Professional Documents
Culture Documents
2.0 Nursing assessment and management of patients with dysfunctions of circulation, and undergoing related diagnostic tests.
This is important!
There are three systems that must work together for the heart to beat efficiently:
1.
2. 3.
Arteries and veins act simply as conduits for blood! Only capillaries directly serve cells by exchanging materials with them.
Cardiac Tissues
Connective tissues form the fibrous skeleton and valves. Cardiac muscle produces the contractile force of the heart. Epithelial tissue lines the cardiac chambers and covers the outer surfaces of the heart.
Arterial System
General Features
Tricuspid Directs the flow of blood from the right atrium to the left ventricle. Mitral Valve Directs the flow of blood from the left atrium to the left ventricle. Pulmonic (semilunar) Lies between the right ventricle and the pulmonary artery. Aortic Valve (semilunar) Lies between the left ventricle and the aortic artery.
3. The newly oxygen-rich blood (shown in red) returns to the heart and enters the left atrium. 4. Blood flows through the left atrium into the left ventricle. 5. The left ventricle pumps the oxygen-rich blood to all parts of the body.
Coronary Circulation
Autoregulation
Autoregulation is defined as
The intrinsic ability of an organ to maintain a constant blood flow despite changes in perfusion pressure.
Control of an event such as blood flow through a tissue (e.g., cardiac muscle) by alteration of the tissue.
Heart Sounds
Heart sounds are caused by the closure
of heart valves.
The first sound (lub), or S1, is caused by closure of the atrioventricular (AV) valves. The second sound (dup), or S2, is caused by the closure of the semilunar valves.
A valve that does not close efficiently, results in the backflow of blood (i.e., insufficiency or regurgitation). A valve that does not open wide enough may cause turbulent backflow secondary to obstruction or narrowing (i.e., stenosis).
Landmarks
Definitions
Cardiac output Pre-load After-load Cardiac reserve Starlings law of the heart Pulse deficit Pulse pressure
Opposition to flow
A measure of the amount of friction blood encounters as it passes through the vessels.
Most friction is encountered in the peripheral circulation (peripheral resistance (PR)). Sources of resistance
Force per unit area exerted on the wall of a vessel by its contained blood expressed in mm Hg. Usually means systemic arterial blood pressure in the largest arteries near the heart.
The differences in blood pressure within the vascular system provided the driving force that keeps blood moving through the body.
Physiology of Circulation
Blood Flow
Actual volume of blood flowing through the entire circulation or any part of it (a vessel, an organ, etc.) in a given period of time (ml/min). Equals cardiac output (CO) when applied to the entire circulation. Varies widely among individual body organs as determined by their immediate needs.
2. Ventricular ejection
3. Isovolumetric relaxation
4. Ventricular filling
5. Atrial systole
The ejection fraction (EF) represents the amount of blood pumped out of the heart (left ventricle) with each beat. In the healthy heart, it is around 70%.
The inability of the heart to circulate blood effectively enough to meet the body's metabolic needs.
Shortness of breath (dyspnea) Fatigue Edema associated with fluid overload Lightheadedness Hypoxia Orthopnea Cognitive changes Other
The heart is supplied by the two branches of the autonomic nervous system.
Decreased vessel elasticity Increased calcification of vessels Impaired valve function Decreased muscle tone (including the heart Decreased baroreceptor response to blood pressure changes Decreased conduction ability of the heart
Other stuff
Contractility:
The ability of muscle cells to contract after depolarization. This ability depends on how much the muscle fibers are stretched at the end of diastole.
Non-modifiable
Modifiable
Other
Cardiac Testing
Laboratory Tests
CK or CK-MB LDH (LDH1, LDH2) AST (SGOT) Lipids PT/PTT ABGs Electrolytes CBC Troponin & Myoglobin C-reactive protein (CRP) Homocysteine B Type Natriuretic Peptid
Tests
Radiographic
Cardiac Testing
Angiography Angioplasty Biopsy VO2 max
Tests
Tests
Hemodynamic Monitoring
Physical Assessment
General appearance Mental Status Vital signs Pulses Heart rate and rhythm Perfusion Edema Lung sounds Other
82 y/o male w/30 + year history of COPD presents to the ER with C/O SOB and chest pain and now is to be admitted to your unit. He has a IV at TKO and O2 per NP at 2L. He was given a Nitro and an aspirin in the ER.
Fred
Admitting Dx: CHF, R/O MI Past Medical Hx: Mild CHF, COPD x 30 years,
CAD, HTN PE: Skin pink and dry, brisk capillary refill, oriented x 4, S3 heart sounds, SOB with any exertion, audible expiatory and inspiratory wheezes, crackles at bases bilaterally, 1+ pitting edema to mid calf
FRED
1. 2. 3. 4. 5. 6. 7. Chief Complaint Cardiac (Medical) History Tests (Labs & others) Medications Physical exam Vital signs Nursing Diagnosis
Q-R-S-T-A-A-A
Quality - dull/squeezing Region radiation changing right arm/left arm Severity/Setting rest vs exertion after meals scale of pain
Time sudden/gradual onset Alleviators Position Aggravators food/position/exertion/people constant/episodic Associated Symptoms SOB, cough, temp, nausea, diarrhea
Q-R-S-T-A-A-A
Cardiac History
Ask about his personal history, family history and social history.
Fred - Medications
Physical Exam
What we know
SOB (subjective and objective) Vital signs ABGs SkinPerfusion Mental status Heart sounds Lung sounds Edema
Nursing Diagnosis
What nursing diagnosis would be appropriate for Fred at this time?
Remember, NDs serve to guide and direct nursing care!