1

Unit 4 Problems of Cardiac Output and Tissue Perfusion

Lemone and Burke Ch 30-32

2

Objectives

� Review the anatomy and physiology of the cardiovascular system.

� Identify normal heart sounds and relate them to the corresponding events in the cardiac cycle.

� Explain cardiac output and explain the influence of various factors in its regulation.

3

More Objectives

� Describe normal variations in assessment findings for the older adult.

� Identify manifestations of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock.

� Compare and contrast the pathophysiology and manifestations of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock.

2

4

The rest of the objectives

� Relate the outcomes of diagnostic tests and procedures to the pathophysiology of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock and implications of client responses to the disorder and associated nursing care for each.

� Discuss nursing implications for medications and treatments used in the prevention, treatment and management of Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock.

� Explain risk factors and preventive measures for Cardiac Emergency, Permanent Pacemakers, Chronic CHF, Inflammatory Heart Diseases and Shock.

5

Cardiovascular A & P

6

Right vs Left heart

� Right side-� Low oxygenation

� Low pressure

� Light workload

� Goes toward the lungs

� Left side

� High oxygenation

� Thick walled high pressure

� Heavier workload

� Carries oxygenation blood to organs

3

7

Heart Sounds

� http://www.youtube.com/watch?v=2aO0HKIP3vI

8

What is Cardiac Output?

� CO = HR x SV� CO=cardiac output

� HR= heart rate

� SV= stroke volume

� Factors that affect SV:� HR

� Preload

� Afterload

� Contractility

9

Assessing CV status

� Other than physical assessment

� History

� Family History

� Genetic Risk

� Personal History

� Diet History

� Socioeconomic Status

4

10

Risk Factors

� Modifiable

� HTN

� Diabetes

� Hyperlipidemia

� Cigarette smoking

� Obesity

� Physical inactivity

� Diet

� Nonmodifiable

� Age

� Gender

� Genetic Factors

The text also discusses Metabolic Syndrome and Risk

factors unique to women on page 964

11

Risk Factors and Preventive

Measures for Cardiac Disorders

� Heart Failure

� Risk factors

� Coronary artery disease

� Cardiomyopathies

� Hypertension

� Congenital and valvular heart disease prevention

� Education regarding coronary artery disease and diabetes

12

CV Assessment

� Focused physical assessment

� General appearance

� Integumentary system

� Color

� Temperature

� Extremeties

� Blood pressure

� Edema

� Venous flow and arterial pulses

5

13

CV Diagnostic exams

� Lab tests:

� CBC

� Serum electrolytes

� Mark cardiac damage

� Troponin

� CK-MB

� Myoglobin

14

Cardiac lab tests

15

Diagnostic exams

� Chest x-ray

� Angiography

� Cardiac Catheterization

� ECG

� Nursing interventions???

6

16

Diversity concerns CV client

� Clients often fear diseases r/tcardiovascular system

� Require good education, opportunity for client and family to voice concerns/fears

� Support groups

� Cardiac rehab referral

Chapter 32

Nursing Care of Clients with Cardiac

Disorders

18

Pathophysiology of Common Cardiac Disorders

� Heart Failure

� Pulmonary Edema

� Rheumatic Fever/Rheumatic Heart Disease

� Infective Endocarditis

� Myocarditis

� Pericarditis

7

19

Pathophysiology of Common Cardiac Disorders

20

Pathophysiology of Common Cardiac Disorders

21

Right vs Left heart failure

� Right

� Peripheral edema

� Weight gain

� anorexia

� Left

� SOB

� Fatigue

� Crackles on

auscultation of

breath sounds

8

22

Clinical manifestations of Inflammatory Heart Disease

� Types of inflammatory diseases:

� Myocarditis

� Infective endocarditis

� Pericarditis

� Rheumatic Carditis

23

Risk Factors and Preventive

Measures for Cardiac Disorders

� Myocarditis

� Risk factors are any thing that alters immune response

� Advanced age

� Malnutrition

� Alcohol use

� Immunosuppression

� Exposure to radiation

� Stress

24

Anatomy, Physiology, andFunctions of the Heart

� The Pericardium

� Double-layered fibroserous membrane surrounding the heart

� Anchors the heart to surrounding structures

� Space between layers is filled with pericardial fluid

� Lubricates heart muscle

� Helps to cushion the heart

9

25

Anatomy, Physiology, andFunctions of the Heart

26

Infective endocarditis

� An infection of the endocardium

� Common in clients who abuse drugs, had valve replacements, systemic infections or structural cardiac defects

27

Risk Factors and Preventive

Measures for Cardiac Disorders

� Infective Endocarditis� Risk factors

� Congenital deformities

� Tissue damage due to ischemic disease

� Valve prosthesis

� Intravenous drug use

� Invasive catheters

� Dental procedures or poor dental health

� Recent heart surgery

� Prevention

� Education is key

� Prophylactic antibiotics

10

28

Infective endocarditis

� Most common complication is heart failure

� 50% have embolic complications due to vegetation

� Common to have clients with petechia and splinter hemorrhages

� Diagnosed with positive blood culture or echocardiogram

� Treat with antibiotics

� Often need antibiotics before dental procedures

29

Petechiae and splinter hemorrhage

30

Pericarditis vs endocarditis

11

31

Pericarditis

� Often follows a respiratory infection

� Often presents with pain in supine position releived by sitting or leaning forward

� May hear friction rub with stethoscope

� Treated with NSAIDS relieved within 48 hrs. depends on cause for further treatment

� Short term course of illness (2-6 weeks) for acute

� Chronic may require surgery

32

Pericardiocentesis

33

Risk Factors and Preventive

Measures for Cardiac Disorders

� Rheumatic Fever and Rheumatic Heart Disease

� Risk factors

� Crowded living conditions

� Malnutrition

� Immunodeficiency

� Poor access to health care

� Genetic factor may be present

� Prevention

� Prompt identification, treatment

� Importance of finishing medications

12

When the heart can’t keep up, we may need to pace it

35

Pacemakers

� Clients who experience life threatening dysrhythmias may require surgical treatment for short or long-term management

� Small device with a long battery life (20 years or longer)

36

Coronary Circulation and

Electrical Properties of the Heart

13

37

Coronary Circulation and

Electrical Properties of the Heart

38

Care of the client with a pacemaker

� 1012 has a great table for teaching the client with a pacemaker.

Ultimately when the heart fails, the patient will have shock

Chapter 11 Lemone and Burke

14

40

Cellular Homoeostasis and Basic Hemodynamics

� Homeostatic regulation maintained primarily by cardiovascular system

� Four physiologic components

� Sufficient cardiac output

� Uncompromised vascular system

� Sufficient blood volume and blood pressure

� Tissues that are able to extract and use

oxygen

41

Types of Shock

� Hypovolemic Shock

� Affects all body systems

� Most common type of shock

� Cardiogenic Shock

� Loss of pumping action of the heart

� Obstructive Shock

� Impaired diastolic filling (pericardial tamponade,

pneumothorax)

� Distributive Shock

� Also known as vasogenic shock

42

Shock

� Hypovolemic

� Too little circulating blood causes decrease in MAP thus not meeting the body’s total need for oxygen

� Internal hemorrhage

� GI bleed

� External hemorrhage

� trauma

� Dehydration

15

43

Shock

� Cardiogenic

� Heart muscle is unhealthy or pumping is impaired

� Causes a decrease CO, afterload and reduces MAP

� This is seen with an MI

44

Shock

� Obstructive

� Affects the heart muscles ability to pump effectively

� The heart itself is normal however manifestations outside the heart affect filling or contraction� Cardiac tamponade

� Tension pneumothorax

� Pulmonary embolism

45

Shock

� Distributive

� Loss of sympathetic tone

� Vasodilation

� Leaky capillaries

� Spinal cord injury

� Sepsis

� Anaphylaxis

16

46

Interventions for Clients Shock

� Medications

� Inotropic: increases cardiac contractility

� Vasopressors: used to treat neurogenic, septic, or anaphylactic shock

� Opioids: used to treat pain

� Immunizations: tetanus prophylaxis

47

Shock

� Look at the patient

� Compensated vs uncompensated

� Blood pressure

� Urine output

� HR

� RR

� Mental status

Questions??

Mid Term Exam Next Week.

Cumulative to include everything to now. You will have the whole class time to take the exam.