Chapter 3 Nursing Care of Patients with Cardiovascular and Circulatory Disorders

1. 1 Chapter 3Nursing Care of Patients with Cardiovascular and Circulatory Disorders

2. 2 Coronary Artery Disease Atherosclerosis is an abnormal accumulation of lipids and fibrous tissues in the vessel wall. The atheromas (plaque) protrude into the lumen of the vessel, narrowing it and obstructing blood flow. The thrombus may obstruct blood flow leading to myocardial infarction or sudden death.

3. 3 Risk Factors: 1. Modifiable risk factors: - Cholesterol levels - Cigarette smoking - Hypertension - Diabetes mellitus 2. Nonmodifiable risk factors: - Age - Gender - Family history - Race

4. 4 Myocardial Infarction Myocardial cells are permanently destroyed Caused by reduced blood flow in coronary artery due to embolus or thrombus Pharmacologic Therapy: - Thrombolytic - Analgesics - ACE inhibitors Emergency percutaneous transluminal coronary angioplasty

5. 5 Signs/Symptoms: 1. Chest pain, substernally with radiation to arm, neck, jaw, or back; and unrelieved by rest or nitrates. 2. Diaphoresis and cool, clammy, pale skin. 3. Nausea and vomiting. 4. Dyspnea. 5. Palpitations or syncope. 6. Restlessness and anxiety. 7. Tachycardia or bradycardia. 8. Decreased.

6. 6 Nursing Management: 1.Administer prescribed medications, morphine, nitrates, thrombolytic, anticoagulants; or stool softeners during rehabilitation. 2. Monitor ECG and cardiac enzymes( CPK,LDH) 3. Provide liquids or solid diet as tolerated (low sodium, low cholesterol, low fat) 4. Monitor and record vital signs. 5. Provide restful environment. 6. Psychological support. 7. Positioning.

7. 7 Congestive Heart Failure CHF is inability of the heart to pump adequate amount of blood to all vital organs. The incidence increases with aging. CHF Classification: Left- sided (or left ventricular) Right- sided (or right ventricular)

8. 8 Left-Sided Heart Failure Signs/Symptoms: 1. Dyspnea upon exertion, paroxysmal nocturnal dyspnea or orthopnea. 2. Pale, cool extremities. 3. Decreased peripheral pulses. 4. Tachycardia. 5. Oliguria(<30 ml/hour) 6. Insomnia and restlessness.

9. 9 Right-Sided Heart Failure Signs/Symptoms: 1. Dependent pitting edema. 2. Jugular vein distention. 3. Hepatomegaly. 4. Ascites. 5. Weakness, anorexia, and nausea. 6. Weight gain.

10. 10 Nursing Management: 1. Administer prescribed medications, diuretics, digitalis, anticoagulants, vasodilators. 2. Check intake and output. 3. Weigh daily. 4. Provide a low- sodium diet. 5. Auscultate lung sounds. 6. Determine degree of JVD. 7. Assess dependent edema. 8. Monitor vital signs. 9. Administer oxygen as prescribed. 10 Psychological support.

11. 11 Peripheral Arterial Occlusive Disease Is a form of arteriosclerosis involving occlusion of arteries, most commonly in the lower extremities. It may be acute or chronic. Etiology: 1. Acute occlusion may result from trauma, thrombosis or embolism. 2. Chronic occlusion may be caused by: a. Atherosclerosis. b. Inflammation. c. Thrombosis. d. Trauma.

12. 12 1. Resting pain. 2. Paresthesia. 3. Intermittent claudication. 4. Paralysis. 5. Changes in skin and nails such as pale and cold dry skin; and decreased or absent hair growth; brittle and thickened nails. 6. Pulsenesness. Sign/Symptoms:

13. 13 1. Administer prescribed medications, such as vasodilators, anticoagulant, antilipemic, thrombolytic and antiplatelets. 2. Provide proper positioning as prescribed by the physician. 3. Instruct the patient to avoid wear elastic socks. 4. Teach the patient about the vasoconstrictive effect of nicotine and caffeine, emotional stress, and teach skin foot care. 5. Provide care for undergoing surgical procedure. Nursing Management:

14. 14 Venous Thrombus Types of Venous Thrombus: 1. Phlebitis is an inflammation in the wall of a vein. 2. Superficial thrombophlebitis is a condition in which a clot forms in a a vein secondary to phlebitis or because of partial obstruction of the vein. 3. Phlebothrombosis is the formation of a thrombus or thrombi in a vein. 4. Deep vein thrombosis (DVT) is thrombosis of deep rather than superficial veins.

15. 15 High Risk Factors: 1. Hypercoagulability associated with malignant disease blood dyscrasias. 2. Venous stasis-following operations, pregnancy, or bed rest for any prolonged illness. 3. Obesity, smoking, DM. Signs/Symptoms: 1. DVT characterized by calf pain, fever, chills, malaise and swelling and cyanosis of affected leg. 2. Superficial thrombophlebitis characterized by visible and palpable signs, such as heat, pain, swelling, tenderness along the length of the affected vein.

16. 16 Nursing Management: 1. Administer prescribed medications, anticoagulant, thrombolytic and analgesic therapy. 2. Provide bed rest with elevating legs to promote venous drainage reduce swelling. 3. Apply dry or moist warm compresses to promote circulation and reduce pain. 4. Instruct patient to wear elastic stocking, avoid sitting or standing for long period of time, and crossing legs. 5. Measure the calf circumference of the affected leg daily. 6. Encourage frequent changes of position. 7. Observe skin changes of lower limbs.

17. 17 Varicose Vein Bilateral dilatation and elongation of saphenous veins; deeper veins are normal. Predisposing Factors: 1. Hereditary weakness of vein wall or valves. 2. Prolonged standing. 3. pregnancy. 4. Obesity. 5. Advanced age- loss of vein wall elasticity.

18. 18 Signs/Symptoms: 1. Dilated, twisting, discolored vein of the legs. 2. Easy leg fatigue, cramps in leg, heavy feeling, increased, pain during menstruation, nocturnal muscle cramps. Nursing Management: 1. Administer analgesics as prescribed. 2. Maintain elastic stockings. 3. Elevate legs. 4. Instruct the patient to avoid prolonged standing, sitting or crossing legs to prevent obstruction. 5.Discuss the importance of losing weight if the patient is obese. 6.Provide care for undergoing surgical procedure.

19. 19 Hypertension Hypertension is intermittent or sustained elevation in systolic or diastolic blood pressure. There are two major types, primary (essential) hypertension and secondary hypertension. More than 90% of these cases are primary, and about 10% are secondary. Etiology: 1. Primary hypertension. a. Non modifiable risk factors. - Family history. - Gender. Men ? women. - Age. - Race.

20. 20 b. Modifiable risk factors. - Stress. - Obesity. - High dietary intake of sodium or saturated fats. - Excessive caffeine, alcohol, or cigarette smoking. - Oral contraceptives use. 2. Secondary hypertension. - Renal vascular diseases. - Coarctation of aorta. - Primary hyperaldosteronism. - Hyperthyroidism. - Medications, such as estrogen, antidepressants, NSAIDs, steroids.

21. 21 Signs/Symptoms: 1.Usually asymptomatic. 2. May cause headache, dizziness, blurred vision. Nursing Management: 1. Administer medications as prescribed, such as diuretics, antihypertensive…etc 2. Provide patient and family teaching. - Advise the patient to reduce weight. - Instruct the patient to restrict sodium alcohol and caffeine intake.

22. 22 - Smoking cessation. - Discuss the importance of regular blood pressure monitoring. - Discuss the importance of lifelong medical follow up examination.