Cardiac Disorders

Nursing
60B Nursing
Chabot
SpringProgram
2014

Nursing 60 B
Spring 2015

Cardiovascular Objectives
Discuss tests/studies used in the assessment of the cardiovascular system,
to include the following:
a. Laboratory tests
b. Cardiac Catheterization
c. Echocardiography
d. Myocardial Nuclear Perfusion Imaging
e. Exercise Electrocardiography (Stress test)
f. Hemodynamic monitoring
2. Review presentation/treatment of lethal dysrhythmias
3. Discuss critical nursing assessments and interventions in the care of the
client who has undergone cardiac surgery:
4. Review critical assessments and treatments in the care of the client who
has pulmonary edema and congestive heart failure
5. Identify common drug therapies to improve cardiac output.
6. Prioritize nursing care for clients experiencing heart failure
7. Compare and contrast common valvular disorders
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Cardiovascular Disorders
8. Discuss surgical management for clients with valvular disease
9. Develop a teaching/learning plan for clients with valvular disease
10. Differentiate between common cardiac inflammations and infectionsendocarditis, pericarditis, and rheumatic carditis
11. Compare and contrast dilated, hypertrophic and restrictive
cardiomyopathy
12. Explain the pathophysiology of Acute Coronary Syndrome
13. Discuss the assessment findings in clients who have ACS, and
prioritize nursing care for clients who have ACS
14. Discuss medications commonly used in the treatment of the client
with ACS
15. Prioritize nursing care for the client who has underdone CABG
surgery
16. Discuss the differences between CABG surgery, minimally invasive
direct coronary artery bypass, and off-pump CABG.
17. Identify findings in the client who has developed cardiac tamponade
and critical interventions
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Comparison of Types of Cardiomyopathies

Slide 4

Cardiomyopathy Illustrations

Slide 5

Dilated Cardiomyopathy Characteristics

Slide 6

Dilated Cardiomyopathy Clinical Presentation

Slide 7

Dilated Cardiomyopathy Management

Slide 8

Dilated
Cardiomyopathy

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Hypertrophic Cardiomyopathy Characteristics

Slide 10

Hypertrophic Cardiomyopathy Clinical

Presentation

Slide 11

Hypertrophic Cardiomyopathy Management

Slide 12

Slide 13

Hypertrophic Cardiomyopathy

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Restrictive Cardiomyopathy Characteristics

Causes:
Buildup of abnormal proteinsin the
heart muscle (amyloidosis) #1 cause in
U.S.
Build up of scar tissue (no known
reason)
Radiation or chemotherapy exposure
Excess ironin the heart (
hemochromatosis)
systemic diseases (e.g.(
SlideOther
15

Restrictive Cardiomyopathy Clinical Presentation

Slide 16

Restrictive Cardiomyopathy Management

Slide 17

Heart Failure

Inadequacy

of the heart to pump blood

throughout the body; causes insufficient
perfusion of body tissue with vital
nutrients and oxygen
Left-sided heart failure
Right-sided heart failure
High-output failure

Slide 18

Congestive Heart Failure

Most common cause of hospital

admissions for people 65 yrs or older
Major cause of disability and death after
myocardial infarction
Common Risk Factors:
Hypertension
Dysrhythmias
Coronary artery disease
Diabetes
Cardiomyopathy
Smoking
Substance abuse
Obesity
Valvular disease
Family History
Cardiac infections, inflammation
Lung Disease
Hyperthyroidism
Sleep Apnea
Slide 19

Left-Sided Heart Failure

Manifestations:

Weakness
Fatigue
Dizziness
Confusion
Pulmonary congestion
Shortness of breath
(Continued)

Slide 20

Right-Sided Heart Failure

Manifestations:

Distended neck veins, increased abdominal

girth
Hepatomegaly
Hepatojugular reflux
Ascites
Dependent edema
Weight: most reliable indicator of fluid gain or
loss

Slide 21

Heart Failure Assessments

Laboratory

assessment

Electrolytes, BUN, H & H,

B-type natriuretic peptide
UA for protein, microalbumin
ABG to assess hypoxemia

Radiographic

assessment

Cardiomegaly, rule out respiratory causes

Echocardiography
Valves, ventricles, HF Ejection Fraction < 40
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Heart Failure Assessments

Electrocardiography

Assess for acute cardiac conditions such as

MI (elevated ST segment)
Dysrhythmias (decreased cardiac output)
Ventricular hypertrophy
Pulmonary

artery catheters

Hemodynamic monitoring in ICU can guide

medical management of heart failure

Slide 23

Treatment of Heart Failure

Drug therapy including:

Oxygen to keep O2 sat > 90%
Morphine during acute phase anxiety
Angiotensin-converting enzyme
inhibitors enalapril (Vasotec), fosinopril (Monopril)
Angiotensin Receptor Blockers valsartan
(Diovan), irbesartan (Avapro) losartan (Cozaar)

Diuretics furosemide, bumetanide, observe for

potassium deficiency and give replacements; for mild fluid

overload hydrocholorothiazide, metolzazon (Zaroxolyn)

Slide 24

Treatment of Heart Failure

Human

B-type natriuretic peptides

Nesiritide

(Natrecor)

Nitrates

nitroglycerine

Inotropics

digoxin increases contractility, reduces heart rate,

slows condution through AV node, sympathetic activity
parasympathetic activity Beta adrenergic agonists: Dobutamine
(Dobutrex) milrinone (Primacor) acute treatment, both given IV

Beta-adrenergic

blockers

not for acute treatment

used for chronic treatment: carvedilol (Coreg), metoprolol
(Lopressor), bisoprolol (Zebeta)

Morphine

for anxiety
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Hemodynamic Regulation

Interventions:

Reduce afterload.
Reduce preload.
Improve cardiac muscle contractility.
Administer drugs as prescribed.
Monitor for therapeutic and adverse effects.
Teach client and family drug therapy.

Slide 26

Preload and Afterload

Preload is the end diastolic
pressure that stretches the
right or left ventricle of the
heart to its greatest
dimensions under variable
physiologic demand, the
initial stretching of the
cardiomyocytes prior to
contraction

Slide 27

Afterload is the tension or

stress developed in the wall
of the left ventricle during
ejection. The end load
against which the heart
contracts to eject blood.

Drugs That Reduce Afterload

Angiotensin-converting

enzyme (ACE) inhibitors

perindopril, captopril, enalapril, lisinopril, and ramipril.

Relaxes blood vessels, as well as a decreased blood
volume, lowers blood pressure and decreased
oxygen

Slide 28

Drugs That Reduce Afterload

Human

B-type natriuretic peptides

the effect of BNP and Atrial natriuretic

peptide (ANP) causes a decrease in blood
volume, which lowers systemic blood pressure
and afterload, yielding an increase in cardiac
output, partly due to a higher ejection fraction.
Example: Nesiritide (Natrecor) for acute heart
failure is only administered intravenously by
bolus then an infusion
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Interventions That Reduce Preload

Diet

therapy: Patients should be given a

low sodium diet to minimize fluid retention.
Closely monitor fluid balance, fluid
restriction
Oxygen therapy to maintain SaO2 above
90 percent
Drug therapy
Diuretics
Venous vasodilators
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Drugs That Enhance Contractility

Digitalis

Digitalis toxicity includes anorexia, fatigue,

changes in mental status.
Monitor heart rate and electrolytes.
Inotropic

drugs including dobutamine and milrinone

Beta-adrenergic blockers carvedilol (Coreg),
metoprolol (Lopressor)

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Potential for Pulmonary Edema

Pulmonary Edema
Interventions:
Assess for early signs, such as crackles,
dyspnea at rest, disorientation, and confusion.
Rapid-acting diuretics such as Lasix or
Bumex.
Oxygen is always used
Strictly monitor fluid intake and output.

Slide 32

Infective Endocarditis

Infective Endocarditis
Microbial infection involving the
endocardium
Occurs primarily with IV drug abuse, valvular
replacements, systemic infections, or
structural cardiac defects
Possible ports of entry: mouth, skin rash,
lesion, abscess, infections, surgery, or
invasive procedures including IV line
placement
Slide 33

Infective Endocarditis: Manifestations

Infective Endocarditis
Murmur
Heart failure
Arterial embolization
Splenic infarction
Neurologic changes
Petechiae
Splinter hemorrhages

Slide 34

Infective Endocarditis: Interventions

Antimicrobials
Rest,

balanced with activity

Supportive therapy for heart failure
Anticoagulants
Surgical management

Slide 35

Pericarditis
Inflammation

of the pericardium
Dresslers syndrome
Post-pericardiotomy syndrome
Chronic constrictive pericarditis

Slide 36

Assessment

Substernal

precordial pain radiating to left

side of the neck, shoulder, or back
Grating, oppressive pain, aggravated by
breathing, coughing, swallowing
Pain worsened by the supine position;
relieved when the client sits up and leans
forward
Pericardial friction rub: two pieces of
leather rubbing together, boots on snow
Slide 37

Interventions

Hospitalization

for diagnostic evaluation,

observation for complications, and
symptom relief
Non-steroidal anti-inflammatory drugs
Corticosteroid therapy
Comfortable position, usually sitting
Pericardial drainage
(Continued)

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