Review of

Cardiovascular System
Disorders
 System in Failure

► Deficits in one area

▪ Adequate Pump
▪ Good Blood Volume
▪ Peripheral vascular resistance
▪ Normal heart rate
 Diagnostic procedures
► Laboratory Tests
► Electrolytes
► ESR
► blood coagulation tests
▪ PTT
▪ PT
▪ Clotting time
► BUN
► Serum cholesterol
► Triglycerides
► Blood cultures
► Enzymes
▪ CPK
▪ LDH
▪ SGOT
► CVP– 5-10 cm
water
► provides an indication of
pressure in the right
atrium
► ECG
► Echocardiography
► Arteriography
► Definition
► Purpose
► Nursing interventions
▪ NPO, informed consent, allergy history
▪ After
▪ VS
▪ Check for bleeding
▪ Check distal extremity for color,pulse, temp,
sensation
► Cardiac Catheterization
► Nursing Interventions
► Before
▪ Know approach
▪ NPO, consent
▪ Mark distal pulses
▪ Explain procedure
▪ Assess for allergy
► After
▪ BP & apical pulse
▪ Check peripheral pulse
▪ check for bleeding
▪ Assess for chest pain
▪ Keep extremity extended
▪ Assess for impaired circulation
 Angina
► ANGINA PECTORIS
► UNSTABLE ANGINA
► PRINZMETAL
► Manifestations
▪ Location
▪ character of pain, ST elevation
▪ Duration
▪ Precipitating events
 Nursing Interventions

► Assess pain
▪ Location
▪ Character
▪ Duration
▪ Precipitating factors
► Help px adjust lifestyle
▪ Avoid excessive cold weather
▪ Avoid overeating
▪ Avoid constipation
▪ Rest after meals
▪ Exercise
► Teach client how to cope: nitroglycerin
▪ When to take it
▪ How often
▪ Storage
▪ Side effects
▪ Types
 Myocardial Infarction

► Definition
► Causes
▪ ASHD
▪ Coronary artery embolism
► Manifestations
▪ heavy chest pain, radiating to the L arm, jaw,
neck, not relieved by rest
▪ nausea or vomiting
▪ diaphoresis
▪ hypotension
▪ ECG changes: depressed ST segment,
inverted T wave
▪ Denial
▪ increased CPK, LDH
► Nursing interventions
▪ early
► treat arrhythmia
► Analgesics
► Rest
► Administer O2
► VS
► Drugs
► Emotional support
► Latter
▪ Stool softeners
▪ Provide low fat, low cholesterol, low Na, soft food
▪ Commode
▪ Self-care
▪ Plan for Rehabilitation
▪ Exercise program
▪ Stress management
▪ Teach risk factors
▪ Psychological support
▪ Long term drug therapy
▪ Anti-arrhythmic
▪ Anticoagulants
▪ Antihypertensives
 Congestive Heart Failure

► Left ventricular failure:

► Symptoms
▪ Dyspnea
▪ Moist cough
▪ Rales, wheezing
▪ Orthopnea
► Pulmonary edema
▪ moist rales, frothy sputum
▪ severe anxiety
▪ marked dyspnea & cyanosis
▪ edema
 Right Ventricular Failure
► Manifestations
▪ peripheral edema
▪ distended neck veins
▪ weight gain
▪ enlarged liver
▪ elevated CVP
▪ hypotension
▪ tachycardia
▪ rales
► Nursing interventions
▪ reduce pain & anxiety
▪ improve oxygenation
▪ reduce congestion
▪ improve myocardial contraction
 Digitalis therapy

► decrease HR, improve ventricular filling, stroke

volume and perfusion, strength of contraction
► symptoms of toxicity
▪ halo around lights
▪ anorexia, diarrhea
▪ nausea & vomiting
▪ bradycardia, PVCs
► nursing implications
▪ monitor K levels
▪ apical HR
► Diuretics
▪ Furosemide
▪ Spirinolactone
► Vasodilators
▪ ACE Inhibitors
 Valvular disorders

► Symptoms
► heart failure
► murmurs
► decreased CO
► nursing interventions
▪ same as CHF
▪ antibiotic therapy
CARDIOMYOPATHY
 MGT
► Same as HF
► Heart Transplant
► surgical
▪ valve replacement
▪ valvulotomy
► post op care
► monitor VS, ECG
► ventilator
► monitor intake & output
► maintain fluid & electrolyte balance
► chest tubes
► relieve pain
► neuro checks
► peripheral pulses
► TED stockings
► Rehabilitation
▪ activities
▪ diet
▪ medications
▪ special needs
 AV blocks
► 1st degree
▪ delayed transmission
▪ prolonged PR
▪ no treatment
 2nd degree

► some impulse pass through, some do not

► atropine & isoprotenerol
► pacemaker sometimes
 3rd degree

► no impulse pass through AV node

► Pacemaker
 Pacemaker

► Types
▪ demand
▪ fixed
► temporary
► permanent
▪ types
► transvenous
► transthoracic
► nursing interventions
▪ preop teachings
▪ postop care
▪ monitor ECG & pulse
▪ check wound
▪ analgesics
▪ maintain electrically safe environment
▪ observe for hiccups
▪ sterile technique
► complications
▪ infection
▪ arrhythmias
▪ dislodging
▪ malfunction
 Client teaching

► check pulse daily

► wear loose fitting clothes
► no contact sports
► carry ID
► stay away from microwaves
► be aware when battery needs charging
► Body image
► Resume regular activity in 6 weeks
Arterial Disorders:
► Causes:
▪ Arteriosclerosis
▪ Atherosclerosis
► Classic signs and symptoms:
▪ Intermittent Claudication
▪ Tingling and numbness of extremities
▪ Cool extremities
 Client Teaching

► Stop smoking
► Avoid stressful situations
► avoid constricting garments
► Keep legs in straight plane or dependent
► Buerger-Allen exercises
61
► Arteriosclerosisobliterans (ASO) – usually
affects the aorta or the arteries of the lower
extremities
► Characteristics:
▪ Commonly associated with diabetes
▪ Occlusion usually proximal to pain zone
▪ Advanced symptoms: pain at rest, commonly at
night
► Surgical Management:
▪ Vascular graft
▪ Patch grafts
▪ Endarterectomy
 Nursing Interventions:

► Check for pulse on extremities

► Observe for paralysis after operation upon
the thoracic aorta
► Ensure adequate circulating blood volume
through arterial repair: intake and output –
CVP
► Client teaching – avoid dependent positions,
elevate extremities, use of TEDS
► Mini-doses of Heparin
 Buerger’s disease (Thromboangiitis
Obliterans)

► Recurring inflammation of the arteries and

veins of lower and upper extremities
resulting to thrombus and occlusion.
 Characteristics

► Occurs in men 20-35 years

► Most common sx: pain in legs relieved by
inactivity, numbness and tingling of toes in
cold weather
► Cessation of smoking is important
 Raynaud’s Phenomenon

▪ vasospastic condition of the arteries which

occurs with exposure to cold or stress and
affects primarily the hands
 Characteristics:

► Arterialvasoconstriction results in pain,

occasionally ulceration of the fingertips,
color changes from whit to blue to red
 Nursing Interventions:

► Avoidcold
► STOP smoking
Vascular Disorders
► Aortic Aneurysm
▪ local distension of the artery wall – usually
thoracic or abdominal
► Cause:
► Infections
► Congenital
► Atherosclerosis
 Symptoms:

► Thoracic: pain, dyspnea,hoarseness, cough,

dysphagia
► Abdominal: Abdominal pain, persistent or
intermittent low back pain, pulsating
abdominal mass
► Treatment: usually surgery
► Hypertension:
▪ persistent Bp above 140 systolic and 90 diastolic
▪ “silent killer”
 Essential hypertension:

► 90% have this kind

► Hereditary disease
► Cause unknown
► Late symptoms:headaches, fatigue,
dyspnea, edema, nocturia, blackouts
 Secondary hypertension:

► Due to identifiable problem

► Pheochromocytoma
 Nursing Interventions:

► Correct overweight
► Avoid stimulants
► Program of regular exercise
► maintain salt restricted diet
► Teach risk factors
 Antihypertensive drugs:

► Potassium depleting diuretics

► Potassium sparing diuretics
► Adrenergic inhibitors
► Vasodilators
► Calcium Agonist
B. Venous Diseases:
1. Thrombophlebitis – clots lead to vein
inflammation
2. Phlebothrombus – a thrombus w/o
inflammation
3. Phlebitis – vein inflammation usu.
assoc. w/ invasive procedures
4. Deep Vein Thrombosis
▪ pain (calf or groin tenderness)
▪ (+) Homan’s sign
▪ warm skin tender to touch
5. Varicose Veins
distended protruding veins that
appear darkened & tortuous;
vein walls weaken & dilate, the
valves become incompetent
Etiology:
► prolonged standing
► pregnancy
► obesity
► Congenital

Incidence:
► Female
► 35 – 40 y. o.
Assessment: (in comparison w/ arterial
diseases)
Arterial: Venous:
Intermittent Claudication Heaviness & leg cramps
Cyanosis Redness
Coldness Warmth
Absent pulse unpalpable pulse due to edema
Loss of sensation no loss of sensation
Gangrene ulcers venous stasis ulcers
Decreased capillary refill (+) Trendelenburg test
Intervention:
a. Lower down legs Elevate legs
b. Wear warm socks Wear elastic stockings
c. Buerger-Allens Exercise Ankle push-up
d. Avoid obesity, crossing legs Avoid obesity, crossing legs
e. Avoid tight clothing Avoid tight clothing
f. Avoid smoking & cold Avoid smoking & prolong
weather standing
g. Femoral artery bypass Vein stripping & ligation
h. Angioplasty Post-op Care:
i. Amputation - elevate legs
- CBR for 24 Hrs
- Elastic compression
- check for hemorrhage
- prevent thrombophlebitis
Aortic Aneurysms
► abnormal dilation of the arterial wall,
caused by localized weakness &
stretching in the medial layer or wall of
the artery.
Types:
a. According to morphology or form:
b. Fusiform
c. Saccular
d. Dissecting
e. False (Pseudoaneurysm)