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CARDIO
CARDIO
MEDSURG I
Heart
Muscular pumping organ that propel blood into the arerial system
& receive blood from the venous system of the body.
Hollow muscular behind the sternum and between the lungs
Located on the middle of mediastinum
Resemble like a close fist
Weighs approximately 300 – 400 grams
Has heart wall has 3 layers
Endocardium – lines the inner chambers of the
heart, valves, chordate tendinae and papillary
muscles.
Coronary artery – 1st branch of aorta
Myocardium – muscular layer, middle layer,
responsible for the major pumping action of the Right Coronary
SA nodal Branch – supplies SA node
ventricles.
Right marginal Branch – supplies the right border of
Epicardium – thin covering(mesothelium), covers
the outer surface of the heart the heart
AV nodal branch – supplies the AV node
Pericardium – invaginated sac
Posterior interventricular artery – supplies both
Visceral – attached to the exterior of myocardium
Parietal – attached to the great vessels and ventricles
diaphragm Left Coronary
Papillary Muscle Circumflex branch – supplies SA node in 40 % of
Arise from the endocardial & myocardial surface of the people
ventricles & attach to the chordae tendinae Left marginal – supplies the left ventricle
Chordae Tendinae Anterior interventricular branch aka Left anterior
Attach to the tricuspid & mitral valves & prevent eversion descending(LAD)–supplies both ventricles and
during systole interventricular septum
Separated into 2 pumps: Lateral branch – terminates in ant surface of the heart
right heart – pumps blood through the lungs
left heart – pumps blood through the peripheral
organs
Chamber of the Heart
Atria
2 chambers, function as receiving chambers, lies above
the ventricles
Upper Chamber (connecting or receiving)
Right Atrium: receives systemic venous blood through
the superior vena cava, inferior vena cava & coronary
sinus
Left Atrium: receives oxygenated blood returning to the
heart from the lungs trough the pulmonary veins
Ventricles
2 thick-walled chambers; major responsibility for forcing Coronary Veins
blood out of the heart; lie below the atria Coronary sinus – main vein of the heart
Lower Chamber (contracting or pumping) Great Cardiac vein – main tributary of the coronary sinus
Right Ventricle: contracts & propels deoxygenated blood
Oblique vein – remnant of SVC, small unsignificant
into pulmonary circulation via the aorta during
ventricular systole; Right atrium has decreased pressure
Heart Circulation
which is 60 – 80 mmHg
Left Ventricle: propels blood into the systemic circulation
via aorta during ventricular systole; Left ventricle has
increased pressure which is 120 – 180 mmHg in order
to propel blood to the systemic circulation
Heart Valves
Tricuspid
Pulmonic
Mitral
Aortic
CARDIO
MEDSURG I
Cardiac Conduction System a. Sinoatrial node (SA node) "the pacemaker" - has the fastest
autorhythmic rate (70-80 per minute), and sets the pace for
Properties of Heart Conduction System the entire heart; this rhythm is called the sinus rhythm;
• Automaticity located in right atrial wall, just inferior to the superior vena
• Excitability cava
• Conductivity b. Atrioventricular node (AV node) - impulses pass from SA via
• Contractility gap junctions in about 40 ms.; impulses are delayed about
100 ms to allow completion of the contraction of both atria;
Structure of Heart Conduction System located just above tricuspid valve (between right atrium &
ventricle)
c. Atrioventricular bundle (bundle of His) - in the interATRIAL
septum (connects L and R atria)
d. L and R bundle of His branches - within the
interVENTRICULAR septum (between L and R ventricles)
e. Purkinje fibers - within the lateral walls of both the L and R
ventricles; since left ventricle much larger, Purkinjes more
elaborate here; Purkinje fibers innervate “papillary muscles”
before ventricle walls so AV can valves prevent backflow
Diagnostic Assessment
Purposes:
1. To assist in diagnosing MI
2. To identify abnormalities
Heart Sounds: Stethoscope Listening 3. To assess inflammation
4. To determine baseline value
Overview of Heart Sounds (lub-du ; lub, dub ) 5. To monitor serum level of medications
lub - closure of AV valves, onset of ventricular systole 6. To assess the effects of medications
dub - closure of semilunar valves, onset of diastole
Tricuspid valve (lub) - RT 5th intercostal, medial A. Blood Studies
Mitral valve (lub) - LT 5th intercostal, lateral
Aortic semilunar valve (dub) - RT 2nd intercostal 1. Complete Blood Count
Pulmonary semilunar valve (dub) - LT 2nd intercostals a. RBC count- # of RBCs/ mm3 of blood, to diagnose anemia and
S1 - due to closure of the AV(mitral/tricuspid) valves ploycythemia
- timing: beginning of systole b. Hemoglobin- # of grams of hgb/ 100ml of blood; to measure the
- loudest at the apex oxygen-carrying capacity of the blood
S2 - due to the closure of the semi-lunar (pulmonic/aortic) valves c. Hematocrit – expressed in %; measures the volume of RBCs in
- timing: diastole proportion to plasma; used also to diagnose anemia and polycythemia
- loudest at the base and abnormal hydration states
d. RBC indices- measure RBC size and hemoglobin content
a. MCV (mean corpuscular volume)
b. MCH (mean corpuscular hemoglobin)
c. MCHC (mean corpuscular hemoglobin concentrarion)
e. Platelet count- # of Platelet/ mm3; to diagnose thrombocytopenia
and subsequent bleeding tendencies
f. WBC count- of WBCs/ mm3 of blood; to detect infection or
inflammation
S3 – Ventricular Diastolic Gallop g. WBC Differential count- determines proportion of each WBC in a
Mechanism: vibration resulting from resistance to rapid sample of 100 WBCs; used to classify leukemias
ventricular filling secondary to poor compliance
Timing: early diastole Normal Values
Location: Apex (LV) or LLSB (RV) RBC: Women – 4.2-5.4 million/mm3
Pitch: faint and low pitched Men – 4.7-6.1 million/mm3
S4 - Atrial Diastolic Gallop Hgb: Women – 12-16 g/dl
Mechanism: vibration resulting from resistance to late Men – 13-18 g/dl
ventricular filling during atrial systole Hct : Women – 36-42%
Men – 42-48%
CARDIO
MEDSURG I
Normal Values
Bleeding Time: 2.75-8 min
Partial Thromboplastin Time (PTT): 60 - 70 sec.
Prothrombin Time (PT): 12-14 sec.
5. ECHOCARDIOGRAM
2. Holter Monitoring
A non-invasive test in which the client wears a Holter monitor
and an ECG tracing recorded continuously over a period of
24 hours
Instruct the client to resume normal activities and maintain a
diary of activities and any symptoms that may develop
C. Invasive Procedure
D. Hemodynamics Monitoring
CARDIAC DISORDERS
A. PRESDISPOSING FACTORS
1. Sex: male
2. Race: black
3. Smoking
4. Obesity Greater and lesser saphenous veins are commonly used for
5. Hyperlipidemia bypass graft procedures
6. Sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet: increased saturated fats
10. Type A personality
C. TREATMENT
Percutaneous Transluminal Coronary Angioplasty and
Intravascular Stenting
Mechanical dilation of the coronary vessel wall by
compresing the atheromatous plaque.
It is recommended for clients with single-vessel
coronary artery disease. Objectives of CABG
Prosthetic intravascular cylindric stent maintain good 1. Revascularize myocardium
luminal geometry after ballon deflation and withdrawal. 2. To prevent angina
Intravascular stenting is done to prevent restenosis after 3. Increase survival rate
PTCA 4. Done to single occluded vessels
5. If there is 2 or more occluded blood vessels CABG is done
Nursing Management:
Nitroglycerine is the drug of choice for relief of pain from
acute ischemic attacks
Instruct to avoid over fatigue
Plan regular activity program
CARDIO
MEDSURG I
Types of M.I
Transmural Myocardial Infarction: most dangerous type
characterized by occlusion of both right and left coronary
artery
Subendocardial Myocardial Infarction: characterized by
occlusion of either right or left coronary artery
C. NURSING INTERVENTIONS
CARDIO
MEDSURG I
II. RIGHT SIDED HEART FAILURE 2. Administer O2 inhalation at 3-4 L/minute via NC as
ordered high flow
A. PREDISPOSING FACTORS 3. High fowler’s, 2-3 Pillows
1. Tricuspid valve stenosis 4. Restrict Na and fluids
2. COPD 5. Monitor strictly VS and IO and Breath Sounds
3. Pulmonary embolism (char by chest pain and dyspnea) 6. Weigh pt daily and assess for pitting edema
4. Pulmonic stenosis 7. abdominal girth daily and notify MD
5. Left sided heart failure 8. provide meticulous skin care
9. provide a dietary intake which is low in saturated fats
B. SIGNS AND SYMPTOMS (Venous congestion) and caffeine
1. Jugular vein distention 10. Institute bloodless phlebotomy
2. Pitting edema ROTATING TOURNIQUET
3. Ascites Rotated clockwise every 15 minutes to
4. Weight gain promote a decrease in venous return
5. Hepatosplenomegaly 11. Health teaching and discharge planning
6. Jaundice Prevent complications : Arrhythmia, Shock,
7. Pruritus/ urticaria Thrombophlebitis, MI, Cor pulmonale – RV
8. Esophageal varices hypertrophy
9. Anorexia Regular adherence to medications
10. Generalized body malaise Diet modifications
Importance of ffup care
C. DIAGNOSTICS
1. CXR – cardiomegaly
2. CVP – measures pressure in right atrium; N = 4-10cc HYPERTENSION
H2O
During CVP: trendelenburg to prevent pulmo
embolism and to promote ventricular filling Is an abnormal elevation of Bp, systolic pressure above 140
Flat on bed post CVP, check CVP readings mmHg and or diastolic pressure above 90mmHg at least two
Hypovolemia – fluid challenge readings
Hypervolemia – diuretics (loop) WHO: BP >160/95 mmHg
3. Echocardiography – reveals enlarged heart chamber
AHA: BP >140/90 mmHg
Muffled heart sounds cardiomyopathy
In hypertension, vasoconstriction – vasospasm – increases
Cyanotic heart diseases
PVR – decrease blood flow to the organ.
TOF “tet” spells cyanosis with
hypoxemia Target Organs:
Tricuspid valve stenosis Heart : MI, CHF, Dysrhythmias
Transposition of aorta Eyes: blurred / impaired vision, retinopathy,
Acyanotic cataract.
PDA – machine-like murmur Brain: CVA, encephalopathy
DOC: indomethacin SE: corneal Kidneys : renal insufficiency, RF
Peripheral Bloods Vessels – aneurysm, gangrene
cloudiness
4. Liver enzymes
CLASSIFICATION OF BP FOR ADULTS 18 YRS AND OLDER
SGPT up
(PHIL. SOCIETY OF HPN)
SGOT up
Optimal
D. NURSING MANAGEMENT
o <120 mmHg / <80 mmHg Recheck in
Goal: increase myocardial contraction increase CO; Normal
CO is 3-6L/min; N stroke volume is 60-70ml/h2o 2 years.
Normal
1. Administer medications as ordered o 120-129 mmHg / 80-84 mmHg Recheck in
Cardiac glycosides 2 years.
Digoxin (N=.5-1.5, tox=2) High normal
Tox: Anorexia, N&V; A: Digibind o 130-139 mmHg / 85-89 mmHg Recheck in
Digitoxin – given if (+) ARF; metabolized in 1 year.
liver and not in kidneys Stage 1 (mild) HPN
Loop diuretics o 140-159 mmHg / 90-99 mmHg Confirm in
Lasix – IV push, mornings 2 months.
Bronchodilators Stage 2 (moderate) HPN
Aminophylline (theophylline) o 160-179 mmHg / 100-109 mmHg Evaluate
Tachycardia, palpitations within a month.
CNS hyperactivity, agitation Stage 3 (severe) HPN
Narcotic analgesics o 180-209 mmHg / 110-119mmHg Evaluate
Morphine sulfate – induces vasodilation within a week.
Vasodilators Stage 4 (very severe) HPN
NTG and ISDN o 210 mmHg / >/=120 mmHg Evaluate
Anti-arrhythmic agents
Lidocaine (SE: dizziness and confusion) A. CLASSIFICATION
Bretyllium Essential / Idiophatic / Primary HPN, accounts for
YOU DON’T GIVE BETA-BLOCKERS TO THESE 90 – 95% of all cases of HPN, cause is unknown
PATIENTS
CARDIO
MEDSURG I
E. NURSING INTERVNTIONS
1. Patient Teaching and Counselling
Teaching about HPN and its risk factors
Stress therapy
Low NA and low saturated fat
Avoid stimulants ( caffeine, alcohol, smoking )
Regular pattern of exercise
Weight reduction if obese
2. Teaching about medication
The most common side effects of diuretics are
potassium depletion and orthostatic hypotension.
The most common side effect of the different
antihypertensive drugs is orthostatic hypotension.
Take anti – hypertensive medications at regular
basis
Assume sitting or lying position for few minutes
Avoid very warm bath
Avoid prolonged sitting and standing
Avoid alcoholic beverages
Avoid tyramine – rich foods ( proteins ) as follows: (
this may cause hypertensive crisis )
Aged cheese
Liver
Beer
Wine
Chocolate
Pickles
Sausages
Soy sauce
3. Preventing Non-compliance
CARDIO
MEDSURG I
D. NURSING MANAGEMENT
1. Encourage slow progressive physical activity
Walking 3-4x/day
Out of bed 3-4x/day
2. Medications as ordered
Analgesics
Vasodilators
Anticoagulants
3. Instruct patient to avoid smoking and exposure to cold
environment
4. Institute foot care management
Avoid barefoot walking
Straight nails
Lanolin cream for feet
(-) constricting clothes
5. Assist in surgery: BKA
C. DIAGNOSTICS
1. Venography
2. Trendelenburg’s test – reveals that veins distend quickly
< 35 seconds incompetent valves