‫‪Cardiovascular disorders of the adult client‬‬

‫ال يصل الناس إلى حديقة النجاح دون أن يمروا بمحطات التعب والفشل واليأس‬
‫الفشل ليس عند الخسارة إ ّنما الفشل عند االنسحاب‬

‫‪T. MOHAMMED SAMI‬‬

‫‪0569945982‬‬

‫غير مسموخ السرقة منه –الملف ليس للبيع‬

‫‪Prometric exam collection‬‬ ‫‪2019‬‬
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The cardiovascular system consists of the heart, which is an anatomical pump, with
its intricate conduits (arteries, veins, and capillaries) that traverse the whole human
body carrying blood.
Heart Wall layers :-
a-The Epicardium (pericardium) is the outermost layer of the heart.

b-The myocardium is the middle layer of the heart.

c-The endocardium is the inner most layer of the heart.

The heart consists of four chambers, two atria (upper chambers) and two ventricles (lower chambers).

The heart consists of four valves:-

1-tricuspid valve: located between the right atrium and the right ventricle

2-pulmonary valve: located between the right ventricle and the pulmonary artery

3-mitral valve: located between the left atrium and the left ventricle

4-aortic valve: located between the left ventricle and the aorta
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The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of theheart that
send signals to the heart muscle causing it to contract.

The main components of the cardiac conduction system are the SA node, AV node, bundle of His,
bundle branches, and Purkinje fibers. The SA node (anatomical pacemaker) starts the sequence by
causing the atrial muscles to contract.

Heart sounds :-
The first heart sound(S1) is heard as the atrioventricular valve close and heard loudest at the apex of
the heart, "lub"

The second heart sound(S2) is heard when the semilunar valve close and heard loudest at the base of
the heart, "dub"
The third heart sound (S3) is a rare extra heart sound that occurs soon after the normal two "lub-
dub" heart sounds (S1 and S2). S3 is associated with heart failure, valvular regurgitation.
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The fourth heart sound (S4) is an extra heart sound that occurs during late diastole, immediately
before the normal two "lub-dub" heart sounds (S1 and S2) and the causes include cardiac
hypertrophy or injury to the ventricular wall.

Coronary arteries :- which transports blood into and out of the cardiac muscle.

Circulation of blood through the heart

Blood comes into the right atrium from the body, moves into the right ventricle and is pushed
into the pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the
heart through the pulmonary veins into the left atrium, to the left ventricle and out to the
body's tissues through the aorta.
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Angina:-
Angina is chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-
rich blood.
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Myocardial infarction: - destruction of cardiac tissue due to reduced coronary blood flow,
myocardial tissue is abruptly and severely deprived of oxygen.
Ischemia can lead to necrosis of myocardial tissue if blood flow not restored and need several
hours.
Assessment:-crushing, sub sternal pain, and radiate to the jaw back and left arm, not relived by
rest or nitroglycerin, and is relived only by opioids.
Nursing diagnosis: - pain related to decrease tissue oxygenation.
Nursing intervention:-
-provide physical and emotional rest to decrease cardiac metabolism.
-position the client in semi fowler.
-oxygen, vital signs, ECG, IV access, nitroglycerine, aspirin, morphine. Cardiac enzymes.
Cardiac catheterization (cardiac cath or heart cath) is a procedure to examine how well your
heart is working. A thin, hollow tube called a catheter is inserted into a large blood vessel that
leads to your heart.
Coronary angiography (PDF) is done during cardiac catheterization. A contrast dye visible in X-
rays is injected through the catheter. X-ray images show the dye as it flows through the heart
arteries. This shows where arteries are blocked.
How do I prepare for cardiac catheterization?
-Usually, you will be asked not to eat or drink anything for six to eight hours before the cath
procedure.
-Tell your doctor or nurse if you are allergic to anything, especially iodine, shellfish, latex or
rubber products, medicines like penicillin, or X-ray dye
-Before the cath procedure, a nurse will put an IV (intravenous) line.
-The nurse will clean and shave the area where the doctor will be working. This is usually in the
groin area.
-Document the client height and weight
-Kidney function test for patient.
What happens after cardiac catheterization?
-You will go to a recovery room for a few hours. During this time, you have to lie flat.
-Pressure will be applied to the puncture site to stop the bleeding.
-You will be asked to keep your leg straight and will not be able to get out of bed.
-Your heartbeat and other vital signs (pulse and blood pressure) will be checked during your
recovery.
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-Report any swelling, pain or bleeding at the puncture site, or if you have chest pain.
-Before you leave the hospital, you will receive written instructions about what to do at home.
-Encourage fluid intake.

Shock:-Sudden fall in total arterial blood pressure.

The main types of shock include:
-Cardiogenic shock (due to heart problems)
-Hypovolemic shock (caused by too little blood volume)
-Anaphylactic shock (caused by allergic reaction)
-Septic shock (due to infections)
-Neurogenic shock (caused by damage to the nervous system)
-Obstructive shock: - physical obstruction of great vessels.
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Heart failure is a condition in which the heart cannot pump enough blood to meet the body's
needs.
Assessment:-

Nursing intervention:-
- Administer supplemental oxygen
-monitor vital signs
- Inspect skin for pallor, cyanosis.
- Monitor urine output, noting decreasing output and concentrated urine.
- Provide quiet environment: explain therapeutic management, help patient avoid stressful
situations, listen and respond to expressions of feelings.
-Elevate legs, avoiding pressure under knee. Encourage active and passive exercises. Increase
activity as tolerated
-Check for calf tenderness, diminished pedal pulses, swelling, local redness, or pallor of
extremity.
-Note heart sounds, ECG, monitor for electrolyte
- Note changes in sensorium: lethargy, confusion, disorientation, anxiety, and depression.

- provide bedside commode. Have patient avoid activities eliciting a vasovagal response
(straining during defecation, holding breath during position changes).
-Administer medications as indicated: Diuretics: furosemide (Lasix), digoxin, anticoagulants.
-Prepare for insertion and maintenance of pacemaker, if indicated.
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Blood pressure: - the force of your blood pushing against the arterial walls.