CARDIOVASCULAR DISORDERS

SITTIE ADAWEYAH L. MACABAGO, RN

 Blood Circulation

Figure 11.3
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 11.7
PULSES
 ELECTRO
CARDIOGRAM
 ECG PLACEMENT
 V1 – RIGHT SIDE OF
STERNUM 4TH ics
 V2 – left side of Sternum 4th
intercostal space
 V3 – midway between v2 and
V4 – left midclavicular line, 5th
ICS
 V5 – Left Anterior Axillary
line, same level as V4
 V6 - Left MID Axillary line,
same level as V4
ELECTRO CARDIOGRAM
INTERPRETATION
 STEP 1: CHECK THE P wave
- Upright – Sinus
- Not Definite – Atrial
- Purely QRS, no P wave– Ventricular
 STEP 2 : DETERMINE RATE
- > 60 – BRADY
- < 100 TACHY
 IDENTIFY RHYTHM
- Regular – CARDIA
- Irregular – ARRYTHMIA/DYSRHYTHMIA
RATE: 110 BPM
RATE: 50 BPM
RATE: 170 BPM
Rate: 150
 The assessment of the patient’s circulation status
- Heart Rate
- INTRA ARTERIAL PRESSURE (IAP)
- PULMONARY ARTERY
- PULOMONARY CAPILLARY WEDGE PRESSURE
(PCWP)
- CENTRAL VENOUS PRESSURE (CVP)
- Cardiac Output
- Blood/Stroke Volume
The Heart: Cardiac Output
 Cardiac output (CO)
 Amount of blood pumped by each side of
the heart in one minute
 CO = (heart rate [HR]) x (stroke volume
[SV])
 Stroke volume
 Volume of blood pumped by each ventricle
in one contraction
Central venous pressure (CVP)
 THE MEASUREMENT OF THE GREAT VEINS WITHIN
THE THORAX
 Purpose:
- To serve as a guide for fluid replacement
- To monitor the pressure in the right atrium and central
veins
- To administer blood products, total parenteral nutrition
and drug therapy for contraindicated in peripheral
infusion
- To obtain venous access when peripheral vein sites are
inadequate
- To obtain central venous status
PULMONARY ARTERY PRESSURE
MONITORING

 Purposes:
- To monitor pressure in pulmonary &
ventricular pressure
- To measure CO
- To obtain Blood for central venous oxygen
saturation
PERICARDIOCENTESIS
 THERAPEUTIC and Diagnostic
procedure in which fluid is
removed from the pericardium,
the sac that surrounds the heart

 Removal of 5-10 ml can increase

the stroke volume by 25-50%
Coronary Artery Balloon Angioplasty - Series:
Indication
 Fat and cholesterol
accumulates on the
inside of arteries
(atherosclerosis). The
small arteries of the
heart muscle (the
coronary arteries) can
be narrowed or
blocked by this
accumulation. If the
narrowing is small,
percutaneous
transluminal coronary
angioplasty, or PTCA
for short, may be the
course for treatment.
 Coronary Artery Balloon Angioplasty -
Series: Procedure, part 4

A device called a stent

may be placed. A stent
is a latticed, metal
scaffold that is placed
within the coronary
artery to keep the
vessel open
 Coronary Artery Stent
An intraluminal
coronary artery stent
is a small, self-
expanding, stainless
steel mesh tube that is
placed within a
coronary artery to
keep the vessel open. It
may be used during a
coronary artery
bypass graft surgery
to keep the grafted
vessel open, after
balloon angioplasty
to prevent reclosure
of the blood vessel, or
during other heart
surgeries.
CORONARY ARTERY DISEASE
 Results from accumulation of fatty deposits along the
innermost layer of the coronary arterieas
 Pathophysiology
Causes:
Cigarette smoking, gender, lifestyle, stress, diabetes
- Results to Accumulation of fats in the lumen – plaque
formation – resulting to:
- High cholesterol level
- Hypertension
Manifestations
 Stable angina Pectoris
- Pain radiating to arms, hands, &
intrascapular area
- Chest Pain that may occur after a
specific activity
 Unstable Angina Pectoris
- Chest pain at rest
MANAGEMENT
 DRUG THERAPY:
- NITRATES – CAUSES vasodilation throughout the
body
- Beta Blockers – inhibits sympathetic stimulation
- Calcium channel blockers – inhibits calcium
movement within the heart muscle
- Antilipid agent – decreases cholesterol formation
 Coronary artery bypass
 Intracoronary stent
 Lifestyle changes
COMPLICATIONS

 SUDDEN DEATH due to lethal

dysrhythmias
 Congestive Heart Failure
 Myocardial infarction
NURSING INTERVENTIONS
 RELIEVING PAIN
- Determine intensity of patient’s angina
- Positioning
- O2 administration if prescribed
- Obtain v/s
- Monitor for relief of pain
- ECG Monitoring
- When angina is present, monitor V/S Every 5 to 10
minutes
- Administer meds
- Encourage Weight reduction