husni rousan1 cardio vascular system cardio vascular system

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Husni Rousan3 THE HEART Anatomy and Physiology Pericardium consists of Veseral, parital pericardium layers and space in between, pericardium space is filled with 30 ml of lubricating fluid

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Husni Rousan1 CARDIO VASCULAR SYSTEM CARDIO VASCULAR SYSTEM Husni Rousan2 THE HEART Anatomy and Physiology THE HEART Anatomy and Physiology The heart compose of three layers Endocardium: the inner layer of endothelial tissue Myocardium: the middle layer of the muscle fiber responsible for pumping action Epicardium: the outer layer it is encased in a thin fibrous sac epicardium Husni Rousan3 THE HEART Anatomy and Physiology Pericardium consists of Veseral, parital pericardium layers and space in between, pericardium space is filled with 30 ml of lubricating fluid Husni Rousan4 Heart Champers Heart Champers Right heart consists of Rt atrium, Rt ventricle, distribute deoxygenated blood Left heart consists of Lt atrium, Lt ventricle, distribute oxygenated blood Varying thickness of a trial and ventricular wall and left and right ventricles related to work load Husni Rousan5 Heart Champers HEART VALVES : Atrioventricular, separate atria from ventricles Semilunar valves ( three half-moon leaflet Husni Rousan6 Coronary Arteries Coronary Arteries The heart has large metabolic requirement, % of delivered oxygen Coronary arteries are perfused during diastole Left coronary artery branches ( LAD & LCX ) Right coronary artery branch ( RCA ) Posterior wall received blood by ( PDCA ) Husni Rousan7 CONDUCTING SYSTEM CONDUCTING SYSTEM cardiac electrical cell is characterized by Atomicity: ability to initiate electrical impulses Exitability: ability to respond to impulses Conductivity: ability to transmit impulses ( SA AV bundle of his bundle branch ) Husni Rousan8 CONDUCTING SYSTEM Physiology of cardiac conduction Electrical activity (ions move across cell membrane) Polarization, Depolarization, electromechanical coupling and repolarization Husni Rousan9 cont Cardiac homodynamic Cardiac cycle ( flow of blood ) Cardiac output ( ejection of blood ) = stroke volume x heart rate Heart Rate: affected by central nervous system and baroreceptors Husni Rousan10 cont. cont. STROKE VOLUME : the amount of blood ejected by Lt ventricle in each beat which is 70 ml determined by preload, after load and contractility EJECTION FRACTION: 42% for right heart and 50% for the left heart Husni Rousan11 ASSESSMENT ASSESSMENT The extent of assessment is determined by: Purpose of nursing assessment Severity of pt s condition Practice setting of the nurse Husni Rousan12 ASSESSMENT Health history and clinical manifestations Acute symptoms: current medication, allergies, general appearance, homodynamic status Stable patients: complete history, spouse or partner, demographic information Husni Rousan13 ASSESSMENT Cardiac symptoms: pt will have one of the following Shortness of breath, dizziness, syncope, loss of consciousness, edema and weight gain, fatigue, palpitation and chest discomfort Husni Rousan14 NURSING DIAGNOSIS NURSING DIAGNOSIS Decrease cardiac output related to structural disorders Activity intolerance related to decrease cardiac output or excessive fluid volume Anxiety related to change in health status and change in role function COLLABRATIVE PROBLEMS Congestive heart failure, ventricular dysrhythmias, and atrial dysrhythmias Husni Rousan15 PLANNING AND GOALS PLANNING AND GOALS Improve and maintain cardiac output Increase activity tolerance Reduction of anxiety Absence of complications Husni Rousan16 NURSING IMPLEMENTATION NURSING IMPLEMENTATION Encourage rest, leaning back in a chair Oxygen through nasal prongs Careful monitoring to correlate intervention with patient s response to adjust treatment plan Decrease sodium diet intake Change position frequently Husni Rousan17 PHYSICAL ASSESSMENT PHYSICAL ASSESSMENT Performed to confirm the data in health history It should include the following Effectiveness of heart as a pump, filling volume and pressure, cardiac output, compensatory mechanisms Husni Rousan18 PHYSICAL ASSESSMENT General appearance Level of consciousness, thought process, heart ability to perfuse brain tissue, distress and anxiety Husni Rousan19 PHYSICAL ASSESSMENT Skin Pallor around finger nails and lips, peripheral cyanosis, central cyanosis, xenthelasma ( yellowish indicates high cholestrol), reduce skin turgor, bruice ( anti coogulants ) Blood pressure Normal is 120/80 mmhg ( 100/60 140/90 ) invasive and non invasive Husni Rousan20 Pulse pressure: Difference between systolic and diastolic, mmhg, reflects strock volume & ejection velocity, vascular resistance, Less than 30 mmhg = serious reduction in output Husni Rousan21 PHYSICAL ASSESSMENT Postural hypotension Orthostatic hypotension, may indicates low intravascular volume, inadequate vaso constrictor mechanism or autonomic insufficiency Arterial pressure Rate, rhythm, quality, volume, configration ( contor) Husni Rousan22 PHYSICAL ASSESSMENT Jugular venous pressure Reflects Rt heart function, provide estimation of CVP, increase incase of HF decrease in FVD Heart Inspection, palpation, percussion, auscultation, S1 S2 Husni Rousan23 PHYSICAL ASSESSMENT Inspection of Extremities Capillary refill time (CHF, hypertension ), hematoma (surgery & cath ), vascular changes, peripheral edema, lower extremeties ulcer Lungs Tachypnea ( HF, pain, anxiety ), chynestokes breathing ( pulmonary edema ), dry cough, crackles and whezes Husni Rousan24 PHYSICAL ASSESSMENT Abdomen Hepato jugular reflux, bladder distention RISK FACTORS Nonmodifiable: age, positive family history, race &gender Modifiable: hyperglycemia, hyperlipidemia, hypertension, inactivity, smoking, obesity & type A personality Husni Rousan25 DIAGNOSTIC EVALUATION DIAGNOSTIC EVALUATION Laboratory tests Cardiac enzymes Released from injured cells when ruptured the membrane Most of them are not specific for one type of cell Iso enzymes are more specific, createnine kinase ( CK ) and its iso enzyme( CK-MB ), lactic dehydrogenase (LDH), troponin I Husni Rousan26 DIAGNOSTIC EVALUATION Blood chemistry Lipid profile A- cholesterol (less than 200 mg / dl ), required for hormonal synthesis, found mainly in brain tissue and liver B- triglycerides ( 40 150 mg / dl ) source of energy, cell wall, store in a dipose tissue Husni Rousan27 DIAGNOSTIC EVALUATION C- LDL ( less than 130 mg / dl ) transport cholesterol from blood to peripheral tissues, synthesized from VLDL D- HDL ( 35 65 mg / dl M, 35 85 mg / dl F ) transport cholesterol from peripheral tissues to the liver, cardio protective effect, increase with exercise and decrease with smoking DM and obesity Husni Rousan28 Serum electrolytes K, Na, Ca and other electrolytes can reflect the heart function as well as fluid & electrolyte disturbances BUN May indicates impaired renal function and impaired cardiac output Husni Rousan29 DIAGNOSTIC EVALUATION Coagulation studies Partial Thromboplastine Time ( PTT ) 25 40 sec, used to regulate heparin dosage, 1.5 2.5 is the theraputic range Prothrombin Time ( PT ) less than 13 sec, used to regulate warfarin, 1.5 2.5 times of PT is the theraputic range International Normalized Ratio ( INR ) standarized method for reporting PT level, used for regulating warfarin dosage Husni Rousan30 Chest X-Ray ( CXR ) Assess size, position of the heart, cardiothoracic ratio ( CTR ), position of central lines Electrocardiography ( ECG ) Can be either on bed side or from a distance, 12 leads ECG, continuous monitoring, telemetry monitoring 2 or 3 leads monitoring ) Husni Rousan31 DIAGNOSTIC EVALUATION Cardiac Stress Test During time of increased demand, abnormalities in cardiovascular functions are more likely to be detected, used to evaluate the heart function, coronary arteries as well as the cause of chest pain Husni Rousan32 Con. Exercise stress test: pt walk on a treadmill or pedals (stationary bicycle), the goal is to increase HR and monitored for ECH changes, arrhythmias, hypotension, pain, dyspnea and dizziness. Pt fast 4 hours before test, nurse needs to instruct pt about the test Husni Rousan33 DIAGNOSTIC EVALUATION Echocardiography: a non invasive ultrasound used to examine size shape and cardiac motion, used also to evaluate heart function, valves and peripheral effusion Pharmacologic stress test: used for pts unable to achieve target HR, Dipyridamole, Adenosine & dobutamine are used for this purpose Husni Rousan34 Cardiac catheterization Invasive diagnostic procedure involves introduction of specific catheter into Rt & Lt side blood vessels under fluoroscopy. Its used to evaluate coronary arteries patency, heart function as a pump, vascular system and heart structure Its considered as a highly critical procedure Take in consideration: monitoring IV line, BP, ECG, LOC, well prepared staff to provide ACLS, revission of lab tests Husni Rousan35 CORONARY VASCULAR DISORDERS CORONARY VASCULAR DISORDERS Husni Rousan36 ATHEROSCLEROSIS Definition: abnormal accumulation of lipid or fatty substances and fibrous tissues in vessel wall Pathophysiology It begins as a fatty streak, this streak develop into advanced lesion which involves inflammatory response, T.lymphocytes and monocytes ingest the lipid and form fibrous cap called Atheroma Plaque, this protrude into the lumen of the vessel narrowing and obstruct it Husni Rousan37 ATHEROSCLEROSIS Clinical manifestations Acute onset chest pain, ECG changes, dyarhythmias & death Risk factors Age, family history of non modifiable risk factors, high cholestrol, cigarette smoking, hypertension & DM Husni Rousan38 PREVENTION Control cholestrol level, LDL less than normal Dietary control decrease fat & increase fiber Medication to decrease serum fat & cholesterol Quit smoking Early detection & control hypertension Control DM Gender & estrogen level Behavior pattern Husni Rousan39 ANGINA PECTORIS ANGINA PECTORIS Definition: it s a clinical syndrome ch.ch by episodes of pain or pressure in the anterior chest Pathophysiology Caused by atherosclerotic disease, associated with significant obstruction of CA