CARDIAC - Vincent's
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Transcript CARDIAC - Vincent's
NUR-224
Explain cardiac anatomy/physiology and the
conduction system of the heart.
Incorporate assessment of cardiac risk factors
into the health history and physical assessment
of the patient with cardiovascular disease.
Discuss clinical indications, patient preparation
and other elated nursing implications fro
common test and procedures used to assess and
diagnose cardiovascular diseases.
Three layers
Endocardium
Myocardium
Epicardium
Four chambers
Heart valves
Surrounded by pericardium
Pericardial fluid 10-30 mL
Divided by septum
Left ventricular wall 2-3 x as thick as right
ventricle
Atrial wall thinner than ventricles
Inferior and superior vena cava send
deoxygenated blood to right atrium
Blood passes through tricuspid valve to right
ventricle blood passes from right ventricle
through pulmonic valve via pulmonary artery to
lungs
Blood from lungs enters left atrium via pulmonary
veins
Passes through mitral valve to left ventricle
Blood ejected to body through aortic valve aorta
peripheral system
Depolarization (contraction of heart)
Sinoatrial node – pacemaker of heart
Contraction of atria
AV node
Bundle of His
Right and left bundle branches
Purkinje fibers
Systole
Contraction of myocardium
Ejection of blood from ventricles
Diastole
Relaxation of myocardium
Filling of coronary arteries
Atrium is emptying into the ventricles
Number of times the ventricles contract each
minute
60-100
Regulated by: Autonomic Nervous System
Sympathetic
Parasympathetic
Amount of blood pumped by each ventricle during
a given period
Amount of blood ejected from ventricle with each
beat (stroke volume) x heart rate
CO = SV x HR 4 – 7 L/min
Stroke volume: amount of blood ejected with
each heartbeat
Cardiac output: amount of blood pumped by
ventricle in liters per minute
Preload: degree of cardiac muscle fiber tension
at end of diastole (prior to contraction)
Afterload: resistance that ventricles must
overcome to eject the blood
Contractility: ability of cardiac muscle to
shorten in response to electrical impulse
Health history
Family/genetic history
Chest pain
Dyspnea
Peripheral edema, weight gain
Palpitations
Fatigue
Dizziness, syncope, changes in level of
consciousness
Medications
Nutrition
Elimination
Activity, exercise
Sleep, rest
Self-concept
Roles, relationships
Sexuality
Risk factors
Inspection
Palpation
Percussion
Auscultation
Normal skin color
Capillary refill < 3 seconds
Thorax symmetrical
No jugular vein distention with patient at 45°
Absence of clubbing
PMI palpable at 5th ICS mid-clavicular line
No thrills, heaves
Slight pulsation of abdominal aorta in epigastric
region
Carotid and extremity pulses equal bilaterally
No pedal edema
Normal heart sounds
S1 and S2 heart sounds heard
Apical-radial rate equal and regular
No murmurs or extra heart sounds
No S3 or S4
Pericardial friction rub
Extremities
Lungs
Abdomen
Laboratory test:
Diagnose the cause of cardiac-related
signs/symptoms
Determine baseline values before initiating
therapeutic interventions
Ensure therapeutic levels of medication are
maintained
Evaluate the patient’s response to the therapeutic
regimen
Identify abnormalities
Cholesterol - normal level <200mg/dL
Major sources – diet, liver
Low density lipoproteins LDLs <160
High-density lipoproteins HDLs
Triglycerides <200
CXR/Fluoroscopy
Electrocardiography
Cardiac stress testing
Echocardiography
Coronary arteries dilate to 4x their normal in
response to increased metabolic demands for
oxygen.
Coronary arteries affected by atherosclerosis dilate
less, compromising blood flow to the myocardium
ischemia
Noninvasive test
Abnormalities in CV function are more likely to be
detected during times of increased stress.
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Determine :
presence of CAD
cause of chest pain
functional capacity of the heart after MI/ heart
surgery
effective of antianginal/antiarrhythmic
dysrhythmias/ physical exercise
Pre-Test
Physical and Baseline ECG
Signed consent
Patient teaching
Report cardiac symptoms during test
NPO 4 hours pre-test
Withhold meds
Emergency and resuscitation equipment
need to be at site of test at all times
Testing procedure
Exercise equipment
Increase HR to target rate for age and gender OR
c/o chest pain or fatigue
Speed or incline increased every 2-3 minutes to
increase stress on patient
ECG and BP monitored throughout the test
Rest for 15 minutes post test while being
monitored
Invasive procedure study used to measure cardiac
chamber pressures, assess patency of coronary
arteries
Requires ECG, emergency equipment must be
available
Assessment prior to test: allergies, blood work
Assessment of patient postprocedure: circulation,
potential for bleeding, potential for dysrhythmias
Activity restrictions
Patient education pre/postprocedure
Preparation
√ allergies to shellfish
Signed consent form
D/C anticoagulants,
ASA, salicylates,
herbals affecting
coagulants
Contraindicated;
patients with
bleeding disorders
Elderly, dehydrated
Severe renal failure
Patient Teaching
Palpitations as
catheter enters left
ventricle
Heat/hot flash as
contrast medium
injected
Sensation of need to
cough as medium
injected into right
side of heart
During Procedure
nausea
pain at insertion site
STAT Intervention
chest pain
dysrhythmias
changes in peripheral
pulses
neuro assessment
Post Procedure
VS & Neuro checks
insertion site
pressure dressing
bleeding/hematoma
Assessment
extremities - s/s
ischemia r/t clots
bed rest 4-6 hrs post
procedure
CVP
Pulmonary artery pressure
Intra-arterial BP monitoring