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FINALS
Circulation
Respiratory and circulatory systems linked

Function of one affects the other.

HEART

Enclosed by pericardium

Layers are epicardium, myocardium, endocardium.

Chambers are: two upper atria, two lower ventricles separated by septum.

Atrioventricular (AV) valves separate atria from ventricles.

Tricuspid (right)

Bicuspid or mitral (left)

Semilunar (half-moon) valves: separate ventricles from great vessels.

Deoxygenated blood enters right side of heart, exits to lungs. arteries

Oxygenated blood returns via left side of heart, exits to body. ventricles

FINALS 1
 Coronary Circulation

Coronary arteries

Atherosclerotic plaque or clot- build up of fat and blood vessels

FINALS 2
 Angina or myocardial infarction (heart attack)

Cardiac Cycle

Systole (propels blood)

Diastole (ventricular filling)

Heart sounds

FINALS 3
 Cardiac conduction system

Automaticity

Sinoatrial (SA or sinus) node

Atrioventricular (AV) node

Bundle of His

Purkinje fibers

Cardiac Output (CO)

Amount of blood ejected from the heart each minute

Preload
-Degree of stretch of ventricles at end of diastole
-Depends largely on blood return from veins
-Increased volume leads to more forceful contraction of heart (Frank-
Starling law)

Contractility
-Inotropic state of the myocardium, strength of contraction
-Autonomic nervous system and inotropic medications affect it.

Afterload

-Pressure within arteries that ventricles must overcome to push blood into
circulation
-Left ventricle must work harder than right.

CONDITIONS THAT MAY PRECIPITATE HEART FAILURE:

FINALS 4
 Stroke volume (SV)

Amount of blood ejected from the heart with each beat

SV × HR = CO
-Normal CO is 4 to 8 L/min.

Heart rate

Number of beats per minute

If HR is more than 150/min, ventricles cannot refill and CO will fall.

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 BLOOD VESSELS
1. Low-pressure pulmonary system

2. Higher-pressure systemic system

3. Arteries generally carry oxygenated blood and veins carry deoxygenated

blood.

4. Most blood vessels have tunica intima, tunica media, and tunica adventitia.

Arterial circulation

Blood pressure (BP)

-Peripheral vascular resistance (PVR) × CO = mean arterial pressure
(MAP)

PVR determined by:

Viscosity (thickness) of blood

FINALS 6
 Blood vessel length

Blood vessel diameter

Venous return

Respiratory pump

Muscular pump

Venous valves

BLOOD
-transports oxygen, nutrients, and hormones to cells and removing wastes
-regulating body temperature, pH, and fluid volume
-preventing infection and blood loss

Hemoglobin
-major component of RBC
-binds easily with oxygen

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 LIFESPAN CONSIDERATIONS
Birth

Profound change from fetal to newborn circulation

100–180 bpm at birth

FINALS 8
 Pulse rates highest and most varied in newborns

Later 100–150 bpm

BP 65/40 first few days, 90/55 by 1 month

2 years

80–120 bpm

10 years to adult

60–95 bpm

BP gradually rises to about 110/65 by 16 years.

May rise in later years with atherosclerosis

FACTORS AFFECTING CV FUNCTION

Risk factors

Nonmodifiable risk factors

Heredity

Age

Gender

Modifiable risk factors

Elevated serum lipid levels

Hypertension

High sodium intake

Cigarette smoking

Diabetes

Obesity

Sedentary lifestyle

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 Nontraditional risk factors

Metabolic syndrome

C-reactive protein

Elevated homocysteine level

ALTERATIONS IN CV FUNCTION

Conditions affect:

Functioning of the heart as a pump

Blood flow to organs and peripheral tissues

Composition of blood and its ability to transport oxygen and carbon

dioxide

Decreased cardiac output

Myocardial infarction

Chest pain

Substernal and/or radiating to left arm or jaw

Nausea

Shortness of breath

Diaphoresis

Heart failure

Can develop if heart not able to keep up with body's need for
oxygen and nutrients

Usually occurs because of MI

May result from chronic overwork of heart

Left-sided heart failure can result in pulmonary edema.

Signs:

Pulmonary congestion

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 Adventitious breath sounds

Shortness of breath

Dyspnea on exertion

Increased HR

S3 heart sound

Increased RR

Nocturia

Othopnea

Distended neck veins

Structural defects or infections

Impaired tissue perfusion

Ischemia

Impaired blood flow due to obstruction

Atherosclerosis

Most common cause of impaired blood flow to organs and

tissues

Vessels narrow and become constricted.

Distal tissues receive less oxygen and nutrients.

Coronary arteries most affected

Obstruction leads to myocardial ischemia and may lead

to angina pectoris or myocardial infarctions (MI).

Obstruction in vessels supplying brain results in TIA or

stroke.

Obstruction in peripheral arteries leads to peripheral vascular

disease and possible gangrene.

Signs include pulses, pain, paresthesias, pallor,

coolness, and decreased hair distribution.

FINALS 11
 Vessel inflammation

Arterial spasms

Blood clots

Incompetent venous valves

May allow blood to pool in veins

Edema

Decreased venous return to heart

Incompetent venous valves

Veins become inflamed.

Reduce blood flow

Increased risk of thrombus formation

Thrombi may break loose.

Emboli

Occlude blood supply at alveolar–capillary membrane

Acute pulmonary embolism

Sudden onset of shortness of breath

Pleuritic chest pain

Medical emergency

Blood alterations

Anemia

Chronic fatigue

Pallor

Shortness of breath

Hypotension

Blood volume

Hemorrhage

FINALS 12
 Severe dehydration

Hypervolemia

Sickle cell disease

ASSESSMENT
Nursing History:

1. Current, past CV problem

2. Family History

Physical Assessment:

1. BP

2. Lung sounds

3. Skin

4. Ankle/Brachial Index

DIAGNOSING

1. Decreased Cardiac Output

2. Risk for Peripheral Neurovascular Dysfunction

3. Activity Intolerance

Diagnostic studies

Cardiac monitoring

Blood tests

Hemoglobin

Electrolytes

Creatinine kinase (CK)

FINALS 13
 Troponin

Hemodynamic studies

Continuous monitoring for clients with known or suspected CVD

During and after surgery

Monitor responses to drug therapy

At risk for serious complications such as shock

PLANNING

Maintain or improve tissue perfusion

Maintain or restore adequate cardiac output

IMPLEMENTING

Promoting circulation

Vascular function

Elevate client's legs

Avoid placing pillows under knees or providing more than 15°

knee flexion

Encourage leg exercises for client on bed rest

Promote ambulation as soon as possible

Encourage or provide frequent position changes

Cardiac function

Position client in high Fowler's position

Monitor intake and output

Maintain fluid restriction as ordered

Help client understand purposes, effects, and side effects

Assess effects of medications and potential complications

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 Assess intake and output and potassium levels, if appropriate, for
clients receiving diuretics

Assess BP, HR, peripheral pulses, and lung sounds for clients
receiving positive inotropic medications

Monitor BP (including postural blood pressure) for clients

receiving antihypertensive medications

Medications

Nitrates, calcium channel blockers, and ACE inhibitors

Positive inotropic drugs

Beta-adrenergic blocking agents

Direct vasodilators

Many clients on multiple medications

Assess for effects and potential complications

Preventing venous stasis

Positioning and leg exercises

Applying antiemboli stockings

Applying sequential compression devices (SCDs)

Cardiopulmonary resuscitation

CPR

Oral resuscitation and cardiac massage to reestablish

cardiac function and blood circulation after cardiac arrest

Within 20 to 40 seconds of a cardiac arrest, victim is

clinically dead.

After 4 to 6 minutes, lack of oxygen to the brain causes

permanent, extensive damage.

Must initiate immediately

FINALS 15
 Three cardinal signs of cardiac arrest

Apnea

Absence of a carotid or femoral pulse

Dilated pupils

Respiratory (pulmonary) arrest

Usually from blocked airway or cardiac arrest

Calling a code

Therapeutic presence is a key nursing intervention.

EVALUATING

1. Collect data to evaluate effectiveness of interventions

2. If desired outcomes are not achieved, the nurse, client, and

support person needs to explore reasons before modifying the
care plan

3. If desired outcomes are not achieved, the nurse, client, and

support person need to explore reasons before modifying the
care plan.

Are there additional stressors?

Signs of fluid overload?
Are medications being taken?

FINALS 16