroscopy for visualization of the
cardiovascular system

contrast media (dye) is injected

INTERVENTIONS
Assess

for allergies to seafood, iodine, or

radiopaque dyes. Premedicate client with
antihistamines or corticosteroids to
prevent a reaction

Obtain

informed consent

Monitor
Assess

vital signs

injection site for bleeding or

discomfort

MAGNETIC
IMAGING

RESONANCE

Noninvasive

diagnostic test that produces

an image of the heart or great vessels
through interaction of magnetic fields,
radio waves, and atomic nuclei

Provides

information on chamber size and

thickness, valve and ventricular function,
and blood flow through the great vessels
and coronary arteries

INTERVENTIONS
Evaluate

client for the presence of

pacemaker or other implanted items that
present a contraindication to the test

Ensure

client has removed all metallic

objects such as watch, jewelry, clothing
with metal fasteners, and metal hair
fasteners

Inform

client that she or he may

experience
claustrophobia
while
in
scanner

CORONARY ARTERY
DISEASE

 Narrowing

or obstruction of one or more

coronary
arteries
as
a
result
of
atherosclerosis, which is an accumulation of
lipid-containing plaque in the arteries

Causes

decreased perfusion of myocardial

tissue and inadequate myocardial oxygen
supply

Symptoms

occur when the coronary artery

is occluded to the point that inadequate
blood supply to the muscle occurs causing
ischemia

 Coronary

artery narrowing is significant if

the lumen diameter of the left main artery
is reduced at least 50%, or if any major
branch is reduced at least 75%

The

goal of treatment
atherosclerotic progression

Cardiac

is

to

alter

catheterization provides the most

definitive source for diagnosis

SIGNS AND SYMPTOMS

Chest

pain

Palpitations
Dyspnea
Syncope
Cough

or hemoptysis

Excess

fatigue

 When

blood flow is reduced and ischemia

occurs, ST segment depression, T wave
inversion, or both is noted; ST segment
returns to normal when the blood flow
returns

With

infarction, cell injury results in ST

segment elevation, followed by T wave
inversion and an abnormal Q wave

Blood

lipid levels may be elevated

INTERVENTIONS
Instruct

the client regarding the purpose

of diagnostic medical and surgical
procedures and pre procedure and post
procedure expectations

Assist

the client to identify risk factors

that can be modified

Assist

the client to set goals to promote

lifestyle changes to reduce the impact of
risk factors

 Instruct

the client regarding a low-calorie,

low sodium, low cholesterol, and low fat
diet with an increase in dietary fiber

Stress

to the client that dietary changes

are maintained for life

Provide

community resources to the client

regarding exercise, smoking cessation, and
stress reduction as prescribed

SURGICAL PROCEDURES
PTCA

to compress the plaque against the

walls of the artery and dilate the vessel

Laser

angioplasty to vaporize the plaque

Atherectomy

artery

Coronary

to remove the plaque from

artery bypass grafting to

improve blood flow to the myocardial
tissue at risk for ischemia or infarction

ANGINA

 Chest

pain resulting from myocardial

ischemia caused by inadequate myocardial
blood and oxygen supply

Caused

by an imbalance between oxygen

supply and demand

Causes

include obstruction of coronary

blood flow resulting from atherosclerosis,
coronary artery spasm, or conditions
increasing myocardial oxygen consumption

PATTERNS OF ANGINA
Stable

Also

Angina

called exertional angina

Occurs

with activities that involve exertion

or emotional stress; relieved with rest or
nitroglycerin

Usually

has a stable pattern of onset,

duration, severity and relieving factors

 Unstable

Also

Angina

called preinfarction angina

Occurs

with an unpredictable degree of

exertion or emotion and increases in
occurrence, duration, and severity over time

Pain

may not be relieved with nitroglycerin

 Variant

Also

Angina

called
angina

Results
May

Prinzmetals

or

vasospastic

from coronary artery spasm

occur at rest

Attacks

may be associated with ST segment

elevation noted on the ECG

 Intractable

Angina is a chronic,
incapacitating angina unresponsive to
interventions

Preinfarction

Associated
Lasts

Angina

with acute coronary insufficiency

longer than 15 minutes

Symptom
Occurs

of worsening cardiac ischemia

after an MI, when residual ischemia

may cause episodes of angina

SIGNS AND SYMPTOMS

Pain
Dyspnea
Pallor
Sweating
Palpitations

and tachycardia

 Dizziness

and faintness

Hypertension
Digestive

disturbances

INTERVENTIONS
Assess

pain

Provide

bed rest

Administer

oxygen at 3L/min by nasal

cannula as prescribed

Administer
Obtain

nitroglycerin as prescribed

a 12-lead ECG

 Provide

a continuous cardiac monitoring

Assist

the client in identifying anginaprecipitating events

Instruct

client to stop activity and rest if

chest pain occurs and to take nitroglycerin
as prescribed

Instruct

client to seek medical attention if

pain persists

 Assist

client to identify risk factors that

can be modified

Provide
Provide

dietary instructions

community resources to the client

regarding exercise, smoking cessation, and
stress reduction

MYOCARDIAL INFARCTION

 Occurs

when myocardial tissue is abruptly

and severely deprived of oxygen

Ischemia

can lead to necrosis of

myocardial tissue if blood flow is not
restored

Infarction

does not occur instantly but

evolves over several hours

Obvious

physical changes do not occur in

the heart until 6 hours after the
infarction, when the infarcted areas
appears blue and swollen

 Not

all clients experience the classic

symptoms of an MI

Women

may
experience
atypical
discomfort , shortness of breath, or fatigue

An

older client may experience shortness

of breath, pulmonary edema, dizziness,
altered mental status, or a dysrhythmia

SIGNS AND SYMPTOMS

Pain
Nausea

and vomiting

Diaphoresis
Dyspnea
Dysrhythmias

 Feelings

of fear and anxiety

Pallor
Cyanosis
Coolness

of extremities

INTERVENTIONS
Obtain

a
discomfort

description

of

Assess

vital signs

Assess

cardiovascular status

Place

the

chest

client in a semi-Fowlers position

Administer

oxygen at 2 to 4L/min by nasal

cannula as prescribed

 Establish

an IV access route

Administer

nitroglycerin as prescribed

Administer

morphine
sulphate
prescribed to relieve chest discomfort

Obtain

as

a 12-lead ECG

Monitor

thrombolytic therapy, which may

be prescribed for the first 6 hours of the
coronary event

 Administer

beta blockers as prescribed

Assess

distal peripheral pulses and skin

temperature

Monitor
Assess

failure

intake and output

RR and breath sounds for signs of heart

Monitor

BP closely

Provide

reassurance to the client and family

 Maintain

bed rest for the first 24 to 36

hours as prescribed

Allow

the client to stand to void or use a bed

side commode if prescribed

Provide

ROM exercises

Encourage

client
regarding the MI

to

verbalize

feeling