week 6

Perfusion

  • Definition: The process by which blood is delivered to tissues and returned to the heart in the cardiovascular system. Effective perfusion ensures that oxygen and nutrients are supplied to organs and tissues while removing waste products, thereby maintaining cellular function and health.

Cardiovascular System

  • Overview: The cardiovascular system comprises the heart, blood vessels, and blood, functioning to transport nutrients, gases, hormones, and waste products throughout the body.

  • Critical Conditions: Key disorders include:

    • Hypertension: Chronically high blood pressure leading to various complications.

    • Coronary Artery Disease (CAD): Reduced blood flow to the heart muscle due to the narrowing or blockage of coronary arteries.

    • Acute Coronary Syndromes (ACS): A range of conditions associated with sudden reduced blood flow to the heart, such as unstable angina and myocardial infarction.

    • Vascular Disorders: Conditions affecting the blood vessels, which may include peripheral artery disease (PAD), aneurysms, and varicose veins.

Assessment of the Cardiovascular System

Subjective Data:

  • HPI

    • Fully explore all symptoms

  • Past Health History

    • CP, SOB, fatigue, anemia, palpitations, dizzy, syncope, HTN, edema, throat infections

  • Meds

    • Many non- cardiac drugs can adversely affect the cardiovascular system

  • Drug Class

    Cardiovascular Effects

    Anti-Cancer Agents

    (“chemo”)

    Dysrhythmias

    Cardiomyopathy

    Antipsychotics

    Dysrhythmias

    Orthostatic Hypotension

    Corticosteroids

    Hypotension

    Edema

    Potassium Depletion

    Hormone Therapy,

    Oral Contraceptives

    Myocardial Infarction

    Thromboembolism

    Stroke

    Hypertension

    NSAIDs

    Myocardial Infarction

    Stroke

    Hypertension

    Heart Failure

    Psychostimulants

    (cocaine, amphetamines)

    Tachycardia

    Angina

    Myocardial Infarction

    Dysrhythmias

    Hypertension

  • Subjective Data (cont)

    • §Presence of major cardiovascular risk factors?

      • Abnormal serum lipids, HTN, sedentary lifestyle, diabetes, obesity, tobacco use

      §Family history of cardiovascular disease?

      • CAD, HTN, diabetes, atherosclerosis can run in families

      §Problems with sleep?

      • SOB or Cheyne-Stokes respirations can mean heart failure

      • Orthopnea

      • Sleep apnea can lead to life-threatening dysrhythmias

      Objective Data: Perform systematic assessments including:

    • Monitoring vital signs (heart rate, blood pressure, respiratory rate).

    • Assessing jugular venous distension to reflect right heart function.

    • Checking for edema, indicating fluid retention and possible heart failure.

    • Performing pulse palpation to evaluate circulation adequacy in extremities.

Risk Factors for Cardiovascular Disease

  • Major Risk Factors:

    • Abnormal Serum Lipids: High levels of LDL cholesterol and low levels of HDL cholesterol increase the risk of atherosclerosis.

    • Hypertension: High blood pressure inflicts extra strain on heart and blood vessels.

    • Sedentary Lifestyle: Lack of physical activity increases the risk of weight gain, hypertension, and diabetes.

    • Diabetes: Poor blood sugar management is associated with an increased risk of cardiovascular complications.

    • Obesity: Excess body weight contributes to high blood pressure and abnormal cholesterol levels.

    • Tobacco Use: Smoking damages blood vessels and promotes atherosclerosis.

  • Family History: A history of cardiovascular disease in family members is a significant predictor for an individual’s risk.

Diagnostic Studies

  • Cardiac Biomarkers: Important indicators for cardiac injury include:

    • Troponin: Help diagnose myocardial infarction when elevated.

    • CK-MB: Enzyme that indicates muscle damage, particularly cardiac muscle.

    • CRP (C-reactive protein): Marker for inflammation that can suggest risk for heart disease.

  • Imaging: Includes:

    • Chest X-ray: Assesses heart size and fluid around the lungs.

    • ECG (Electrocardiogram): Measures electrical activity and can identify arrhythmias and ischemic changes.

    • Exercise Testing: Evaluates cardiovascular response to physical stress, useful in diagnosing CAD.

Hypertension

  • Definitions: High blood pressure is classified as systolic readings ≥130 mmHg or diastolic readings ≥80 mmHg. Causes may include genetics, lifestyle, and comorbidities.

  • Clinical Manifestations: Symptoms can include severe headache, confusion, vision disturbances, and dyspnea. Often referred to as the “silent killer” due to lack of early symptoms.

  • Nursing Management:

    • Administration of IV antihypertensive medications during hypertensive crises.

    • Rigorous monitoring of vital signs and patient responses.

    • Patient education emphasizing adherence to medication regimens and lifestyle modifications.

Coronary Artery Disease (CAD)

  • Overview: CAD is the leading cause of death worldwide, primarily due to atherosclerosis, where fatty deposits, or plaques, accumulate in the coronary arteries, leading to reduced blood flow.

  • Risk Factors:

    • Non-modifiable Risk Factors: Age, gender, and family history.

    • Modifiable Risk Factors: Sedentary lifestyle, obesity, smoking, and poor diet.

  • Angina Types:

    • Chronic Stable Angina: Predictable pattern triggered by exertion or stress.

    • Prinzmetal's Angina: Caused by coronary artery spasm, often occurring at rest.

    • Unstable Angina: Sudden change in pattern, may occur unpredictably at rest, indicating an urgent medical condition.

Acute Coronary Syndrome (ACS)

  • Definitions and Key Symptoms: ACS is a spectrum of conditions indicative of acute myocardial ischemia. Symptoms include chest pain, sweating, nausea, and shortness of breath, necessitating rapid intervention.

  • Nursing Management:

    • Pain management utilizing nitroglycerin and opioids as prescribed.

    • Close vital sign monitoring to detect changes indicating deteriorating condition.

    • Patient education on recognizing symptoms and seeking prompt medical help.

Peripheral Artery Disease (PAD)

  • Characteristics: Characterized by atherosclerosis in peripheral arteries, causing reduced blood flow and symptoms like intermittent claudication (pain in limbs during activity).

  • Nursing Management:

    • Strategies for smoking cessation to improve vascular health.

    • Optimization of lipid levels through dietary changes and medications.

    • Comprehensive foot care education to prevent ulcers and infections in affected limbs.