NURSING OF ADULTS WITH MEDICAL & SURGICAL CONDITIONS

1. NURSING OF ADULTSWITHMEDICAL & SURGICAL CONDITIONS Diseases and Disorders of the Heart

2. Angina Pectoris • Etiology/Pathophysiology • Cardiac muscle is deprived of oxygen • Ischemia • Increased workload on the heart • Exposure to cold • Exercise • Unusually heavy meals • Emotional stress • Other strenuous activity

3. Angina Pectoris • Signs & Symptoms • Pain (usually relieved by rest) • heaviness or tightness in chest • usually substernal or retrosternal • may radiate • Dyspnea • Anxiety • Apprehension • Diaphoresis • Nausea

4. Ischemic Myocardial Pain

5. Angina Pectoris • Treatment • Correct cardiovascular risk factors • Avoid precipitating factors • Medications • dilate coronary arteries and decrease workload of heart • Nitroglycerin • give SL, repeat q 5 min, up to three times • Beta adrenergic blocking agents • Inderal, Corgard, Lopressor • Calcium channel blockers • Procardia, Cardizem, Calan, Isoptin

6. Angina Pectoris • Surgical Interventions • Coronary Artery Bypass Graft (CABG) • Saphenous vein used to bypass occluded arteries • Percutaneous Transluminal Coronary Angioplasty (PTCA) • Cardiac catheterization is done and a balloon inflated in narrowed artery • Stent Placement • Expandable, meshlike structures designed • to maintain vessel patency

7. Coronary Artery Bypass Graft

8. PTCA & Stent

9. Myocardial Infarction • Etiology/Pathophyisiolgy • Occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium • Most common cause is atherosclerosis • Ability of the cardiac muscle to contract and pump blood is impaired

10. Common Locations of MI

11. Myocardial Infarction • Signs & Symptoms • Asymptomatic (silent MI) • Similar to Angina Pectoris, but are more severe and last longer • Pain (not relieved by rest, position, or nitroglycerine) • Nausea • SOB • Dizziness • Weakness • Diaphoresis • Pallor - ashen color • Sense of impending doom

12. Myocardial Infarction • Treatment • Oxygen • Fibrinolytic agents • Streptokinase • Tissue plasma activator (TPA) • Percutaneous Transluminal Coronary Angioplasty (PTCA) • Coronary Artery Bypass Graft surgery • Medications

13. Myocardial Infarction

14. Congestive Heart Failure • Etiology/Pathophysiology • Abnormal condition characterized by circulatory congestion as a result of the heart’s inability to act as an effective pump. • Left ventricular failure • Most common • Right ventricular failure • Usually caused by left ventricular failure

15. Congestive Heart Failure • Signs & Symptoms • Decreased cardiac output • fatigue • angina • anxiety • oliguria • decreased GI motility • pale, cool skin • weight gain • restlessness

16. Congestive Heart Failure • Left Ventricular Failure • Pulmonary congestion • dyspnea • paroxysmal nocturnal dyspnea • cough • frothy, blood-tinged sputum • orthopnea • pulmonary crackles • pleural effusion (x-ray)

17. Congestive Heart Failure • Right Ventricular Failure • Distended jugular veins • Anorexia, nausea, and abdominal distention • Liver enlargement • Ascites • Edema in feet, ankles, sacrum; may progress up the legs into thighs, external genitalia, and lower trunk

18. Congestive Heart Failure • Treatment • Increase cardiac efficiency • Digitalis • Vasodilators • nitroglycerin • ACE inhibitors (decrease B/P) • Capoten, Vasotec, Altace, Lotnesin, Prinivil, Zestril, Accupril Monopril • Lower oxygen requirements • Bedrest, HOB elevated • Oxygen

19. Congestive Heart Failure • Treat edema and pulmonary congestion • diuretics • sodium restricted diet • restriction of fluids • Monitor fluid retention • weigh daily • strict I&O

20. Pulmonary Edema • Etiology/Pathophysiology • Accumulation of fluid in lung tissues and alveoli • Complication of CHF

21. Pulmonary Edema • Signs & Symptoms • Restlessness • Agitation • Disorientation • Diaphoresis • Dyspnea & Tachypnea • Tachycardia • Pallor or cyanosis • Cough - large amounts of blood-tinged, frothy sputum • Wheezing, crackles • Cold extremities

22. Pulmonary Edema • Treatment • High Fowler’s or Orthop. postion • Morphine sulfate • Oxygen • Nitroglycerin • Diuretics • Lasix, Bumex • Inotropic agents (increase myocard. Contraction & periph. dilation) • Dobutrex, Inocor • Vasodilators • Nitropress

23. Valvular Heart Disease • Etiology/Pathophysiology • Heart valves are compromised and do not open and close properly • Stenosis • thickening of the valve tissue, causing the balve to become narrow • Insufficiency • valve is unable to close completely • Congenital • Rheumatic fever

24. Valvular Heart Disease • Signs & Symptoms • Fatigue • Angina • Oliguria • Pale, cool skin • Weight gain • Restlessness • Abnormal breath sounds • Edema

25. Valvular Heart Disease • Treatment • Restrict activities • Sodium restricted diet • Diuretics • Digoxin • Antidysrhythmics • Pronestyl, Quinidine, Lidocaine, Norpace • Surgery • Open mitral commissurotomy • splitting of the fused valve • Valve replacement • valve replaced with a bioprosthetic or mechanical valve

26. Rheumatic Heart Disease • Etiology/Pathophysiology • Rheumatic Fever • inflammatory disease which is a delayed childhood reaction to inadequately treated childhood upper resp. tract infection of Beta hemolytic streptococci • causes scar tissue in the heart

27. Rheumatic Heart Disease • Signs & Symptoms • Elevated temperature • Elevated heart rate • Epistaxis • Anemia • Joint pain and stiffness • Nodules on the joints • Specific to valve affected • Heart murmur

28. Rheumatic Heart Disease • Treatment • Prevention • Treat infections rapidly and completely • Penicillin • Bedrest • NSAID’s • Application of heat • Well-balanced diet (supplement with Vit. B & C) • Encourage fluids • Commissurotomy or valve replacement

29. Pericarditis • Etiology/Pathophysiology • Inflammation of the membranous sac surrounding the heart • May be acute or chronic • Bacterial, viral, or fungal • Noninfectious conditions • azotemia, MI, neoplasms, scleroderma, trauma, SLE, radiation, drugs

30. Pericarditis • Signs & Symptoms • Debilitating pain • aggravated by lying supine, deep breathing, coughing, swallowing and moving the trunk • Dyspnea • Fever • Chills • Diaphoresis • Leukocytosis • Pericardial friction rub • Pericardial effusion (x-ray)

31. Pericarditis • Treatment • Analgesia • morphine, Demerol • Oxygen • IV fluids • Salicylates • Antibiotics • Antiinflammatory agents • Indocin • Corticosteroids • Surgery • Pericardial window, pericardial tap

32. Endocarditis • Etiology/pathophysiolgy • Infection or inflammation of the inner membranous lining of the heart • Risk factors • rheumatic heart disease • CHF • Degenerative heart disease • Invasive procedures • “mainline” drug users

33. Endocarditis • Signs & Symptoms • Influenza-like symptoms • Fever • Fatigue • Chest pain • Headaches • Joint pain • Chills • Petechiae in the conjunctiva, mouth, and legs • Anemia • Splinter hemorrhages under nails • Weight loss • Heart murmur

34. Endocarditis • Treatment • Bedrest • Antibiotics • IV 1-2 months • Prophylactic antibiotics for “high risk” patients • Surgical repair of diseased valves or valve replacement

35. Myocarditis • Etiology/Pathophysiology • Inflammation of the myocardium • Rheumatic heart disease • Viral, bacterial, or fungal infection • Endocarditis • Pericarditis

36. Myocarditis • Signs & Symptoms • Vary according to site of infection • Cardiac enlargement • Murmur • Gallop • Tachycardia

37. Myocarditis • Treatment • Bedrest • Oxygen • Antibiotics • Antiinflammatory agents • Assessment and correction of dysrhythmias

38. Cardiomyopathy • Etiology/Pathophysiology • A group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium • Not associated with CAD, hypertension, vascular disease, or pulmonary disease • Primary - unknown cause • Secondary - Infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis

39. Cardiomyopathy • Signs & Symptoms • Angina • Syncope • Fatigue • Dyspnea on exertion • Severe exercise intolerance • S/S of left and right-sided CHF • dyspnea, peripheral edema, ascites, hepatic dysfunction

40. Cardiomyopathy • Treatment • Treat underlying cause • Diuretics • ACE inhibitors • Beta-adrenergic blocking agents • Internal defibrillator • Cardiac transplant