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Cardiovascular Challenges

Cardiovascular Challenges. NURS 2016 Chapters: 27-32. CV Challenges. Hypertension Coronary Vascular disorders Congestive Heart Failure. Diet and Blood Cholesterol. Factors include: cholesterol, total and type of fat, dietary fibre and energy ¾ of cholesterol is manufactured in liver

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Cardiovascular Challenges

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  1. Cardiovascular Challenges NURS 2016 Chapters: 27-32

  2. CV Challenges • Hypertension • Coronary Vascular disorders • Congestive Heart Failure

  3. Diet and Blood Cholesterol • Factors include: cholesterol, total and type of fat, dietary fibre and energy • ¾ of cholesterol is manufactured in liver • 2/3 population: liver manufactures fluctuate with dietary intake • 1/3 population: liver production does not accommodate dietary intake

  4. Factors affecting Heart Disease • Cholesteral • LDL • HDL • Triglycerides • Goal : Low LDL values, High HDL values • Triglycerides <200mg/dL • Low cholesteral

  5. Hypertension • BP > 140/90mmHg over a sustained period • Approximately 20% adult population in Canada • Primary hypertension • Secondary hypertension

  6. Hypertension • Sign • Risk • Disease

  7. Complications of Hypertension • Left ventricular hypertrophy • Myocardial infarction • Heart failure • Transient Ischemic Attacks or Cerebral Vascular Accident • Renal insufficiency • Retinal hemorrhage

  8. Nursing Assessment • Angina • Shortness of breath • Alterations in speech, vision, or balance • Headaches • Dizziness • Nocturia • Monitor BP • Monitor for symptoms-target organ damage • Pt. knowledge deficit

  9. Goal • Decrease BP to normal range without causing adverse affects or undo cost

  10. Nursing Intervention/Action Teaching/Learning • Lifestyle • Medication regime

  11. Lifestyle • Increase aerobic activity • Obtain and maintain optimal body weight • Discontinue smoking • Decrease intake of saturated fats & cholesterol • Limit intake of alcohol

  12. Lifestyle • Electrolytes • Na+: RNI 500-2400mg (1/4 tsp salt) • K+: RNI 2000mg • Ca+: RNI 800mg • Mg+: RNI 200mg

  13. Medication Regime • Monotherapy is best • Minimal/simple • Approximately 50% of individuals discontinue medication within one year • Encourage regular monitoring (self or other)

  14. Non-modifiable Family hx of CAD Increasing age Gender Race Modifiable High serum cholesterol Cigarette smoking Hypertension DM Low estrogen Inactivity & obesity Stress Coronary Vascular DisordersRisk Factors

  15. Angina • Episodes of pain or pressure in the anterior chest • Insufficient coronary blood resulting in inadequate supply of O2 • Can be induced by • exertion, exposure to cold, eating a heavy meal, stress, emotional situation (inc. myocardial work)

  16. Angina • Pain: • indigestion (choking, heavy sensation) • severe apprehension (impending death) • retrosternal (deep in chest) • poorly localized (neck, arm) • tightness (strangling) • SOB • vomiting

  17. Types of Angina • Stable • Unstable • Intractable or Refractory • Variant • Silent

  18. Goal:  demand  supply Treatment Approaches Pharmacological Surgical Angina

  19. Pharmacological • Nitroglycerin • Beta-adrenergic blocking agents • Calcium channel blocking agents • Antiplatelet and anticoagulant medications • Oxygen (2-4 L/m via nasal cannula) • controversial

  20. Nursing DxAngina • Altered myocardial tissue perfusion secondary to CAD, as evidenced by chest pain. • Anxiety related to fear of death. • Learning need related to underlying disease. • Teaching/learning opportunity related to therapeutic regime.

  21. Goals • Immediate and appropriate txmt & avoidance of complications • Decreased anxiety • Increase awareness of disease process • Understanding of prescribed care, adherence to self-care program

  22. Nursing InterventionPain • Immediate action required • Patient to D/C all activity • Sit or recline in semi-fowler’s position • Assess pain and vital sign & O2 saturation • Administer nitroglycerin (if ordered), repeat x 3 if needed • Administer oxygen • ECG

  23. Surgical Intervention • PercutaneousTransluminal Coronary Angioplasty (PTCA) • Coronary Artery Stent • Coronary Artery Bypass Graft

  24. Neurologic status Cardiac status Respiratory status Peripheral vascular status Fluid & electrolyte status Pain Nursing CarePost Cardiac Surgery

  25. Nursing InterventionsPost Cardiac Surgery • Restoring Cardiac output • Promoting Adequate Gas Exchange • Maintaining Fld & Elect. Balance • Reducing symptoms of Sensory Overload • Relieving Pain • Maintaining Adequate Tissue Perfusion • Maintaining Adequate Renal Perfusion • Maintaining Adequate Body Temperature

  26. Myocardial Infarction Areas of myocardial cells are permanently destroyed • Chest pain not relieved with antianginals or rest • Dx based on hx, ECG and lab results

  27. Creatine Kinase (CK-MB) Increased within 1hr and peaks at 24h Lactic Dehydrogenase Peaks at 2-3 days Myoglobin Negative results may indicate no MI Troponin An elevated serum level indicates an MI Diagnostic Lab TestsMI

  28. Thrombolytic Therapy • Used to dissolve or lyse the thrombus in a coronary artery • ‘Door to needle’ time: quicker the better • 3 hours • Streptokinase • TPa • Retavase

  29. Health Promotion • Nutrition • Activity • Symptom recognition and management • NCP for MI

  30. Nursing Care Plan Uncomplicated for MI • Ineffective cardiopulmonary perfusion • Potential of effective air exchange • Risk for inadequate tissue perfussion • Anxiety • Knowledge deficit

  31. Congestive Heart Failure • Occurs when the contractility of the heart is reduced & the ventricle is unable to pump as much blood out during systole as comes in during diastole • Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

  32. Left Sided Most common Blood backs up into pulmonary veins Forces fluid shift leading to pulmonary congestion and edema Right Sided Blood backs up into venous circulation Peripheral edema, hepato/splenomegaly,jugular distention Sidedness

  33. Planning & Goals • Manage fluid overload • Decrease peripheral edema • Decrease shortness of breath • Increase activity tolerance • Knowledge of treatment regime and self-care • Decreasing incidence of anxiety • Able to verbalize ability to make decisions/ influence outcomes

  34. Promoting Activity Tolerance 20-30 minute physical activity daily • Warm up activity (3 minutes) • Avoid temperature extremes • Ensure ability to talk during activity • Wait 2 hours pc prior to activity • Stop activity if pain, SOB or dizzy • Cool down activity (3 minutes)

  35. Managing Fluid Overload: Low Sodium Diet • 500-1500mg sodium per day • Most sodium is added in processing of food • Review the hand out on Sodium content • For fun, calculate your daily sodium intake

  36. Other Nsg Interventions • Control anxiety • Teach self care • Auscultate lung fields • Monitor I & O • Wt pts • Semi-high fowlers • Skin integrity/pos chgs • Elastic stockings/leg exercises

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