Cardio Vascular Problem

Ms. Leani M. Fuñe, RN

 CONDITIONS AFFECTING THE HEART

ANGINA PECTORIS:
 transient paroxysmal episode of substernal or precordial pain
 insufficient blood flow through coronaries
 temporary myocardial ischemia

risk factors:
 Atherosclerosis, aortic regurgitation, hypertension, hormonal
and blood disorders
Subjective data:
A. Pain
type: squeezing, pressing, burning
location: retrosternal,substernal,left of sternum,radiates to left arm
duration: short usually 3-5 minutes
cause: emotional stress, physical exertion, exposure to cold
relief: rest, nitrolycerin
A. Dyspnea
B. Palpitations
D. Dizziness, faintness

Objective data:
a) tachycardia
b) pallor
c) diaphoresis
NURSING PLAN/IMPLEMENTATION:

1. Provide relief from pain - rest until pain subsides,

nitroglycerin as ordered, assist with ambulation:
dizziness, flushing occur
2. Provide emotional support
3. Health teaching: pain: alleviation, differentiation of
angina from MI, medication: frequency, expected
effects (headache, flushing) carry fresh nitroglycerin;
losses potency after six months, diet: restricted
cholesterol, gas-producing foods, small, frequent
meals
4. Exercise
5. Behavioral modification
6. Diagnostic tests- cardiac catheterization, coronary
bypass surgery
MYOCARDIAL INFARCTION (MI):
 localized area of necrotic tissue in myocardium form
cessation of blood flow
 coronary occlusion due to thrombosis, embolism or
hemorrhage adjacent to atherosclerotic plaque
 insufficient blood flow from cardiac hypertrophy,
hemorrhage, shock or severe dehydration

risk factors:
 age (35-70 yr), men, lifestyle, stress, high cholesterol
diet, chronic illness (DM, hpn)
Subjective data:
A. PAIN
type: sudden, severe, crushing, heavy, tightness
location: substernal, radiates to one or both arms, jaw, neck
duration: 30 minutes
caution: unrelated to exercise, frequently occurs when sleeping
relief: narcotics, oxygen, not relieved by rest or nitroglycerin
B. nausea
A. shortness of breath
B. apprehension, fear of impending death
C. history of cardiac disease

Objective data:
 vital signs: shock, rapid (>100), thready pulse, fall in blood pressure,
tachypnea, shallow respiration, elevated temp. within 24 hr
 Skin:cyanotic, ashen or clammy, diaphoretic
 Emotional: restless
 Lab data: increased WBC, serum enzymes (CPKMB, SGOT, LDH),
changes EKG (elevated ST segment, inverted Twave,
arrhythmia)
NURSING PLAN/IMPLEMENTATION:
1. Reduce pain, discomfort- Narcotics-morphine,
Meperidine (Demerol) HCL
2. Humidified Oxygen
3. Position: Semi-fowler’s to improve ventilation
4. Maintain adequate circulation
5. Recognize heart failure: edema, cyanosis, dyspnea,
cough, rales
6. Decrease oxygen demand/promote oxygenation
7. Maintain fluid, electrolyte, nutritional status
8. Provide emotional support
9. Health teaching
CONGESTIVE HEART FAILURE (CHF):

 inability of the heart to meet the peripheral circulatory

demands of body, cardiac decompensation, combined
right and left sided heart failure
 increased cardiac workload or decreased effective
myocardial contractility ---decreased cardiac output.
Left ventricular failure---pulmonary congestion, right
atrial and right ventricular failure----systemic
congestion---peripheral edema. Compensatory
mechanism in CHF include: tachycardia, ventricular
dilation, and hypertrophy of the myocardium
Subjective data:
A. shortness of breath
Orthopnea (sleeps on two or more pillows)
Paroxysmal nocturnal dyspnea (sudden breathlessness during sleep)
Dyspnea on exertion (climbing stairs)
B. apprehension; anxiety, irritability
C. fatigue; weakness
D. reported weight gain; feeling of puffiness

Objective data:
a) Vital signs
BP: decreasing systolic, narrowing pulse pressure
pulse: pulsus alternans (alternating strong weak-strong
cardiac contraction), increased
respiration: moist rales
b) Edema: dependent, pitting
c) Liver: enlarged, tender
d) Neck veins: distended
• CXRAY: cardiac enlargement, dilated pulmonary vessels, diffuse
interstitial lung edema
NURSING PLAN/IMPLEMENTATION:
1. Provide physical rest/reduce emotional stimuli
2. Provide for relief of respiratory distress, reduce
cardiac workload
 Oxygen: low flow rate, encourage deep breathing, auscultate breath
sounds for congestion
 Position: head of bed 20-30cm alleviates pulmonary congestion
 Medications as ordered: digitalis, diuretics, tranquilizers, stool softeners
3. Maintain fluid and electrolyte balance, nutritional
status
 Urine output: 30ml/hr minimum
 Daily weight: same time, clothes, scale
 IV: use microdrips to avoid circulatory overloading
 Diet: low sodium, small frequent, discuss food preferences with client