RHEUMATIC FEVER Age Gender Poor hygiene Crowding Infection

Streptococcal infection (group-A beta hemolytic streptococcus)

Abnormal humoral and cell mediated response to antigen

Binds to joints, heart and tissue receptors

Inflammatory process Endocardial inflammation Bacterial vegetation form on valve tissue Attract platelets Platelet- fibrin formation Scarring or shortening narrowed/ stenosed cardiac workload swelling of valve leaflets valve dysfunction shortened closure ability blood regurgitation

Impaired cardiac function Complications: > valvular disorders >cardiomegaly >CHF Nursing Diagnosis: Altered in comfort: pain r/t inflammatory process Nursing Management: Obtain a clear description of pain or discomfort Identify the source of greatest discomfort as s focus for intervention Balance rest and activity based on degree of discomfort and activity tolerance Provide comfort measures, quiet environment and calm activities to promote nonpharmacological pain management Instruct client to use relaxation techniques such as focused breathing, imaging CDs to distract attention and reduce tension

HYPERTENSION Age Gender Race stress obesity diet Smoking Alteration in peripheral- vascular resistance

Hypovolemia

juxta cell Renin secretion Angiotensinogen Angiotensin 1 ACE Angiotensin 2

hyponatremia

adrenal cortex

Vasoconstriction

aldosteron

Peripheral resistance

Sodium retention

HPN

Water retention

Vascular volume Nursing Diagnosis: Activity Intolerance r/t imbalance between oxygen supply and demand

Nursing Management: Instruct client in energy- conserving techniques to reduce the energy expenditure thereby assisting in equalization of oxygen supply and demand Encourage progressive activity/ self care when tolerated. Adjust activities to prevent overexertion Provide assistance as needed to protect client from injury Promote comfort measures and provide for relief of pain to enhance ability to participate in activities

CARDIOGENIC SHOCK Age Gender Myocardial Infarction Cardiomyophathies Blunt Cardiac Injury Hypertension Cardiac Tamponade

Massive MI

Myocardial contractility

Cardiac output

Hypo perfusion (heart, brain, kidneys)

Manifestations: - Systolic BP - Oliguria - Cold clammy skin, weak pulse, cyanosis - Mental lethargy, confusion

Tissue hypoxia

Organ damage

Death

Nursing Diagnosis: Decreased Cardiac Output r/t altered contractility Nursing Management: Keep client on bed or chair rest in position of comfort to decrease oxygen consumption and risk of decompensation Administer high flow oxygen via mask or ventilator as indicated to increase oxygen available for cardiac function or issue perfusion Instruct client to avoid or limit activities that may stimulate a valsalva response which can cause changes in cardiac pressure and impede blood flow Decrease stimuli; provide quiet environment to promote adequate rest Monitor vital sign frequently to note response to interventions

MYOCARDIAL INFARCTION Age Gender Race History of CAD Smoking Obesity Hyperlipidemia HPN, DM Physical inability

Myocardial Ischemia Myocardial oxygen supply Cellular hypoxia

Changed in pH (acidosis) Contractility of Myocardium Cardiac Output

Nursing Diagnosis: Ineffective tissue perfusion r/t reduction or interruption of blood flow

Nursing Management: Encourage active or passive exercise, avoidance of isometric exercises Monitor for sudden changes or continued alteration in mentation Inspect for pallor, cyanosis mottling, cool clammy skin Monitor intake, note changes in urine output Position client in semi- fowlers to allow greater diaphragm expansion thereby lung expansion and better CO2 and O2 exchange

CONGENITAL HEART DEFECTS Age Gender Accidents Alcoholism Drug ingestion SLE

Presence of abnormal opening between left and right side of the heart

Blood shunt from the left to the right side Systemic circulation

shunting of blood from right to left side pulmonary circulation

acyanosis

Oxygenated blood goes back to the lungs

deoxygenated blood goes back to the systems

deoxygenated blood from the systemic circulation mixes with the oxygenated blood abnormal bluish discoloration of blood

Pulmonary blood flow

pulmonary blood flow

Pulmonary hypertension

vasoconstriction

cyanosis

Irreversible pathologic changes in pulmonary vasculature

delays/ reduces blood flow

Manifestations: - pulmonary congestion - cardiac failure - respiratory difficulty - cough - whizzes and crackles

RIGHT- SIDED CONGESTIVE HEART FAILURE Age Gender Ethnicity Family History hypertension Diabetes Mellitus smoking Physical inactivity

Myocardial contractility Diastolic Filling Obstruction of right atrial emptying RA pressure

Right Sided Failure Blood flow into pulmonary circulation

congestion/ accumulation of blood systemic venous viscera GI tract

pulmonary edema RA, RV, end diastolic Systemic venous pressure

blood draws back to the hepatic veins

interfere digestion and absorption

hepatomegaly Manifestations: - neck vein engorgement - hemolytic anemia -internal hemorrhoids - S3,S4 heart sounds -weight gain -portal hypertension

anorexia, abdominal pain

LEFT- SIDED CONGESTIVE HEART FAILURE

Age Gender Ethnicity Family History Myocardial contractility Diastolic Filling Cardiac workload Left Atrial Pressure

Hypertension Diabetes Mellitus Smoking Physical inactivity

Left sided heart failure Pulmonary venous pressure Pressure in pulmonary capillary Stroke volume Tissue perfusion

Shifting of intravascular fluid into the interstitium spaces

Cellular hypoxia

Blood flow into kidneys

Pulmonary edema

stimulation of RAAS

Vasoconstriction Manifestations: -dyspnea - Orthopnea -syncope - Fatigue - cough - wheezing - PND

reabsorption of H2O & Na

ECF volume BP

Nursing Diagnosis: Cardiac output r/t altered myocardial contractility

Nursing management: monitor blood pressure monitor urine output noting decreasing output and dark or concentrated urine encourage rest, semi- recumbent in bed a chair , assist in physical care as indicated Elevate legs, avoiding pressure under knee. Encourage active/ passive exercise, increase ambulation or activity as tolerated. Provide bedside commode. Have client avoid activities eliciting a vasovageal response (e.g straining during defecation)

CHRONIC ARTERIAL OCCLUSIVE Age Gender Smoking Hypertension Obesity Hyperlipidemia

Alteration in blood flow

Disruption of supply and demand Prolonged in blood flow

Compensatory mechanism

Vasodilation O2 demand

Collaterization

anaerobic metabolism Production of lactic acid and pyruvic acid change in bodys acidbase balance

limitation met

fast dilatation

slowed diffuse network of collateral vessels Ability of compensatory mechanism to meet peripheral- vascular needs

Peripheral gangrene

Nursing Diagnosis: Altered Tissue Perfusion r/t interruption of blood flow 2 to arterial occlusion

Nursing Management: Perform assistive/ active range- of- motion exercises Encourage early ambulation when possible to enhance venous return Exercise caution in use of hot water bottles or heating pads. Tissue may have decreased sensitivity due to ischemia and heat also increases metabolic demands of already compromised tissue Provide air mattress, foam padding, bed/foot cradle to protect the extremities Elevate HOB at night to increase gravitational blood flow

ANGINA PECTORIS Gender Race Age Sedentary lifestyle Excessive physical exertion Excessive intake of food Exposure to cold environment Obesity

Occlusion of plaque into vessels

Platelet aggregation

Vessel spasm Blood and O2 supply

Reduced coronary tissue perfusion

Diminished myocardial oxygenation

Manifestations: -dizziness -faintness -dyspnea -tachycardia

Anaerobic metabolism Production of lactic acid

Chest pain

Nursing Diagnosis: Acute pain r/t myocardial blood flow

Nursing Management: Instruct client to notify nurse immediately when chest pain occurs Place client at comfortable rest during angina episodes Monitor vital sign every 5 minutes during initial angina attack Maintain quiet, comfortable environment, restrict visitors as necessary Prove light meals and have client rest for 1 hour after meals

DEEP VEIN THROMBOSIS

Age Family History Gender

Smoking Immobilization Long period of standing Obesity

Venous stasis Blood flow

Damage to vessel wall

Inflammation of vessel wall

Platelet formation

Formation of thrombus

Breakdown of blood clot

propagation of clot formation

Goes into microcirculation

Possible occlusion of pulmonary vessels

Manifestations: -edema -swelling -tenderness -calf pain

Complications: -limb ischemia -post thrombotic syndrome

Complication: -pulmonary embolism

Nursing Diagnosis: Ineffective peripheral tissue perfusion r/t blood flow

Nursing Management: Elevate legs to promote venous return and prevent edema Avoid standing still and sitting for prolonged periods Check pulse distal to the site of thrombosis Have the client rest for 5-7 days Promote early ambulation to prevent pulmonary complications

RAYNAUDS DISEASE Age Gender Smoking Occupational trauma Vessel injury

Exposure of digital arteries to cold Stress

Vasospasm/ vasoconstriction Arterial flow

pallor

Arterial occlusion O2 supply Cyanosis pain Swelling

Tissue ischemia

Tissue hypoxia

Necrosis

Ulceration/

Superficial Gangrene Nursing Diagnosis: Ineffective peripheral tissue perfusion r/t compromised blood flow 2 to Raynauds Disease Nursing Management: Keep extremities warm Avoid standing or sitting with legs dependent for long periods Reduce or remove external venous compression that may impede venous flow Encourage range of motion exercises Discuss smoking cessation to client Encourage avoidance of crossing the legs to avoid compression

ATHEROSCLEROSIS History of CAD Age Gender Race Hyperlipidemia Smoking Hypertension Obesity

Injury to vascular endothelium

Inflammatory response

Attraction of inflammatory cells

Formation of fatty steaks of lipids

Release of biochemical substances by activated macrophage

Further damage to endothelium

Platelet attraction and mutation of clotting mechanism

Formation of fibrous cap with lipid & inflammatory infiltrate

Thick fibrous cap

Thin cap

Resistance of blood flow

Growing of lipid core

Rupture of plaque

Formation of thrombus M.I ACS

Obstruction of blood flow

Nursing Diagnosis: Ineffective tissue perfusion r/t reduction or interruption of blood flow

Nursing Management: Encourage active or passive exercise, avoidance of isometric exercises Monitor for sudden changes or continued alteration in mentation Inspect for pallor, cyanosis mottling, cool clammy skin Monitor intake, note changes in urine output Position client in semi- fowlers to allow greater diaphragm expansion thereby lung expansion and better CO2 and O2 exchange

THROMBOANGITIS OBLITERANS (BUERGERS DISEASE) Age Gender Race Genetic factors Smoking Tobacco chewing

Inflammatory process

Cause injury to the arterial wall

Platelets aggregation

Thrombosis formation

Occurrence of fibrosis inside the cell

Segmental occlusion of the vessels

Tissue ischemia of small distal arteries & veins

Ischemia of proximal arteries

Ulceration

Gangrene

Nursing Diagnosis: Ineffective Peripheral Tissue Perfusion r/t compromised blood flow

Nursing Management: Maintain warm temperature and avoid chilling to promote arterial flow Discourage use of tobacco products which causes vasospasm that may impede peripheral circulation Elevate extremities above heart level to counteracts gravity, promotes venous return and prevent venous stasis Discourage standing still or sitting for a long period of time to prevent venous stasis Encourage moderate amount of walking or graded extremity exercise to promote blood flow

ANUERYSM

Age Gender Congenital defects

Trauma Infections Pregnancy- related- degenerative

Plaque formation Pressure

Change in medial layer of the vessel Elasticity of vessel & weakening

Abnormal dilatation of vessels

Complication: Rupture

Hemorrhage

Tamponade

Death

Nursing Diagnosis: Altered Comfort: Pain r/t inflammatory response

Nursing Management: Provide comfort measures, quiet environment, and calm activities to promote non pharmacological pain management Encourage diversional activities Have client rate his pain to determine level of interventions to be applied Instruct in or encourage use of relaxation techniques, such as focused breathing, etc. to distract attention and reduce tension Encourage adequate rest periods to prevent fatigue

PATHOPHYSIOLOGY OF CARDIOVASCULAR DISORDERS

>Congestive Heart Failure >Coronary Artery Disease - Atherosclerosis -myocardial Infarction