MAINTAINING CARDIAC AND VASCULAR FUNCTION

DR. IRENE ROCO

ASST. PROFESSOR

MAINTAINING CARDIAC AND VASCULAR FUNCTION

OUTLINE

• MAINTAINING CARDIAC FUNCTION

• MAINTAINING VASCULAR FUNCTION

1.POSITIONING AND LEG EXERCISES

2.ANTI EMBOLI STOCKINGS –

3.SEQUENTIAL COMPRESSION DEVICES (SCD)

• MEDICATIONS

• ROLE OF THE NURSE

NURSING INTERVENTIONS

1. POSITION THE CLIENT IN HIGH FOWLER’S POSITION TO DECREASE PRELOAD AND REDUCE PULMONARY CONGESTION

2. MONITOR INTAKE AND OUTPUT

a. MILD TO MODERATE CARDIAC FUNCTION – FLUID RESTRICTION IS NOT REQUIRED

b. SEVERE HEART FAILURE - FLUID RESTRICTION MAY BE ORDERED

I - MAINTAINING CARDIAC FUNCTION

NURSING INTERVENTIONS

1. POSITIONING AND LEG EXERCISES

A. AVOID PILLOWS UNDER THE KNEES OR MORE THAN 15 DEGREES OF KNEE FLEXION TO IMPROVE BLOOD FLOW TO THE LOWER EXTREMITIES AND REDUCE VENOUS STAGNATION

B. LEGS ELEVATED ( 20 – 30 DEGREES) TO PROMOTE VENOUS RETURN TO THE HEART

• AVOID THIS POSITION FOR PATIENTS WITH CARDIAC DYSFUNCTION BECAUSE IT WILL INCREASE PRELOAD AND MAY STRESS THE DYSFUNCTIONAL HEART

II - MAINTAINING VASCULAR FUNCTION

C. ALTERNATE CONTRACTION AND RELAXATION OF THE MUSCLES ONCE EVERY ONE TO TWO HOURS WHILE AWAKE

1. CALF PUMPING EXERCISES – ALTERNATE DORSIFLEXION AND EXTENSION OF THE FEET

2. KNEE FLEXION AND EXTENSION

3. RAISING AND LOWERING LEG

CONT.. POSITIONING

AND LEG EXERCISES

2. ANTI EMBOLI STOCKINGS –

• MADE OF STRONG ELASTIC MATERIAL WHICH PROMOTES VENOUS RETURN USING CONTINUOUS PRESSURE

• ANTI EMBOLISM STOCKINGS MUST FIT PROPERLY. TOO LARGE STOCKINGS CANNOT PROVIDE SUFFICIENT VEIN COMPRESSION; TOO TIGHT CAN OBSTRUCT BLOOD FLOW

• INSPECT THE CLIENT’S LEGS AND FEET REGULARLY TO ENSURE CIRCULATION IS NOT IMPEDED BY THE STOCKINGS

• SHOULD BE APPLIED IN THE MORNING BEFORE CLIENT GOES OUT OF BED

• USUALLY REMOVED FOR 30 MINUTES ONCE EVERY EIGHT HOURS

II - MAINTAINING VASCULAR FUNCTION

3. SEQUENTIAL COMPRESSION DEVICES (SCD)

• PLASTIC SLEEVES ATTACHED BY A TUBING TO AN AIR PUMP THAT ALTERNATELY INFLATE AND DEFLATE PORTIONS OF THE SLEEVES TO A SPECIFIED PRESSURE, WRAPPED AROUND THE LEGS THE ANKLE AREA INFLATES FIRST FOLLOWED BY THE CALF REGION AND THEN THE THIGH AREA

• SCD IS REMOVED FOR AMBULATION AND DISCONTINUED IF CLIENT RESUMES ACTIVITIES

II - MAINTAINING VASCULAR FUNCTION

Purpose / Indication of SCD CONTRAINDICATION

• to promote venous return from the legs

• Arterial Insufficiency

• To decrease risk of DVT and /or pulmonary embolism

• Cellulitis

• Prevention of thrombi and edema from venous stasis

• Infection of extremity

• Preexisting venous thrombosis

III - MEDICATIONS

1. TO REDUCE THE WORKLOAD OF THE HEART AND PREVENT VASOCONSTRICTION - NITRATES, CALCIUM CHANNEL BLOCKERS, ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS

2. TO TREAT CARDIAC DYSRHYTHMIAS

3. TO INCREASE THE CONTRACTILE STRENGTH OF THE HEART- POSITIVE INOTROPIC DRUGS (DIGITALIS)

4. TO BLOCK THE SYMPATHETIC NERVOUS SYSTEM ACTION ON THE HEART AND DECREASE OXYGEN CONSUMPTION - BETA ADRENERGIC BLOCKERS (PROPRANOLOL, METOPROLOL)

5. FOR PERIPHERAL VASCULAR DISEASE AND HYPERTENSION - DIRECT VASODILATORS

ROLE OF THE NURSE

1. HELP CLIENT UNDERSTAND THE PURPOSE, EFFECTS, AND SIDE EFFECTS OF DIFFERENT NUMEROUS MEDICATIONS

2. ASSESS FOR THE EFFECTS AND POTENTIAL COMPLICATIONS

Medication Effects and potential complications

Nurse’s Role

Diuretics can lower potassium level Assess I & O, potassium Level

Positive Inotropics

Strengthen contraction Assess BP, HR, Peripheral pulses , lung sounds as indicators of cardiac output

Antihypertensives

May cause postural hypotension

Monitor blood pressure

ROLE OF THE NURSE

3. PROMOTE CLIENT COMPLIANCE WITH THE MEDICATION REGIMEN . INCLUDE THE CLIENT’S SPOUSE OR SIGNIFICANT OTHERS IN DISCUSSION CONCERNING MEDICATIONS

•MISSING DOSES

•STOPPING MEDICATION

4. CAUTION CLIENT TO GET OUT OF THE BED SLOWLY AND AVOID HOT BATHS WHICH COULD INCREASE VASODILATION OR SYNCOPE

5. INSTRUCT LOW FAT, LOW SODIUM DIET

6. NEVER IGNORE ANY CLIENT’S COMPLAINTS OF CHEST PAIN OR DISCOMFORT . CHEST PAIN IN CARDIAC CLIENT MUST BE ASSUMED TO BE A SERIOUS SIGN OF CARDIAC HYPOXIA

REFERENCES

• KOZIER & ERBS FUNDAMENTALS OF NURSING. EIGHTH ED.

• CRAVEN & HIRNLE. FUNDAMENTALS OF NURSING. HUMAN HEALTH AND FUNCTION. LIPPINCOTT & WILLIAMS. FOURTH ED.