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Cardiovascular-Disorders-CA-Surigaocity.pdf
- 1. Christian John B. Timogan, RN, USRN CARDIOVASCULAR DISORDERS
- 2. ELECTRICAL CONDUCTION OF THE HEART SA Node AV Node Bundle of His Bundle Branches Purkinje Fibers = 60 100 bpm = 40 60 bpm = 20 40 bpm = 20 bpm
- 3. BLOOD SUPPLY TO THE MYOCARDIUM
- 4. BLOOD SUPPLY TO THE HEART CORONARY ARTERY From Aorta to MYOCARDIUM
- 5. BLOOD SUPPLY TO THE HEART 1. LEFT ANTERIOR DESCENDING Supplies anterior part of the heart (ventricles) 2. LEFT CIRCUMFLEX Supplies blood to the posterior-lateral part of the heart.
- 6. BLOOD SUPPLY TO THE HEART 3. RIGHT POSTERIOR DESCENDING AKA: Right Coronary Artery - Supplies posterior part of the heart 4. RIGHT MARGINAL Supplies inferior path of the heart
- 8. CORONARY ARTERY DISEASE AKA: Ischemic Heart Disease Risk factors: NON MODIFIABLE Age: 50 years old Gender: Male Race: African American Heredity MODIFIABLE Lifestyle Smoking Excessive alcohol Diet Obesity
- 9. CORONARY ARTERY DISEASE Pathophysiology: RISK FACTORS Endothelial wall damage Fats/Cholesterol/Platelet will be deposited to the damaged site Foam cells production Atheroma (Plaque) formation
- 10. ATHEROSCLEROSIS Narrowing / Obstruction of Coronary Artery
- 11. Decrease oxygenation to the myocardium Cardiac Ischemia ANGINA PECTORIS MYOCARDIAL INFARCTION
- 12. CORONARY ARTERY DISEASE Hallmark sign: Chest Pain Due to decrease perfusion and oxygenation to the myocardium = Release of LACTIC ACID = Chest Pain Universal sign: Levines Sign - Right hand clench over the chest.
- 13. CORONARY ARTERY DISEASE Chest pain characteristics: CHEST PAIN ANGINA PECTORIS MYOCARDIAL INFARCTION PROVOKING Extreme Fatigue, Exercise, Eating, Temperature, Emotion Rest / Fatigue QUALITY Squeezing, Tightness, Vise-like Heaviness, Pressure-Like, Stabbing RADIATION Left Shoulder Left Arm Left Shoulder Left Arm Neck Jaw Back SEVERITY Mild to Moderate (1-7) Severe (8-10)
- 14. CORONARY ARTERY DISEASE Chest pain characteristics: CHEST PAIN ANGINA PECTORIS MYOCARDIAL INFARCTION TIME Less than 30 minutes More than 30 minutes RELIEF Rest Nitroglycerin Narcotics (Morphine Sulfate)
- 15. CORONARY ARTERY DISEASE Diagnostics: ANGINA PECTORIS MYOCARDIAL INFARCTION ECG Most important initial diagnostics for chest pain Same ST segment depression (Zone of Ischemia) T wave inversion (Zone of Ischemia) ST segment elevation (Zone of injury) T wave inversion (Zone of ischemia) Pathologic Q wave (Zone of necrosis)
- 16. CORONARY ARTERY DISEASE Diagnostics: Serum Cardiac Markers: Increase Myoglobin (Protein from damaged muscle) = NEPHROTOXIC Increase Troponin I (Protein from damaged cardiac muscle) CONFIRMATORY Increase CK MB(Enzyme found on cardiac & skeletal muscle)
- 17. CORONARY ARTERY DISEASE Diagnostics: CORONARY ANGIOGRAPHY - To determine location of blockage - CONFIRMATORY - Will use dye - Ask for seafood allergy - INC. FLUID after procedure
- 18. CORONARY ARTERY DISEASE Diagnostics: HOLTER MONITORING - Ambulatory 24 hour ECG - To detect presence of cardiac ischemia - To detect activity tolerance - No restrictions except for strenuous activity - Have a diary on what activities done for the day - Contraindications: Bathing Signal transmission tower MRI machine Airport detectors
- 19. CORONARY ARTERY DISEASE Diagnostics: TREADMILL STRESS TEST
- 20. TYPES OF ANGINA STABLE ANGINA / TYPICAL Exertion Angina Predictable Chest pain is caused by extremes Relieved by rest Duration: 2 10 minutes UNSTABLE ANGINA / TYPICAL Unpredictable May occur at rest Occur not more than 30 minutes
- 21. TYPES OF ANGINA SILENT ANGINA No chest pain (Asymptomatic) ECG changes occurs VARIANT ANGINA (PRINZMETAL) Caused by: Coronary Artery Spasm May occur at rest and cold temperature May cause ST elevation on ECG tracing DOC: Calcium Channel Blockers
- 22. TYPES OF MYOCARDIAL INFARCTION STEMI ST Elevation Myocardial Infarction Complete blockage of Coronary Artery ECG: ST Segment Elevation = Pathologic Q wave NSTEMI Non ST Elevation Myocardial Infarction Partial Blockage of Coronary Artery ECG: ST Segment Depression = No Pathologic Q wave
- 23. CORONARY ARTERY DISEASE Management: Morphine Oxygen Nitroglycerin Antiplatelet ; Antilipidemics Thrombolytic Antihypertensive Stool Softeners
- 24. CORONARY ARTERY DISEASE Management: MORPHINE SULFATE - Opioids (Narcotics) - Decreases myocardial workload by: Decreasing O2 consumption Decreasing pain and discomfort Decreasing anxiety and shock - Assess for Respiratory Depression - Antidote: NALOXONE (NARCAN) OXYGEN THERAPY - 2 4 L/min (Semi-Fowlers Position)
- 25. CORONARY ARTERY DISEASE Management: NITROGLYCERIN - Vasodilator - Route: Sublingual: Max Dose: 3 doses Interval: Every 5 minutes - When to call 911: No relief after 1st dose - Side effect: Temporary Headache Facial flushing Orthostatic Hypotension Tingling sensation on the tongue
- 26. CORONARY ARTERY DISEASE Management: NITROGLYCERIN - Medication Care: Place in a dark room Store away from light Must be carried all the time Shelf Life: 6 months - Can be administered via PATCH: Wear gloves when handling Administer at non hairy and dry areas Avoid shaving ; use clippers Remove before bedtime to prevent tolerance
- 27. CORONARY ARTERY DISEASE Management: ANTIPLATELET - Aspirin, Clopidogrel - Blocks platelet production THROMBOLYTICS - Steptokinase; RTPA - To dissolve clot
- 28. CORONARY ARTERY DISEASE Management: SUPPORTIVE THERAPY 1. Bed rest (First 24 hours) > Note: At risk for Postural Hypotension - Dangle feet before standing 2. Smoking cessation 3. Weight management (30 mins brisk walking daily) 4. Low Salt ; Low Fat ; High Fiber diet
- 29. CORONARY ARTERY DISEASE Management: SEX EDUCATION 1. Avoid Sex in FUSHIE Fatigue Unfamiliar partners Stress Heavy meals Intake of Alcohol Extremes of Temperature 2. Best time: Morning 3. Avoid Seldinafil (Viagra) if taking NITROGLY
- 31. End point of ALL cardiovascular diseases Failure of the heart to meet the peripheral demands of the body due to impaired pumping ability Risk Factors: CARDIAC - Reason: Non compliance - Hypertension - Untreated heart disease NON - CARDIAC - Pregnancy - Diet - Renal Disorders - Endocrine Disorders - Pneumothorax CONGESTIVE HEART FAILURE
- 32. Types of Congestive Heart Failure: RIGHT SIDED HEART FAILURE Failure of the right side of the heart to pump Blood will backflow to systemic circulation CONGESTIVE HEART FAILURE
- 33. RIGHT SIDED HEART FAILURE Manifestation: Ascites Edema Initial Sign ! ! ! Neck vein distention Cardiomegaly Hepatomegaly Periorbital edema Facial edema CONGESTIVE HEART FAILURE
- 34. LEFT SIDED HEART FAILURE Failure of the left side of the heart to pump Blood will backflow to the lungs Manifestations: Hypoxia and cyanosis Breath sound Crackles Productive coughing Dyspnea , orthopnea INITIAL SIGN ! ! ! Paroxysmal Nocturnal Dyspnjea Pulmonary edema Oliguria Frothy / foamy / pinkish sputum CONGESTIVE HEART FAILURE
- 35. Management: 1. Diet - Restrict Na and Fluids 2. Small frequent feedings 3. Diuretics To remove fluid volume excess - Administer in the morning - Weight the patient daily (Same scale, dress, time) - Loop diuretics + K sparing 4. Digoxin (Lanoxin) - Cardiac Glycoside - (+) Inotropic = Increases force of contraction - (-) Chronotropic = Decreases the heart rate CONGESTIVE HEART FAILURE
- 36. Management: 4. Digoxin (Lanoxin) - Before administration: > Monitor apical pulse; withhold if not normal > Monitor serum potassium; withhold if hypokalemia = Increases risk for Toxicity - Sign of Toxicity: Anorexia Nausea and Vomiting Abdominal Cramping - Antidote: Digibind / Immunefab Diarrhea Bradycardia Green-Yellow Halo Vision CONGESTIVE HEART FAILURE
- 38. ARTERIAL INSUFFICIENCY VENOUS INSUFFICIENCY Nature Tissue hypoxia Venous hypertension Pain Intermittent Claudication Homans Sign Hair loss (+) (-) Nails Thickened / Ridged Normal Sensation Paresthesia / Tingling Itchiness Pulse (-) (+) PERIPHERAL VASCULAR DISEASE
- 39. ARTERIAL INSUFFICIENCY VENOUS INSUFFICIENCY Edema (-) (+) Temp Cool (Poikilothermic) Warm Color Pallor on elevation Dusky red on dependency Normal With Petechia Elevation No Yes Compression Stocking No Yes PERIPHERAL VASCULAR DISEASE
- 40. BUERGERS DISEASE AKA: Thromboangitis Obliterans Triggered by stress and cold temperature Common in men (30-55 y/o) Signs and Symptom: Intermittent claudication Management: Stop smoking PERIPHERAL VASCULAR DISEASE
- 41. RAYNAUDS DISEASE AKA: Tricolor Phenomenon Triggered by stress and cold temperature Common in women Signs and Symptom: - White = Due to decrease perfusion - Blue = Cyanosis - Red = Hyperemia - Painful Management: Stop smoking PERIPHERAL VASCULAR DISEASE
- 43. The nurse is the team leader RN working with a student nurse. The student nurse is teaching a patient how to use a metered-dose inhaler (MDI) without a spacer. Put in the correct order the steps that the student nurse should teach the patient. 1. Remove the inhaler cap and shake the inhaler. 2. Open your mouth and place the mouthpiece 1 to 2 inches (2.5 to 5.0 cm) away. 3. Breathe out completely. 4. Hold your breath for at least 10 seconds. 5. Press down firmly on the canister and breathe deeply through your mouth. 6. Wait at least 1 minute between puffs. BONUS QUESTION