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Cardiovascular Disorders

Nio C. Noveno, RN
OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

‰ Chest x-ray
‰ Fluoroscopy
‰ Cardiac Enzymes
9 LDH - elevated in 48 hrs
9 SGOT
9 CPK – elevated 4-24 hrs
ƒ CPK-MM [skeletal muscles]
ƒ CPK-BB [brain]
ƒ CPK-MB [myocardium, cardio-specific]
‰ Echocardiography [Ultrasound cardiography]
‰ Electrocardiography [ECG] – electrical activity

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CARDIAC ENZYMES
AST/SGOT 5 – 40 U/L
CPK
M 12 – 70
F 10 – 55
CPK-MB 0%
LDH 45 – 90 U/L
Myoglobin < 85 ng/mL
Troponin I < 0.03
Troponin T < 0.2
CRP < 0.8 mg/dL

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ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY

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OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

‰ Electrocardiography [ECG] – graphic record of the
electrical activity of the heart

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OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

Electrocardiography [ECG]

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OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

‰ Stress test (treadmill)
‰ Transesophageal echocardiography [TEE]
‰ Angiocardiography
‰ Positron Emission Tomography [PET]
‰ Coronary Arteriography
‰ Cardiac catheterization
‰ Hemodynamic monitoring

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OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

Coronary Arteriography - introduction of radiopaque
catheter into brachial or femoral artery [arteriotomy
w/ percutaneous puncture] to ascending aorta to
coronary artery for fluoroscopy

‰ Nursing Intervention
9 NPO
9 Vital signs
9 Check for bleeding at puncture site
9 Check color of extremity and pulses

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CARDIAC
ARTERIOGRAPHY CATHETERIZATION

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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Cardiac Catheterization - catheter into heart & BV to :
‰ measure O2 conc., saturation, tension & pressure of
heart chambers
‰ Detect shunts, heart output & pulmonary outflow
‰ Right CC – antecubital v → VC → R A&V → Pulm a.
‰ Left CC – brachia/femoral a → aorta → R V

‰ Nursing Intervention
9 Before: NPO, allergic hx, mark distal pulse, instruct pt
thudding sensations in chest & strong desire to cough and
transient heat

9 After: VS, peripheral pulses, site, chest pain, bed rest
for 12-24hrs;
Femoral site – bleeding inflammation, tenderness, apply
sandbag & ice on site, HOB >30°, avoid flexing femoral
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region Cardiovascular Diseases 10
OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

Hemodynamic Monitoring: assessment of circulatory
status
‰ Central Venous Pressure [CVP] (N= 5-12 cms H2O)
9 Catheter into external jugular vein → antecubital
or femoral v. → vena cava

9 Provides information on blood volume &
adequacy of venous return

9 Reveals right atrial pressure

9 Route for drawing blood samples, administration
of fluids or meds and pacing
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CVP

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OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT
Hemodynamic Monitoring (CVP)

‰ Nursing Intervention
9 Pt. in supine. Changes in position, coughing or
straining during reading may result to inaccuracies of
readings

9 Zero point of manometer should be at a level with the
pt’s R atrium (midaxillary line)

9 To measure CVP: turn stopcock so that IV solution
flows into manometer filling to about 20-25cm level,
then turn stopcock to let flow the solution in the
manometer into pt.

9 Observe the fall in the height of column of fluid in
manometer. Read where it stops.
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OXYGENATION (Cardiovascular)
DIAGNOSTIC ASSESSMENT
Hemodynamic Monitoring
‰ Swan-Ganz Pressure (N=5-12 cms H2O)
9 Catheter into external jugular vein/subclavian
→ superior vena cava → R atrium → tricuspid
valve → R vent → pulm a. → pulm capillary
[pulm capillary wedge pressure]
9 Interpretations of Pressure Readings:

Pulmonary Artery Pressure [PAP]: 10-20 mmHg;
- increased in pts w/ chronic pulmonary disease
& CHF

Pulmonary Capillary Wedge Pressure: 4-12 mmHg
- indicative of pressure in the L cardiac
chambers
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Swan-Ganz Procedure

PAWP CATHETER

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The PRESSURE Guidelines
P ressure monitor
R ise slowly to reduce orthostatic hypotension
E ating must be considered
S tay on medications
S topping or skipping is discouraged
U ndesirable responses
R emind to exercise, stop alcohol
E liminate smoking, educate

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Pharmacology
Nitroglycerin

Interventions:
MOA: relaxes vascular
smooth system, ↓ Monitor BP & AP
myocardial demand Have client sit or lie
for O2, ↓ LV preload down (first time)
by dilating veins, NO defibrillation over
thus indeirectly ↓ area of nitro patch
afterload Assist during ambulation

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Pharmacology
Nitroglycerin cont…

Health Teachings:
Oral:
– Take on an empty stomach, with a glass of water.
SL:
– Take at first sign of anginal pain
– Take every 5 mins to a maximum of 3 doses
• NO relief, seek MD
– Stinging or biting sensation
– Protect from light, moisture and heat
Transderm patch:
– OD in AM
– Rotate sites

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Pharmacology
Lidocaine
MOA: decreases cardiac
excitability, cardiac conduction
is delayed in the atrium or
ventricle
Drug interactions:
– ↑ effects with Phenytoin,
Undesirable effects: Procainamide, Propranolol,
– ↓ or ↑ HR quinidine,
– ↓ BP – ↑ risk of toxicity with ß-
– Confusion adrenergic blockers, cimetidine
– Drowsiness (1st sign of
toxicity)
– Dizziness
– Nausea, vomiting
– Seizures (severe toxicity)
– Cardiac arrest

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Pharmacology
Lidocaine cont…

Interventions:
• Give I.V.
• Monitor serum levels: 1.5-5 mcg/ml
• Monitor EKG, BP, PR
• Monitor I & O
• Do not mix syringes with cefazolin and amphotericin
B
• Have Dopamine available for circulatory collapse
• Assist and provide safety

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Pharmacology
ACE INHIBITORS Interactions:
– Probenecid: ↓
MOA: suppress the RAAS; blocks elimination
the conversion of angiotensin I
to angiotensin II – NSAIDs: hypotensive
effect
Undesirable effects: – Other anti-HTN: ↑
– Gastric irritation hypotensive effects
– Headache – Hyperkalemia
– Dizziness
– ↑ HR
– Angioedema Interventions:
– Cough – Assess for renal function
– Maculopapular rash – Do not give with food
– Pruritus
– Do not take potassium-
– Infection
rich foods
– Hyperkalemia

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Pharmacology
ACE INHIBITORS cont… ACE INHIBITORS cont…

S VR/PVR decreased C ough; contraindicated
with renal artery
T reatment for MI stenosis

R elease of aldosterone is low H ypotension;
hyperlipidemia
O occult diabetic nephropathy
F ood has less taste;
L VD after MI is low WOF hypotension

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Pharmacology
Angiotensin II receptor blockers (ARB)
A dminister without
MOA: blocks angiotensin II regard to meals
from binding with
angiotensin receptors; R enal function tests –
lowering BP review
Information:
– Same with ACE inhibitors B locks vasoconstriction
effect of RAAS

S alt substitution or
potassium supplements
is not allowed

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Pharmacology
Alpha adrenergic blockers

MOA: blocks alpha1 S yncope; sexual
adrenergic receptors dysfunction
resulting in vasodilation of
arteries and veins;
decreases PVR; relaxes I ncreased drowsiness;
smooth muscles of orthostatic
bladder and prostate hypotension, HR

Undesirable effects:
– Same as other anti-HTN
N eed to be recumbent
meds for 3-4 H after the
– WOF: 1st dose syncope initial dose
• 2-3 H post initial dose

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Pharmacology
Beta adrenergic blockers B radycardia
MOA: blocks ß1 (heart) or ß2 L ipidemia/libido
(lungs) receptors to decreased
prevent the release of
catecholamines; br O nchospasm
decreases contractility,
renin release and C HF; conduction
sympathetic output abnormalities

Caution:
K onstriction, peripheral
vascular
– COPD
– CHF E exhaustion; emotional
– Sinus bradycardia depression
– Heart block
– DM R educes glucose

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Pharmacology
Calcium channel blockers

MOA: blocks Ca2+ influx into Interventions:
the cells causing • Elevate extremity affected
decreased contractility, • Increased dietary fiber;
decreased PVR and low increase OFI
BP
• Take with meals or milk
Undesirable effects:
– Hypotension
– Headache
– Dizziness
– Peripheral edema
– Constipation

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Pharmacology
Central alpha2 agonist C ontrols release of
adrenergic hormones
MOA: decreased A dverse effects: low BP,
release of hepatotoxicity,
hemolytic anemia
adrenergic
hormones from the T ransient drowsiness
brain resulting in a A rterial pressure is
lowered
decrease PVR,
hence BP P aradoxical HTN with
propranolol
R ecord baseline VS
E valuate weight and liver
function
S lowly taper the doses
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Pharmacology
Vasodilators D ilates vascular muscles
I ncreases renal and
cerebral flow
L upus-like reaction (fever,
facial rash, muscle and
MOA: direct relaxation of joint ache, splenomegaly)
vascular smooth muscles,
decreases afterload A ssess for peripheral edema
T ake with food
O ther SE: headache,
dizziness, anorexia,
tachycardia, hypotension
R eview BP

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D iet high in K+ for all except aldactone

I ntake and output daily

U undesirable effects: fluid & electrolye imbalance

R review HR, BP

E lderly with caution

T ake with or after meals in AM

I ncrease risk of orthostatic hypotension; move slowly

C ancel alcohol
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CORONARY ARTERY DISEASE or Coronary Ischemic HD

Myocardial impairment due to imbalance between
coronary blood flow myocardial O2 demand
Manifested as:
Ischemia [Angina Pectoris] – reversible
Infarction – irreversible

Ischemia – reversible if myocardial blood flow is
↑ or the need for the demand is ↓
may progress to infarction

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

Angina Pectoris
Chest pain associated w/ transient myocardial
ischemia

Causes:
Atherosclerosis – most common
Vasospasm
Aortic stenosis

Kinds:
Stable [Effort] AP
Unstable [Preinfarction] AP

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ASSESSMENT OF PAIN
P rovoking/precipitating

Q uality

R adiation

S everity

T iming

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
Angina Pectoris
Signs & Symptoms:
Substernal or precordial pain radiating to L
shoulder lasting for 3-5 mins, relieved by rest
Heaviness, tightness, squeezing precipitated
by exertion, emotion and exposure to cold
VS may be normal

Diagnostic Tests:
Nitroglycerine test – relieves pain
Blood chemistry - ↑ cholesterol
Stress test, abnormal ECG – inverted T-waves
Cardiac enzymes – N
Coronary arteriography – plaque
accumulation
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
Angina Pectoris
Nursing Intervention
↑ O2 to the myocardium & relief of acute
attacks
Administer meds as ordered.
Short & long acting nitrates [NG]
β-adrenergic agonists [Propranolol]
Reducing demand for O2
Limit activities, moderate exercise
Sedatives, tranquilizers, antidepressants
Helping client prevent future attacks
Diet – low calorie, saturated fat
5-6 small frequent feedings
Daily exercise; avoid cold environment,
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

Myocardial Infarction
Life threatening condition caused by occlusion
of coronary artery or its branches leading to
death of myocardial cells

Causes:
Atherosclerosis
Thrombus
Embolus
Coronary artery spasm

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

Myocardial Infarction
Signs & Symptoms:
Steady constrictive substernal chest pain,
sever, not relieved by rest & Nitroglycerine
Symptoms of shock, increase in temp
Nausea & vomiting, diaphoresis, pallor
Anxiety and apprehension

Management:
Provide rest – CBR, use bedside commode
Relieve pain – demerol or morphine
O2 by mask, cannula or nasal catheter
ECG monitoring
IVF to KVO
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
Myocardial Infarction

Management:
Diuretics
β-adrenergic agonists
Anti-arrhythmics [Procainamide, Lidocaine]
Diet: no iced or very hot drinks, may
precipitate arrhythmias, no gas-forming
foods
Mild laxatives, stool softeners
If due to thrombus: give
Thrombolytics [Streptokinase]
Follow up therapy w/ anticoagulant
Heparin, Coumadin, ASA, Dicumarol

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONGESTIVE HEART FAILURE (CHF)

Inability of the heart to pump blood from the
ventricles as quickly as it enters the atria leading
to congestion in the lungs & systemic circulation

Causes:
inflow of blood → heart is greatly reduced
inflow of blood → heart is greatly increased
outflow of blood from the heart is obstructed
myocardial damage
increased metabolic state

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONGESTIVE HEART FAILURE (CHF)

Cardiac Compensatory Mechanisms:
Ventricular dilatation
Ventricular hypertrophy
Tachycardia

Forms of CHF:
Left ventricular failure
Right ventricular failure

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
Signs and Symptoms of CHF
Left-sided HF Right-sided HF
Forward Effects: Forward Effects:
Weakness, fatigue Decreased volume to the
mental confusion, lungs
insomnia, anxiety,
oliguria Backward Effects:
ankle/pretibial swelling,
Backward Effects: pitting edema, abdominal
breathlessness, distention, ascites,
cough, anorexia, JV distention,
orthopnea, hepatomegaly
crackles, ↑ PCWP, splenomegaly, wt. gain,
frothy sputum ↑ CVP
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Congestive Heart Failure

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONGESTIVE HEART FAILURE (CHF)
Interventions:
Improve ventricular pump performance
Inotropic agents [Digitalis]
Administer O2 therapy
Reduce myocardial workload
Preload:
Administer diuretics
Restrict fluid & Na intake
Upright position
Phlebotomy
Afterload:
Vasodilators
Reduce physical and emotional stress
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

ACUTE PULMONARY EDEMA

Complication of L-sided HF
Edema results from the heart’s inability to pump
adequately
Results in impaired oxygenation & hypoxia

Causes:
Heart failure
Atherosclerosis
Valvular disease

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

ACUTE PULMONARY EDEMA

Assessment findings:
• Dyspnea
• Paroxysmal cough
• Blood-tinged frothy sputum
• Orthopnea
• Restlessness

Diagnostic test findings:
CXR: interstitial edema
ABGs: respiratory alkalosis or acidosis
ECG: tachycardia, ventricular enlargement
EMODYNAMICS: ↑ PAWP, CVP, ↓ CO
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

ACUTE PULMONARY EDEMA

Medical management:
Low-sodium diet; limit fluids
O2 therapy
High-Fowler’s position
VS, I/O, ECG, & hemodynamics
Analgesics
Vasodilators
Cardiac inotropes & glycosides
Nitrates
Bronchodilators
Pulse oximetry

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

ACUTE PULMONARY EDEMA

Nursing management:
Assess CV & respiratory status
Withhold food & fluid
Provide:
Suctioning
Turning
Coughing
Deep breathing
Keep in High-Fowler’s
Allay anxiety
Note the color, amount & consistency of
sputum
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

ACUTE PULMONARY EDEMA

Home instructions:
• Recognize the signs of fluid overload &
respiratory distress
• Sleep with the head of the bed elevated

Complications:
Digitalis toxicity
Fluid overload
Pulmonary embolism
Hypokalemia
Hyernatremia

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CARDIOGENIC SHOCK

Failure of the heart to pump adequately, thereby
educing the CO & compromising tissue perfusion

Causes:
MI
Myocarditis
Advanced heart block
Heart failure
Metabolic abnormalities
Cardiac tamponade
Pulmonary embolus

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CARDIOGENIC SHOCK

Assessment findings:
Hypotension
SBP <90 mm Hg
Oliguria:
<30 mL/H
Cold, clammy, pale skin
Tachycardia
Restlessness

Diagnostic findings:
ABGs: metabolic acidosis, hypoxemia
ECG: MI (enlarge Q wave, ST elevation)
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

Injury ↓ SV ↑ HR
Myocardial
contractility
↓ LV emptying ↓ Coronary
artery
perfusion
LV dialtion & backup of
blood
Myocardial
hypoxia
↑ Preload
CARDIOGENIC SHOCK ↓ CO
Pulmonary
congestion Compensation

↓ Decompensation
& death
Myocardial
contractility

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CARDIOGENIC SHOCK

Management:
O2 therapy
Semi-Fowler’s position
Intra-aortic balloon pump
Diuretics
Vasodilators
Cardiac inotropes
Vasopressors
Adrenergic agents

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CARDIOGENIC SHOCK

Nursing management:
Administer:
IVF, O2, medications
Assess CV, respiratory status, & fluid balance
Monitor & record:
VS
I/O
Hemodynamics
LOC
Lab values

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CARDIOGENIC SHOCK

Complications:
• Arrhythmias
• Cardiac arrest
• Infection

Surgical interventions:
CABG
Heart transplantation

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
MITRAL STENOSIS
Narrowing of the mitral valve opening
Due to:
Rheumatic endocarditis
Congenital

Assessment findings:
• Fatigue
• Dyspnea on exertion
• Peripheral edema
• Orthopnea

Diagnostic findings:
CXR: enlargement of the LA & RV; pulmonary
congestion
ECHOCARDIOGRAM: thickened mitral valve & LA
enlargement
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

MITRAL STENOSIS

Management:
Low-sodium diet; fluid restrictions
Semi-Fowler’s position
Cardiac glycosides
Nitrates
Diuretics
Anti-arrhythmics
Ani-coagulants
Antibiotics

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

MITRAL STENOSIS

Nursing management:
Administer:
IVF, O2, medications
Assess CV & respiratory response
Monitor & record:
VS
I/O
Hemodynamics
ECG readings
Lab values

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
MITRAL STENOSIS
Home care:
9 Signs & symptoms
9 Activity limitations
9 Infection control
9 Occult blood

Complications:
Thrombosis
Embolism
HF
Atrial fibrillation

Surgery:
Valve replacement
Open mitral commissurotomy
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

MITRAL INSUFFICIENCY
Incomplete closure of the mitral valve
Due to:
↑ LA pressure
Pulmonary HTN
LA hypertrophy

Assessment findings:
• Fatigue
• Dyspnea on exertion
• Peripheral edema
• Angina pectoris
• Orthopnea

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

MITRAL INSUFFICIENCY
Diagnostic findings:
ECHOCARDIOGRAM: enlarged LA, abnormal
movement of the mitral valve
CARDIAC CATH: ↑ LA pressure & ↑ LV pressure

Management:
Low-sodium diet; fluid restrictions
Semi-Fowler’s position
Cardiac glycosides
Nitrates
Diuretics
Anti-arrhythmics
Ani-coagulants
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

MITRAL INSUFFICIENCY

Nursing management:
Maintain on diet; limit OFI
Keep on semi-Fowler’s position
Assess peripheral edema

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

AORTIC STENOSIS
Narrowing of the aortic valve
Lower CO leads to increased congestion in the
lungs causing RSHF

Causes:
Syphilis
Rheumatic fever
Atherosclerosis
Congenital malformations

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

AORTIC STENOSIS

Assessment findings:
• Angina pectoris
• Pulmonary HTN
• LSHF
• Orthopnea

Diagnostic findings:
ECG: L bundle branch block, 10 heart block, LV
hypertrophy
ECHOCARDIOGRAM: thickened LV wall,
thickened aortic valve that moves abnormally

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC STENOSIS
Management:
• Low-sodium diet; fluid restrictions
• Monitor lab studies
• Cardiac glycosides
• Nitrates
• Diuretics
• Anti-arrhythmics
• Percutaneous transluminal valvuloplasty

Nursing management:
Maintain on diet; limit OFI
Assess CV & respi status
Monitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab
values
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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC STENOSIS

Complications:
• HF
• Pulmonary edema

Surgery:
Aortic valve replacement
Commissurotomy

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC INSUFFICIENCY

Retrograde flow of blood from the aorta to the LV
An incomplete closure of the aortic valve

Causes:
Syphilis
Rheumatic fever
Infective endocarditis
Atherosclerosis
Congenital defect

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC INSUFFICIENCY

Assessment findings:
• Signs of LSHF
• Dyspnea on exertion
• Dizziness
• Angina pectoris

Diagnostic findings:
CXR: enlarged LV, aortic valve calcification
ECHOCARDIOGRAM: LV enlargement, abnormal
valve movement

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC INSUFFICIENCY
Management:
• Low-sodium diet; fluid restrictions
• Antibiotics
• Cardiac glycosides
• Nitrates
• Diuretics
• ACE inhibitors
• Anti-arrhythmics
• Percutaneous transluminal valvuloplasty

Nursing management:
Maintain on diet; limit OFI
Assess CV & respi status
Monitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab values

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
AORTIC INSUFFICIENCY

Complications:
• HF
• Thrombosis
• Embolism
• Infection

Surgery:
Valvuloplasty
Valve replacement

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OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE
Chronic inadequate blood flow in the lower extremities

Types:
1. Arteriosclerosis obliterans – sclerosis of arterioles
resulting in thickening of the walls & occlusion
2. Raynaud’s phenomenon – intermittent
vasoconstriction & ischemia of fingers & toes
accompanied by pallor & cyanosis
3. Buerger’s disease (thromboangiitis obliterans) –
inflammation of BV resulting in occlusion of the vessel

Causes:
Atherosclerosis
Vasospasm
Inflammation
nionoveno@yc Cardiovascular Diseases 75
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE
Assessment findings:
Intermittent claudication
Pain at rest
Trophic changes: thickened nails, absence of hair, &
taut skin
Diminished or absent pulses in extremities (unilateral)
Temperature changes in extremities
Color changes:
Rubor, cyanosis, pallor
Ulcerations in extremities

Diagnostic findings:
ARTERIOGRAPHY: location of obstruction
DOPPLER STUDIES: decreased blood flow & arterial
pressure
nionoveno@yc Cardiovascular Diseases 76
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE

Buerger’s disease

Raynaud’s phenomenon

nionoveno@yc Cardiovascular Diseases 77
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE

Management:
• Active ROM & isometric exercises
• Antiplatelet agents
• Vasodilators
• Anticoagulants
• Antilipemics

Nursing management:
Assess for:
Pulses
Color
Temperature
Complaints of abnormal sensations
Numbness or tingling
nionoveno@yc Cardiovascular Diseases 78
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE

Home care:
Symptoms of ↓ peripheral circulation
Skin breakdown
Foot care
Avoid stress
Prolonged standing
Extremes of temperature
Constrictive clothing
Crossing legs at knee when seated

nionoveno@yc Cardiovascular Diseases 79
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERIPHERAL VASCULAR DISEASE

Complication:
• Gangrene
• Septicemia
• Pressure sores
• Acute vascular occlusion

Surgery:
Bypass grafting
Endarterectomy
Sympathectomy
Amputation
Embolectomy

nionoveno@yc Cardiovascular Diseases 80
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
THROMBOPHLEBITIS
Massing of RBCs in a fibrin network
Obstruction by enlarged thrombus
Results to inflammation of the venous wall causing clots
to form

Causes:
Venous stasis
Varicose veins, pregnancy, HF, prolonged bed
rest
Hypercoagulability
Cancer, blood dyscrasias, oral contraceptives
Injury to venous wall
IV, fractures, antibiotics

nionoveno@yc Cardiovascular Diseases 81
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
THROMBOPHLEBITIS
Assessment findings:
SUPERFICIAL VEINS:
Red, warm skin that’s tender to touch
DEEP VEINS:
Major venous trunks:
Edema
(+) Homans sign
Tenderness
Cramping pain,
Cyanosis
Venous distention
SMALL VEINS:
Tenderness
Induration
Minimal to no distention
nionoveno@yc Cardiovascular Diseases 82
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
THROMBOPHLEBITIS
Diagnostic findings:
VENOGRAPHY/ PHLEBOGRAPHY : venous filling
defects
UTZ: ↓ blood flow

Management:
Activity limitation
Antiembolism stockings
Anticoagulants

Nursing management:
Assess for Homans sign
Apply warm, moist compress
Measure & record circumference of thighs & calves
Keep patient I bed & elevate extremities
nionoveno@yc Cardiovascular Diseases 83
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
THROMBOPHLEBITIS

Complications:
• Pulmonary embolism
• Stroke

Surgical intervention:
Vena cava filter
Vein ligation & stripping
Thrombectomy

nionoveno@yc Cardiovascular Diseases 84
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE
Obstruction or narrowing of the aorta’s lumen & its major
branches
Reduced perfusion
Obstruction: endogenous or exogenous

Causes:
Atherosclerosis
Emboli
Thrombosis
Trauma or fracture

Risk factors:
Age
DM
Family history
Hyperlipidemia
HTN
Smoking
nionoveno@yc Cardiovascular Diseases 85
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Assessment findings:
Femoral, popliteal or innominate arteries:
↓ decreased distal pulses
Mottling & pallor
Paralysis & paresthesia
Sudden & localized pain*
Internal & external carotid arteries:
stroke., TIA
Subclavian:
Subclavian steal syndrome
Vertebral & basilar:
TIA

nionoveno@yc Cardiovascular Diseases 86
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Angiography findings:
The type (thrombus or embolus), location, & degree
of obstruction
Collateral circulation

Medications:
Antilipemics
Antiplatelets
Pentoxyfilline
Anticoagulants
Throbolytics

nionoveno@yc Cardiovascular Diseases 87
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Nursing management:
Assess distal pulses, skin color, & temperature
Assess pain & give analgesics
Administer IV fluids, O2, & medications as Rx
Monitor for signs of stroke

nionoveno@yc Cardiovascular Diseases 88
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ABDOMINAL AORTIC ANEURYSM
Dilation of or localized weakness in the medial layer of an
abdominal artery

Causes:
Atherosclerosis
HTN
Smoking

4 types:
1. Saccular – unilateral, pouch-like bulge
2. Fusiform – spindle-shaped bulge; encompasses entire
diameter of the vessel
3. Dissecting – hemorrhagic separation of the medial
layer of vessel wall; creates a false lumen
4. False – pulsating hematoma; often mistaken for an
abdominal aneurysm
nionoveno@yc Cardiovascular Diseases 89
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

nionoveno@yc Cardiovascular Diseases 90
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Assessment findings:
Asymptomatic
Lower abdominal pain, lower back pain
Abdominal mass to the left of the midline
Abdominal pulsations
Bruits

Diagnostic findings:
Apparent on CXR, abdominal UTZ, aortography

Medications:
Analgesics
ß-blockers

nionoveno@yc Cardiovascular Diseases 91
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Nursing management:
Check peripheral circulation
Observe for signs of shock:
Anxiety
Restlessness
Decreased pulse pressure
Increased thready pulse
Pale, cool, moist, clammy skin
Palpate abdomen for distention
Teach signs & symptoms of decreased peripheral
circulation

nionoveno@yc Cardiovascular Diseases 92
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ARTERIAL OCCLUSIVE DISEASE

Complication:
Rupture of aneurysm
Hemorrhage
Renal insufficiency

Surgery:
Resection of aneurysm
Endovascular graft repair

nionoveno@yc Cardiovascular Diseases 93
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
CARDIOMYOPATHY
Disease of the heart’s muscle impacting the structure &
function of the ventricle
Heart failure develops later
Myocardium becomes flabby

Types:
1. Congestive (dilated) – chronic alcoholism
2. Hypertrophic – idiopathic hypertrophic subaortic
stenosis
Pressure overload hypertension or aortic valve
stenosis
Hypertrophic cardiomyopathy
3. Restrictive (obliterative) – amyloidosis, cancer

nionoveno@yc Cardiovascular Diseases 94
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
CARDIOMYOPATHY

Major manifestations:
• Dyspnea
• Dry cough
• Fatigue
• Palpitations
• Weakness

Diagnostic findings:
ECG: LV hypertrophy
ECHOCARDIOGRAM: decreased myocardial
function
CXR: cardiomegaly

nionoveno@yc Cardiovascular Diseases 95
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
CARDIOMYOPATHY

Management:
• Low-sodium diet; fluid restrictions
• LV assist device
• Diuretics
• ß-blockers
• Anticoagulants
• CCBs
• ACE inhibitors

Nursing management:
Keep in semi-Fowler’s position
Monitor ECG results
Administer O2 & medications

nionoveno@yc Cardiovascular Diseases 96
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
CARDIOMYOPATHY

Home care:
Signs & symptoms of HF
Weigh daily
Report increments of 3 lbs.
Demonstrate exercises to increase CO
Refrain from smoking & drinking alcohol

Complications:
• Heart failure
• Arterial emboli

Surgery:
Ventricular myomectomy
Heart transplant
nionoveno@yc Cardiovascular Diseases 97
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ENDOCARDITIS
Endocardial lining inflammation
Destruction of heart valve leaflets

Causes:
ß-hemolytic strep infections
S. aureus, Candida, G(-)
Rheumatic heart disease
Dental procedures
Invasive monitoring
IV drug abuse

nionoveno@yc Cardiovascular Diseases 98
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ENDOCARDITIS
Assessment findings:
• Elevated temperature
• Heart murmur
• Malaise

Diagnostic findings:
• BLOOD CULTURES: (+) microorganisms
• ECHOCARDIOGRAPHY: valvular damage,
vegetations

Medical management:
Antibiotics
(+) inotropic agents
Antipyretics
Anticoagulants
nionoveno@yc Cardiovascular Diseases 99
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
ENDOCARDITIS
Nursing management:
• Administer medications
• Asses CV status
• Encourage rest periods

Home care:
• Avoid infections
• Monitor for infections specially after dental or gynecologic
exam; seek treatment
• Wear ID

Complications:
• Embolism
• HF
• Mycotic aneurysm

Surgery:
Valve replacement
nionoveno@yc Cardiovascular Diseases 100
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERICARDITIS
Inflammation of the pericardium
May be: fibrinous or effusive

Causes:
Infection
Neoplasms
High dose radiation to the chest
Hypersensitivity or autoimmune disease
Hydralazine or procainamide
Postcardiac injury
Aortic aneurysm
Myxedema

nionoveno@yc Cardiovascular Diseases 101
OXYGENATION (Cardiovascular)

nionoveno@yc Cardiovascular Diseases 102
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERICARDITIS

Assessment findings:

Pain characteristics:

Sharp, usually sudden over the sternum

Radiates to the neck, shoulders, back & arms

Increases with deep inspiration or when lying
down

Decreases when sitting up & leaning forward

nionoveno@yc Cardiovascular Diseases 103
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERICARDITIS
Diagnostic findings:
ECG
Elevated ST segments
QRS segments may be diminished with pericardial
effusion
Rhythm changes may occur:
Atrial ectopic rhythms – atrial fibrillation & sinus
arrhythmia
Echocardiography reveals the problem

Management:
Bed as long as fever & pain persist
NSAIDS
Corticosteroids
Antibiotics
nionoveno@yc Cardiovascular Diseases 104
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES
PERICARDITIS
Nursing management:
• Maintain CBR
• Place on upright position
• Monitor & record VS, I/O, & hemodynamics
• Assess pain & give analgesics as Rx

Complications:
• Pericardial effusion
• HF
• Chronic RSHF
• Cardiac tamponade

Surgery:
Pericardectomy

nionoveno@yc Cardiovascular Diseases 105
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONDUCTION ARRHYTHMIAS
Disruption in the normal events of cardiac cycle
Sinus Tachycardia – HR > 100 beats/min originating from
the SA node (100-160bpm); regular rhythm
Causes: fever, apprehension, physical activity,
anemia, hyperthyroidism, epinephrine, caffeine

Management:
Correction of underlying
cause
No stimulants
Drug of choice:
propranolol [Inderal], Digoxin

nionoveno@yc Cardiovascular Diseases 106
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONDUCTION ARRHYTHMIAS

Sinus Bradycardia – HR < 60 beats/min; regular rhythm
May be caused by:
Excessive vagal/or ↓ sympathetic tone
MI, intracranial tumors, meningitis
N variation of HR in well-trained athlete

Management:
Not needed, unless CO is inadequate
Pharmacotherapy: Atropine, Isuprel
Pacemakers – pulse generator to control
potentially dangerous dysrhythmias

nionoveno@yc Cardiovascular Diseases 107
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONDUCTION ARRHYTHMIAS

Atrial Fibrillation: Atrial rate: 35-600bpm;
Vent. rate: 100-160 bpm; irregular
May be seen it pts with:
Rheumatic mitral stenosis, thyrotoxicosis,
hypertensive disease, cardiomyopathy,
pericarditis and CHD
Management
Digitalis, Propranolol
Verapamil in conjunction w/ digitalis
Direct-current cardioversion

nionoveno@yc Cardiovascular Diseases 108
OXYGENATION (Cardiovascular)

CONDUCTION ARRHYTHMIAS
Ventricular Tachycardia – run of 3 or more consec. PVCs;
Atrial rate: 60-100bpm; Vent. rate: 110-250bpm; occ’l
ventricular irregularity
May be caused by:
Acute MI, CAD, intoxication, hypokalemia
Management
IV push Lidocaine, then IV drip
Procainamide via IV infusion
Propranolol [Inderal], Bretylium
Direct-current cardioversion

nionoveno@yc Cardiovascular Diseases 109
OXYGENATION (Cardiovascular)

COMMON CARDIOVASCULAR DISEASES

CONDUCTION ARRHYTHMIAS

Premature Ventricular Contractions – HR varies
according to number of PVCs; irregular rhythm

May be caused by:
Myocardial dse, CHD, hypoxia
Electrolyte imbalance [hypokalemia]
Digitalis tx, stimulants

Management
IV push Lidocaine, then IV drip
Procainamide [Pronestyl]
Treatment of underlying cause
nionoveno@yc Cardiovascular Diseases 110
Cardiovascular Disorders

THANK YOU!

Nio C. Noveno, RN