hesi cardio medsurg

CARDIOVASCULAR SYSTEM

Relationship of Kidneys to the Cardiovascular System

  • Kidneys filter about 1 L of blood per minute. If cardiac output is decreased, the amount of blood going through the kidneys is also decreased, resulting in decreased urinary output. This decrease in urinary output may indicate cardiac problems.

  • Minimal Adequate Blood Supply: The kidneys are considered to provide a minimally adequate blood supply to perfuse vital organs when urine output is 0.5 mL/kg of body weight or averages 30 mL/h.

Angina

Description

  • Angina: Chest discomfort or pain occurs when myocardial oxygen demands exceed oxygen supply.

Common Causes

  1. Atherosclerotic heart disease

  2. Hypertension

  3. Coronary artery spasm

  4. Hypertrophic cardiomyopathy

  5. Activities increasing heart's oxygen demand (physical exertion, cold temperatures)

Nursing Assessment
Pain

  1. Characteristics: Pain can be mild to severe, described as heavy, squeezing, pressing, burning, choking, aching, and accompanied by apprehension.

  2. Location: Typically substernal, radiating to the left arm, shoulder, jaw, right shoulder.

  3. Duration: Might be transient or prolonged, with gradual or sudden onset; often short duration.

  4. Precipitating Factors: Commonly precipitated by exercise, cold weather, heavy meals, mental stress, or sexual activity.

  5. Relief: Pain is often relieved by rest or nitroglycerin.

Other Symptoms

  • Dyspnea, tachycardia, palpitations

  • Nausea and vomiting

  • Fatigue

  • Diaphoresis, pallor, weakness

  • Syncope

  • Dysrhythmias

Diagnostic Information

  1. ECG: Typically at client baseline unless taken during an anginal attack, may show ST-segment depression and T-wave inversion.

  2. Exercise Stress Test: Shows ST-segment depression and hypotension.

  3. Stress Echocardiogram: Assesses changes in wall motion, particularly indicated for women.

  4. Coronary Angiogram: Detects coronary artery spasms.

  5. Cardiac Catheterization: Identifies arterial blockage.

Risk Factors
Nonmodifiable

  1. Heredity

  2. Gender: males at higher risk than females until menopause, at which point the risk is equalized.

  3. Ethnic background: African American higher risk.

  4. Age.

Modifiable

  1. Hyperlipidemia:

    • Total serum cholesterol above 300 mg/dL correlates with four times the risk for developing coronary artery disease (CAD) compared to levels under 200 mg/dL (desirable).

    • Low-density lipoprotein (LDL) ("bad cholesterol"): desirable <100 mg/dL.

    • High-density lipoprotein (HDL) ("good cholesterol"): inversely related to CAD risk; desirable >60 mg/dL.

  2. Hypertension

  3. Cigarette smoking

  4. Obesity

  5. Physical inactivity

  6. Metabolic syndrome

  7. Stress

  8. Elevated homocysteine levels

  9. Substance abuse

Nursing Plans and Interventions

  1. Medication Monitoring: Monitor medications and instruct clients in proper administration.

  2. Lifestyle Adjustments: Determine factors precipitating pain and assist clients and families in lifestyle adjustments to reduce these factors.

  3. Risk Factors Education: Teach clients about risk factors and help them identify their own.

  4. During an Attack:

    • Provide immediate rest.

    • Take vital signs; record an ECG.

  5. Medical Interventions:

    • Percutaneous Transluminal Coronary Angioplasty (PTCA): A balloon catheter is inflated to split or fracture