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09/08/2018
ACUTE BIOLOGICAL CRISIS
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09/08/2018
Conditions:
1. Cardiac failure & dysrhythmias
2. Respiratory failures & ARDS
3. Renal Failure & ESRD
4. Burns
5. Hepatic coma
6. Diabetic ketoacidosis
7. Thyroid crisis & adrenal crisis
8. Multisystem organ failure & shock
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Ms. Jenneth E. dela Cerna, R.N.
09/08/2018 7
CARDIOVASCULAR
DISORDERS
09/08/2018 8
• Enclosed within the inferior
mediastinum. THE HEART
• Enclosed by a double sac
of serous membrane –
Pericardium
Serous fluid
• Lubricating fluid that is
produced by the serous
pericardial membranes.
• Allows heart to beat easily.
Pericarditis:
• Decreased in the amount of
serous fluid adhesions
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3 LAYERS OF THE HEART WALLS:
1. Epicardium
tightly hugs the external
surface of the heart.
2. Myocardium
Consist of thick bundles of
cardiac muscle
Contracts
3. Endocardium
thin, glistening sheet of
endothelium that lines the
heart chambers.
2. VENTRICLES (2)
inferior, thick-walled
Discharging chambers
Contraction
propulsion of blood
circulation
Thursday, August 9,
28
2018
CORONARY ARTERY DISEASE
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Etiology:
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ATHEROSCLEROSIS
Abnormal deposit
of fatty substances
and fibrous tissue
in the intima of the
blood vessel.
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ATHEROSCLEROSIS
PATHOPHYSIOLOGY:
Injury in the endothelial lining
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fatty streak or foam cells formation
Intimal ulceration
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Platelet aggregation further increasing the
plaque
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ANGINA PECTORIS
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Types of angina pectoris:
1. Stable angina
a consistent pain that occurs on activity and
is relieve by rest.
2. Unstable angina
increasing in frequency, duration and
intensity of pain at lower level of activity.
3. Prinzmetal angina
result of coronary vasospasm
4. Silent angina
ischemia occurs without at all
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Clinical Manifestations:
a. Pain
b. Shortness of breath
c. Diaphoresis
d. Pallor
e. Weak or numbness of arm
f. Dizziness or lightheadedness
g. Feeling of impending doom
h. Choking or strangling sensation
i. Anxiety
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Diagnostic tests:
1. ECG
2. 2D echocardiogram
3. Cardiac enzymes
4. CBC, ESR
5. Lipid levels
6. Exercise Stress Test
7. Cardiac catheterization & angiography
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Medical management:
1. Oxygen therapy
2. Pharmacological treatment:
a. Nitrates
b. Beta-adrenergic blocker
d. Antiplatelet drugs
e. Antilipidemics
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3. Surgical management
A. CABG
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B. PTCA
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C. Laser angioplasty
- atherectomy
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Nursing Management:
1. Lifestyle modification
2. Careful monitoring during anginal episodes
3. Keep nitroglycerin available for immediate
use.
4. Complete bed rest
5. Provide stress reduction activity
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MYOCARDIAL INFARCTION
09/08/2018
Coronary occlusion, heart attack, & MI are
used synonymously, but the preferred term is
MI.
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CAUSES:
09/08/2018
1. Atherosclerosis
09/08/2018
occlusion/vasospasm
NECROSIS 47
09/08/2018
CLINICAL MANIFESTATIONS:
09/08/2018
1. ECG
2. 2D echocardiogram
3. Coronary angiography
4. Myocardial perfusion imaging with thallium-
201
5. Serial serum cardiac markers:
a. Creatine kinase (CK)
b. Lactic dehydrogenase (LDH)
c. Myoglobin
d. Troponin T & I 49
Cardiac Normal value with Acute Myocardial Infarction
enzyme
09/08/2018
Goals: reperfusion of the necrotized area
a. To minimize myocardial damage
b. To preserve myocardial function
c. Prevent complications
1. Oxygen therapy
2. Pain control
Opiate analgesic
a. Morphine sulfate (DOC)
Vasodilator
a. Nitoglycerine
Anxiolytic therapy
a. Benzodiazepine 51
09/08/2018
3. Other pharmacologic therapy
Thrombolytics
to dissolve & lyse the thrombus in the coronary artery
(thrombolysis) allowing blood flow through the coronary
artery
Do not affect the atherosclerotic lesion.
Must be administered ASAP after the onset of symptoms that
indicate an AMI.
a. Streptokinase
increases the amount of plasminogen activator thus increasing
the amount of both circulating & clot-bound plasminogen.
Made from bacteria (risk of allergic reaction)
Vasculitis is noted up to 9 days after adminstration.
Not used if the patient received streptokinase in the past 6-12
months. 52
09/08/2018
b. Tissue Plasminogen activator (t-PA)
activates the plasminogen on the clot more than the
circulating plasminogen.
Heparin can be used (to prevent another clot from formingh
at the same lesion site because t-PA dose not decrease the
clotting factors)
Anticoagulants/antiplatelet
Beta-adrenergic blockers
Antidysrhythmics
ACE inhibitors
4. Surgical management
PTCA
CABG
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09/08/2018
NURSING INTERVENTIONS:
4. Reducing anxiety.
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Cardiac tamponade
09/08/2018
is a rapid, unchecked increase in pressure in the pericardial
sac compressing the heart, impairing the diastolic filling,
reducing cardiac output
CAUSES:
1. Effusion
2. Hemorrhage due to trauma
3. Hemorrhage due to nontraumatic causes
4. Chronic renal failure
5. Connective tissue disorder
6. Acute myocardial infarction
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Pathophysiology:
09/08/2018
accumulation of fluid in the pericardial sac
MEDICAL MANAGEMENT:
Goal: to relieve intrapericardial pressure & cardiac compression
1. Pericardiocentesis
2. Pericardiotomy
3. Insertion of a drain into the pericardial sac
4. Inotropic drugs
5. Blood transfusion
6. Protamine sulfate (heparin-induced tamponade)
7. Vitamin K administration (warfarin-induced tamponade) 58
09/08/2018
Nursing responsibilities:
59
Cardiogenic shock
09/08/2018
occurs when the heart cannot pump enough blood to supply
the amount of oxygen needed by the tissues.
CAUSES:
1. Myocardial infarction (most common)
2. Myocardial ischemia
3. End-stage cardiomyopathy
4. Myocarditis
5. Depression of myocardial contractility
6. Prolonged cardiac dysfunction
7. Acute mitral or aortic insufficiency
8. Ventricular septal defect
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09/08/2018
PATHOPHYSIOLOGY:
decreased contractility
Myocardial ischemia
hypoxia
pulmonary pressure
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decreased coronary artery perfusion
09/08/2018
Clinical manifestations:
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09/08/2018
Medical management:
Goals:
to increase cardiac output
to improve myocardial perfusion
to decrease cardiac workload
NURSING RESPONSIBILITIES:
1. Monitor & record vital signs & peripheral pulses every 5
minutes until stable.
2. Assess the skin color & temperature.
3. Closely monitor PAP, PAWP & cardiac output.
4. Measure CVP.
5. Measure urine & output every through an indwelling catheter.
6. Monitor ABG, CBC & electrolyte levels.
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7. Administer medications as ordered.
09/08/2018
8. IABP:
Move the client as little as possible.
Never flex the “ballooned” leg at the hip.
Never place the patient sitting position.
Assess pedal pulses, skin temperature & color.
Check the dressing over the insertion site for bleeding.
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09/08/2018
CONGESTIVE HEART FAILURE:
Is the inability of the heart to pump enough blood to meet the
metabolic needs of the body.
Categories:
a. Left-sided failure
b. Right-sided failure
c. Systolic dysfunction
d. Diastolic dysfunction
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09/08/2018
Causes:
1. Myocardial dysfunction
Coronary artery disease
Ischemia
Myocardial infarction
Dilated cardiomyopathy
2. Arterial hypertension
3. Valvular heart disease
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09/08/2018
Etiologic factors:
1. Increased metabolic rate
2. Hypoxia
3. Anemia
4. Respiratory & metabolic acidosis
5. Cardiac dysrhythmias
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09/08/2018
PATHOPHYSIOLOGY:
1. Myocardial dysfunction
a. CAD
b. Ischemia
c. M.I . decreased blood flow to myocardium
d. Dilated cardiomyopathy
hypoxia - - - acidosis
necrosis
decreased contractility
CHF
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09/08/2018
2. Arterial hypertension increased workload of the heart
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09/08/2018
3. Valvular heart disease difficulty of blood in moving
forward
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09/08/2018
• Left & right-sided dysfunction : word format
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09/08/2018
Compensatory mechanisms:
all types of heart failure reduced cardiac output
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Clinical manifestations:
Left-sided Cardiac Failure: Right-sided Cardiac Failure:
1. Dyspnea on exertion 1. Dependent edema
2. Paroxysmal nocturnal 2. Weight gain
dyspnea 3. Hepatomegaly
3. Orthopnea 4. Distended neck veins
4. Cough 5. Ascites
5. Pulmonary crackle 6. Anorexia & nausea
6. Lower than normal 7. Nocturia
oxygen saturation level 8. Weakness
7. Restlessness & anxiety
8. Tachycardia/palpitations
9. Easily fatigued
10. Insomia
09/08/2018 75
09/08/2018
Diagnostic exam:
1. Chest x-ray
2. ECG
3. Liver & renal function test
4. ABG
5. Echocardiogram
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