Effects of cardiac problems on individuals Functions of the cardiac system Deliver nutrients and oxygenated blood Remove waste

te Delivery of deoxygenated blood to the right side of the heart and to the pulmonary circulation via the right ventricle Oxygenated blood from the lungs to the left side of the heart and tissues throughout the body via the left ventricle Structures & Tissues Pericardium Layers: epicardium, myocardium, endocardium 4 chambers: R & L atria and ventricles 4 valves: aortic semilunar, pulmonary semilunar, tricuspid, bicuspid (mitral) Blood vessels Coronary Arteries Regulation of Blood Flow Stroke volume (SV) is the amount of blood ejected from the ____________ with each contraction. What decreases SV? _________________________________ Cardiac output is the amount of blood pumped from the left ventricle each __________ Cardiac output is determined by multiplying stroke volume x heart rate Cardiac reserve is the hearts ability to increase output and pressure to meet the demands of the body. Ejection fraction percent of blood ejected with each heart beat Preload- end diastolic volume Afterload: the resistance to left ventricular ejection. ______________ increases afterload. Myocardial Contraction- affects cardiac output. Poor contraction ____________ the amount of blood ejected by the ventricles.

Conduction System

The conduction system includes a group of specialized cells that have the ability to generate electrical activity. The impulse begins in a small bundle of specialized cells located in the R atrium, called the SA node. The impulse leaves the SA node and travels to the R & L atria, causing them to contract. The electrical signal reaches the A-V node. There, the signal pauses to give the ventricles time to fill with blood. Then it goes to the bundle of His and divides into the R & L bundle branches where it rapidly spreads using the Purkinje fibers to the muscles of the R & L ventricle, causing them to contract at the same time. The blood from the R ventricle is pumped to the lungs, and the blood from the left ventricle is pumped to the rest of the body. SA Node The natural ________________ of the heart. Maintains heartbeat between 60-100/min Problems with node affect heart rate AV Node 40-60/min Bundle of His & Purkinjie fibers 20-40/min Impulses that do not begin at the SA node cause conduction disturbances called dysrhythmias

 ____________ reflects the electrical activity of the conduction system. On an EKG, _________________ rhythm implies that the impulse originated at the SA node and followed the normal sequence through the conduction system Conduction system controls heart rate to meet demands of body.

Dysrhythmias Possible Causes Response to ischemia Valvulvar Abnormality Anxiety Drug Toxicity Caffeine Tobacco Alcohol Acid-Base or F & E imbalances Classification of Dysrhythmias Cardiac Response o Tachycardia o Bradycardia o Premature Beat o Blocked (delayed or absent) Beat Site o Atrial fibrillation (atria) o Supraventricular (originates above ventricles) o Ventricluar (within the ventricles) o Life-threatening rhythms that require immediate attention __________________ &_______________________________. General Classification of Cardiac Disorders Disturbances in Conduction o Results: Impaired Valvular Function o Backflow or regurgitation of blood through the valve that is not working properly, causing a ____________. Myocardial Hypoxia o Results: Cardiomyopathic Conditions

 Peripheral Tissue Hypoxia

Altered Cardiac Output Causes of myocardial pump failure o CAD o Cardiomyopathy o Valvular Disorders o Pulmonary Disease Failure of myocardium to eject sufficient volume to the systemic and pulmonary circulations results in heart failure.

Left-Sided Heart Failure Decreased function of left ventricle If significant, results in decreased cardiac output Assessment Findings Fatigue Shortness of Breath Dizziness Confusion As the ventricle continues to fail, blood begins to pool in the pulmonary circluation causing pulmonary congestion Assessment findings related to the congestion include: crackles, hypoxia, SOB, cough, and difficulty breathing that wakens the pt from their sleep. Right-Sided Heart Failure Results from impaired functioning of right ventricle Often results from pulmonary disease or as a result of long-term left-sided heart failure Blood begins to back up in the systemic circulation Findings: Weight gain, distended neck veins, hepatomegaly, spenomegaly, and dependent peripheral edema Impaired Valvular Function Characterized by stenosis or regurgitation of blood Stenosis obstructs the flow of blood Regurgitation causes a blackflow of blood into an adjacent chamber Myocardial Ischemia

 Supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands Common manifestations Angina Myocardial Infarction Atherosclerosis
Angina Transient imbalance between myocardial oxygen supply and demand. Results in chest pain that is aching, sharp, tingling, burnings, or that feels like pressure. Usually lasts from 1 to 15 minutes It is usually precipitated by activities that increase myocardial oxygen demand Usually relieved by rest and coronary vasodilators

Myocardial Infarction in Men Results from sudden decrease in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion. IN men pain is described as crushing, squeezing, or stabbing felt in the left chest and sternal area,. It may be felt in the back, and radiate down the left arm to the neck, jaws, teeth, epigastric area, and back. The pain occurs during rest and lasts more than 30 minutes Rest, position changes, or vasodilators do not relive the pain Myocardial Infarction in Women Symptoms differ from men The most common initial symptom is angina, but atypical symptoms of fatigue, indigestion, vasospasm, shortness of breath, or back or jaw pain may be present. Common Manifestations of Heart Disease Chest Pain Difficulty Breathing on exertion Rapid Breathing


Risk

Palpitations Cyanosis Edema Fainting (syncope) Anxiety Factors for Heart Disease: Smoking Physical Inactivity Hyperlipidemia Hypertension Diabetes mellitus Stress Oral Contraceptives Heredity Obesity Family History Age Gender Race

Lifestyle Modifications Smoking Cessation Weight Reduction Healthy Diet Exercise Manage HTN, DM, cholesterol Laboratory tests CBC (hgb, Hct, RBC, WBC etc.) Anemia, Infection Coagulation studies (PT, PTT, INR) Serum Electrolytes (K, Na, Ca, Mg ) Serum lipids Cardiac enzymes: CK Troponin- elevates within 12 hours of event Myoglobin- elevates within 3 hours Brain natriuretic peptide (BNP)- CHF Diagnostic testing (Chart p. 925) Chest X-ray EKG

Holter monitor Stress test Thallium Stress Test Echocardiography

Diagnostic procedures (Chart p. 925) Cardiac catheterization and angiography Nursing History Pain & Characteristics Dyspnea Fatigue Peripheral Circulation Cardiac Risk Factors Presence or history of cardiac conditions Functional Health Patterns Activity/Exercise Coping and stress Cognitive/perceptual Elimination Nursing Diagnoses Activity intolerance Fatigue Impaired gas exchange Decreased cardiac output Ineffective tissue perfusion Knowledge deficit Assessment General observations History of the illness/family history/risk factors Head to toe with focused assessment on the skin, respiratory, cardiac, urinary and nervous system. Base line information Profusion is the main concern for cardiac issues. Results of doctor ordered tests Pulse rate, rhythm, quality Blood pressure Heart sounds

 Peripheral pulses, rate Capillary Refill Edema Activity Tolerance (Why) Pain (location, duration (how long does it last, how long have you had it), radiation, description, severity, does anything make it better or worse) Pain complaint, use the patients words in quotes (impending doom) Anything relieve the pain, aggravate the pain? PQRST Clubbing Questions Do you have Chest discomfort, pressure, or pain? Palpitations? Shortness of Breath? Dizziness or lightheadness?
Goal? Same as for the respiratory system The goal will be directed toward Self care activity Improving cardiac function Improving health maintenance Patient teaching Planning Vital signs Pulse oximetry Pain evaluation Dependent nursing actions Independent nursing actions Interdependent nursing actions Telemetry monitoring Diagnostic testing pre and post

Nursing interventions Head to toe observations Vital signs, pain, pulse oximetry Position of comfort

Diagnostic testing Medication administration Monitoring Oxygen therapy

Evaluation Improvement in oxygen exchange Improvement in activity tolerance ADL function improvement Mental status Peripheral pulses Anxiety level Health maintenance Case study