Upload
briana-snow
View
218
Download
0
Tags:
Embed Size (px)
Citation preview
Cardiovascular Cardiovascular ChallengesChallenges
NURS 2016NURS 2016
Chapters: 27-32Chapters: 27-32
CV ChallengesCV Challenges
HypertensionHypertension
Coronary Vascular disordersCoronary Vascular disorders
Congestive Heart FailureCongestive Heart Failure
Diet and Blood CholesterolDiet and Blood Cholesterol
Factors include: cholesterol, total and Factors include: cholesterol, total and type of fat, dietary fibre and energytype of fat, dietary fibre and energy
¾ of cholesterol is manufactured in ¾ of cholesterol is manufactured in liverliver
2/3 population: liver manufactures 2/3 population: liver manufactures fluctuate with dietary intakefluctuate with dietary intake
1/3 population: liver production does 1/3 population: liver production does not accommodate dietary intakenot accommodate dietary intake
Factors affecting Heart DiseaseFactors affecting Heart Disease
CholesteralCholesteral LDLLDL HDLHDL TriglyceridesTriglycerides
Goal : Low LDL values, High HDL valuesGoal : Low LDL values, High HDL values Triglycerides <200mg/dLTriglycerides <200mg/dL Low cholesteralLow cholesteral
HypertensionHypertension
BP > 140/90mmHg over a sustained BP > 140/90mmHg over a sustained periodperiod
Approximately 20% adult population Approximately 20% adult population in Canadain Canada
Primary hypertensionPrimary hypertension Secondary hypertensionSecondary hypertension
Complications of HypertensionComplications of Hypertension
Left ventricular hypertrophyLeft ventricular hypertrophy Myocardial infarctionMyocardial infarction Heart failureHeart failure Transient Ischemic Attacks or Transient Ischemic Attacks or
Cerebral Vascular AccidentCerebral Vascular Accident Renal insufficiencyRenal insufficiency Retinal hemorrhageRetinal hemorrhage
Nursing AssessmentNursing Assessment AnginaAngina Shortness of breathShortness of breath Alterations in speech, vision, or balanceAlterations in speech, vision, or balance HeadachesHeadaches DizzinessDizziness NocturiaNocturia Monitor BPMonitor BP Monitor for symptoms-target organ Monitor for symptoms-target organ
damagedamage Pt. knowledge deficitPt. knowledge deficit
GoalGoal
Decrease BP to normal range without Decrease BP to normal range without causing adverse affects or undo costcausing adverse affects or undo cost
Nursing Intervention/ActionNursing Intervention/Action
Teaching/LearningTeaching/Learning
LifestyleLifestyle
Medication regimeMedication regime
LifestyleLifestyle
Increase aerobic activityIncrease aerobic activity Obtain and maintain optimal body Obtain and maintain optimal body
weightweight Discontinue smokingDiscontinue smoking Decrease intake of saturated fats & Decrease intake of saturated fats &
cholesterolcholesterol Limit intake of alcoholLimit intake of alcohol
LifestyleLifestyle
ElectrolytesElectrolytes Na+: Na+: RNIRNI 500-2400mg (1/4 tsp 500-2400mg (1/4 tsp
salt)salt) K+:K+: RNI RNI 2000mg2000mg Ca+:Ca+:RNIRNI 800mg800mg Mg+:Mg+: RNI 200mgRNI 200mg
Medication RegimeMedication Regime
Monotherapy is bestMonotherapy is best
Minimal/simpleMinimal/simple
Approximately 50% of individuals Approximately 50% of individuals discontinue medication within one yeardiscontinue medication within one year
Encourage regular monitoring (self or Encourage regular monitoring (self or other)other)
Coronary Vascular DisordersCoronary Vascular DisordersRisk FactorsRisk Factors
Non-modifiableNon-modifiable Family hx of CADFamily hx of CAD Increasing ageIncreasing age GenderGender RaceRace
ModifiableModifiable High serum High serum
cholesterolcholesterol Cigarette smokingCigarette smoking HypertensionHypertension DMDM Low estrogenLow estrogen Inactivity & obesityInactivity & obesity StressStress
AnginaAngina
Episodes of pain or pressure in the Episodes of pain or pressure in the anterior chestanterior chest
Insufficient coronary blood resulting Insufficient coronary blood resulting in inadequate supply of Oin inadequate supply of O22
Can be induced byCan be induced by exertion, exposure to cold, eating a exertion, exposure to cold, eating a
heavy meal, stress, emotional situation heavy meal, stress, emotional situation (inc. myocardial work)(inc. myocardial work)
AnginaAngina
Pain:Pain: indigestion (choking, heavy sensation)indigestion (choking, heavy sensation) severe apprehension (impending death)severe apprehension (impending death) retrosternal (deep in chest)retrosternal (deep in chest) poorly localized (neck, arm)poorly localized (neck, arm) tightness (strangling)tightness (strangling) SOBSOB vomitingvomiting
Types of AnginaTypes of Angina
StableStable UnstableUnstable Intractable or RefractoryIntractable or Refractory VariantVariant SilentSilent
AnginaAngina
Goal: Goal: demand demand
supplysupply
Treatment Treatment ApproachesApproaches
PharmacologicalPharmacological
SurgicalSurgical
Pharmacological Pharmacological
NitroglycerinNitroglycerin Beta-adrenergic blocking agentsBeta-adrenergic blocking agents Calcium channel blocking agentsCalcium channel blocking agents Antiplatelet and anticoagulant Antiplatelet and anticoagulant
medicationsmedications Oxygen (2-4 L/m via nasal cannula)Oxygen (2-4 L/m via nasal cannula)
controversialcontroversial
Nursing DxNursing DxAnginaAngina
Altered myocardial tissue perfusion Altered myocardial tissue perfusion secondary to CAD, as evidenced by secondary to CAD, as evidenced by chest pain.chest pain.
Anxiety related to fear of death.Anxiety related to fear of death. Learning need related to underlying Learning need related to underlying
disease. disease. Teaching/learning opportunity Teaching/learning opportunity
related to therapeutic regime.related to therapeutic regime.
GoalsGoals
Immediate and appropriate txmt & Immediate and appropriate txmt & avoidance of complicationsavoidance of complications
Decreased anxietyDecreased anxiety Increase awareness of disease Increase awareness of disease
processprocess Understanding of prescribed care, Understanding of prescribed care,
adherence to self-care programadherence to self-care program
Nursing InterventionNursing InterventionPainPain
Immediate action requiredImmediate action required Patient to D/C all activityPatient to D/C all activity Sit or recline in semi-fowler’s positionSit or recline in semi-fowler’s position Assess pain and vital sign & OAssess pain and vital sign & O2 2
saturationsaturation Administer nitroglycerin (if ordered), Administer nitroglycerin (if ordered),
repeat x 3 if needed repeat x 3 if needed Administer oxygenAdminister oxygen ECGECG
Surgical InterventionSurgical Intervention Percutaneous Transluminal Coronary Percutaneous Transluminal Coronary
Angioplasty (PTCA)Angioplasty (PTCA) Coronary Artery StentCoronary Artery Stent Coronary Artery Bypass GraftCoronary Artery Bypass Graft
Nursing CareNursing CarePost Cardiac SurgeryPost Cardiac Surgery
Neurologic statusNeurologic status
Cardiac statusCardiac status
Respiratory statusRespiratory status
Peripheral vascular Peripheral vascular statusstatus
Fluid & electrolyte Fluid & electrolyte statusstatus
PainPain
Nursing InterventionsNursing InterventionsPost Cardiac SurgeryPost Cardiac Surgery
Restoring Cardiac outputRestoring Cardiac output Promoting Adequate Gas ExchangePromoting Adequate Gas Exchange Maintaining Fld & Elect. BalanceMaintaining Fld & Elect. Balance Reducing symptoms of Sensory OverloadReducing symptoms of Sensory Overload Relieving PainRelieving Pain Maintaining Adequate Tissue PerfusionMaintaining Adequate Tissue Perfusion Maintaining Adequate Renal PerfusionMaintaining Adequate Renal Perfusion Maintaining Adequate Body TemperatureMaintaining Adequate Body Temperature
Myocardial InfarctionMyocardial Infarction
Areas of myocardial Areas of myocardial
cells are cells are permanently permanently
destroyeddestroyed Chest pain not Chest pain not
relieved with relieved with antianginals or restantianginals or rest
Dx based on hx, Dx based on hx, ECG and lab resultsECG and lab results
Diagnostic Lab TestsDiagnostic Lab TestsMIMI
Creatine Kinase (CK-Creatine Kinase (CK-MB)MB)
Increased within Increased within 1hr and peaks at 1hr and peaks at 24h24h
Lactic Lactic DehydrogenaseDehydrogenase
Peaks at 2-3 daysPeaks at 2-3 days
MyoglobinMyoglobin Negative results Negative results
may indicate no MImay indicate no MI
TroponinTroponin An elevated serum An elevated serum
level indicates an level indicates an MIMI
Thrombolytic TherapyThrombolytic Therapy
Used to dissolve or lyse the Used to dissolve or lyse the thrombus in a coronary arterythrombus in a coronary artery
‘‘Door to needle’ time: quicker the Door to needle’ time: quicker the better better 3 hours 3 hours
StreptokinaseStreptokinase TPaTPa RetavaseRetavase
Health PromotionHealth Promotion
NutritionNutrition
ActivityActivity
Symptom recognition and Symptom recognition and managementmanagement
NCP for MINCP for MI
Nursing Care Plan Nursing Care Plan Uncomplicated for MIUncomplicated for MI
Ineffective cardiopulmonary Ineffective cardiopulmonary perfusionperfusion
Potential of effective air exchange Potential of effective air exchange Risk for inadequate tissue perfussionRisk for inadequate tissue perfussion AnxietyAnxiety Knowledge deficit Knowledge deficit
Congestive Heart FailureCongestive Heart Failure
Occurs when the contractility of the Occurs when the contractility of the heart is reduced & the ventricle is heart is reduced & the ventricle is unable to pump as much blood out unable to pump as much blood out during systole as comes in during during systole as comes in during diastolediastole
Inability of the heart to pump Inability of the heart to pump sufficient blood to meet the needs of sufficient blood to meet the needs of the tissues for oxygen and nutrients.the tissues for oxygen and nutrients.
SidednessSidedness
Left SidedLeft Sided Most commonMost common Blood backs up into Blood backs up into
pulmonary veinspulmonary veins Forces fluid shift Forces fluid shift
leading to leading to pulmonary pulmonary congestion and congestion and edemaedema
Right SidedRight Sided Blood backs up into Blood backs up into
venous circulationvenous circulation Peripheral edema, Peripheral edema,
hepato/splenomeghepato/splenomegaly,jugular aly,jugular distentiondistention
Planning & GoalsPlanning & Goals
Manage fluid overloadManage fluid overload Decrease peripheral edemaDecrease peripheral edema Decrease shortness of breathDecrease shortness of breath
Increase activity toleranceIncrease activity tolerance Knowledge of treatment regime and self-Knowledge of treatment regime and self-
carecare Decreasing incidence of anxietyDecreasing incidence of anxiety Able to verbalize ability to make decisions/Able to verbalize ability to make decisions/
influence outcomesinfluence outcomes
Promoting Activity TolerancePromoting Activity Tolerance
20-30 minute physical activity daily20-30 minute physical activity daily Warm up activity (3 minutes)Warm up activity (3 minutes) Avoid temperature extremesAvoid temperature extremes Ensure ability to talk during activityEnsure ability to talk during activity Wait 2 hours pc prior to activityWait 2 hours pc prior to activity Stop activity if pain, SOB or dizzyStop activity if pain, SOB or dizzy Cool down activity (3 minutes)Cool down activity (3 minutes)
Managing Fluid Overload: Low Managing Fluid Overload: Low Sodium DietSodium Diet
500-1500mg sodium per day 500-1500mg sodium per day Most sodium is added in processing Most sodium is added in processing
of foodof food
Review the hand out on Sodium Review the hand out on Sodium contentcontent
For fun, calculate your daily sodium For fun, calculate your daily sodium intakeintake
Other Nsg InterventionsOther Nsg Interventions
Control anxietyControl anxiety Teach self careTeach self care Auscultate lung fields Auscultate lung fields Monitor I & OMonitor I & O Wt ptsWt pts Semi-high fowlersSemi-high fowlers Skin integrity/pos chgsSkin integrity/pos chgs Elastic stockings/leg exercisesElastic stockings/leg exercises