Nursing management for cardiovascular disorders

## **Presentation Description**

**Title:** Nursing Management of Cardiovascular Disorders

**Overview:**

This presentation provides a comprehensive overview of nursing management for various cardiovascular disorders. It covers key concepts related to assessment, diagnosis, treatment, and patient education.

**Key Topics:**

* **Cardiovascular Assessment:**
- Vital signs (blood pressure, heart rate, respiratory rate, temperature)
- Physical examination (heart sounds, peripheral pulses, edema)
- Diagnostic testing (ECG, echocardiogram, stress test)
* **Common Cardiovascular Disorders:**
- Coronary artery disease (CAD)
- Angina pectoris
- Myocardial infarction (MI)
- Heart failure (HF)
- Arrhythmias
- Hypertension
* **Nursing Interventions:**
- Monitoring vital signs and cardiac rhythms
- Administering medications (antiplatelets, anticoagulants, beta-blockers, ACE inhibitors, diuretics)
- Providing oxygen therapy
- Managing pain and anxiety
- Promoting activity tolerance
- Educating patients on lifestyle modifications (diet, exercise, smoking cessation)
* **Complications:**
- Cardiac arrest
- Cardiogenic shock
- Pulmonary edema
- Thromboembolism
* **Patient Education:**
- Medication adherence
- Self-monitoring (blood pressure, heart rate)
- Lifestyle changes
- Recognizing signs and symptoms of worsening conditions

**Target Audience:**

This presentation is suitable for nursing students, registered nurses, and healthcare professionals involved in the care of patients with cardiovascular disorders.

**Purpose:**

To provide a comprehensive guide for nurses on the management of cardiovascular disorders, emphasizing the importance of early identification, appropriate interventions, and patient education to improve outcomes.

1. Nursing care of Cardiovasular Disorders Dr. Mysara Mogahed Professor of Internal medicine. Benha University

2. Anatomy and physiology The cardiovascular system delivers oxygenated blood to tissues and removes waste products. Heart The heart is a hollow, muscular organ about the size of a closed fist, Located between the lungs in the mediastinum. The heart, controlled by the autonomic nervous system. The heart has four chambers, two atria and two ventricles separated by a cardiac septum, also the heart has four valves. The heart has two sets of valves: Atrioventricular (between atria and ventricles) — tricuspid valve on the heart’s right side and mitral (bicuspid) valve on its left Semilunar — pulmonary valve (between the right ventricle and pulmonary artery) and aortic valve (between the left ventricle and aorta). • Coronary arteries originate from the aorta just above the aortic valve leaflets • The coronary artery perfused during diastole.

3. Myocardial perfusion With a normal heart rate of 60 to 80 bpm there is ample time during diastole for myocardial perfusion. However, as heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply)

4. Blood pathways Blood moves to and from the heart through specific pathways. Deoxygenated venous blood returns to the right atrium through three vessels: Superior vena cava — returning blood from the upper body Inferior vena cava — returning blood from the lower body Coronary sinus — returning blood from the heart muscle Blood in the right atrium empties into the right ventricle (diastole) and is then ejected through the pulmonic valve into the pulmonary artery when the ventricle contracts (systole). The blood then travels to the lungs to be oxygenated. From the lungs, blood travels to the left atrium through the pulmonary veins. The left atrium empties the blood into the left ventricle, which then pumps the blood through the aortic valve into the aorta and throughout the body with each contraction. Because the left ventricle pumps blood against a much higher pressure than the right ventricle, its wall is three times thicker.

5. Normal Heart Sound S1: the first heart sound produced by closure of the atrioventricular (mitral and tricuspid) valves S2: the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves Abnormal Heart Sound S3: an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure S4: an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle

6. Cardiac conduction system . The SA node has the highest inherent rate (60 to 100 impulses per minute), the AV node has the second- highest inherent rate (40 to 60 impulses per minute), and the ventricular pacemaker sites have the lowest inherent rate (30 to 40 impulses per minute). If the SA node malfunctions, the AV node generally takes over the pacemaker function of the heart at its inherently lower rate. Impulses from the autonomic nervous system affect the SA node and alter its firing rate to meet the body’s needs.

7. Sign & symptoms related to cardiovascular disorders Chest pain or discomfort Shortness of breath or dyspnea Peripheral edema, weight gain, abdominal distention due to enlarged spleen and liver or ascites (HF) Palpitations (tachycardia) Vital fatigue, sometimes referred to as vital exhaustion (characterized by feeling unusually tired or fatigued, irritable, and dejected) Dizziness, syncope, or changes in level of consciousness Change in vital signs (Blood Pressure, Pulse rate, Body temperature, Respiratory rate)

8. Diagnostic Evaluation Cardiac Biomarker Analysis Myocardial cells that become necrotic from prolonged ischemia or trauma release specific enzymes (creatine kinase [CK]), CK isoenzymes (CK-MB ), and proteins ( myoglobin, and troponin ) * *myocardial protein; measurement is used to assess heart muscle injury. Brain (B-Type) Natriuretic Peptide Brain (B-type) natriuretic peptide (BNP) is a neurohormone that helps regulate BP and fluid volume. It is primarily secreted from the ventricles in response to increased preload with resulting elevated ventricular pressure. **Diagnostic, monitoring, and prognostic tool in the setting of HF

9. Lipid Profile Cholesterol, triglycerides, and lipoproteins are measured to evaluate a person’s risk of developing atherosclerotic disease, especially if there is a family history of premature heart disease, or to diagnose a specific lipoprotein abnormality. Cholesterol Levels Cholesterol (normal level is less than 200 mg/dL) is a lipid required for hormone synthesis and cell membrane formation. Triglycerides Triglycerides (normal range is 100 to 150mg/dL), composed of free fatty acids and glycerol, are stored in the adipose tissue and are a source of energy ** HDLs (normal range in men is 35 to 70 mg/dL; in women, 35 to 85 mg/dL) have a protective action. ** The risk of CAD increases as the LDL more than HDL: ** LDLs (normal level is less than 130 mg/dL) are the primary transporters of cholesterol and triglycerides into the cell. ** the harmful effect of LDL is the deposition of these substances in the walls of arterial vessels.

10. Chest X-Ray and Fluoroscopy Echocardiography Electrocardiography (ECG) Exercise ECG ( stress test ) Cardiac catheterization: Cardiac imaging:

11. IHD (Ischemic heart disease) Angina Pectoris Myocardial Infraction (MI)

12. 1- Angina Pectoris: Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen in response to physical exertion or emotional stress. Clinical manifestation (angina) The pain is often felt deep in the chest behind the sternum ( retrosternal area ). Weakness or numbness in the arms, wrists, and hands. Shortness of breath. Pallor. Dizziness. Nausea and vomiting. Anxiety.  

13. Myocardial Ischemia  Ischemia more than 20 minutes lead to acute myocardial infarction Modifiable Risk Factors Nicotine use ( ie , tobacco smoking or chewing) Diet (contributing to hyperlipidemia) Hypertension Diabetes mellitus Obesity Stress Sedentary lifestyle (Physical inactivity) Nonmodifiable Risk Factors Age Gender Familial predisposition/genetics

14. Acute Coronary Syndrome and Myocardial Infarction ACS is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death ( ie , MI) if definitive interventions do not occur promptly. (Although the terms coronary occlusion, heart attack, and MI are used, the preferred term is MI.) Etiology: • In unstable angina, there is reduced blood flow in a coronary artery, often due to rupture of an atherosclerotic plaque, but the artery is not completely occluded. • In an MI, an area of the myocardium is permanently destroyed, typically because plaque rupture and subsequent thrombus formation result in complete occlusion of the artery.

15. Clinical Manifestations Chest pain that occurs suddenly and continues despite rest & medication Shortness of breath. Indigestion and nausea. Anxiety. Cool, pale, and moist skin. Heart rate and respiratory rate may be faster than normal.

16. Heart failure Heart failure is a syndrome that occurs when the heart can’t pump enough blood to meet the body’s metabolic needs, resulting in intravascular and interstitial volume overload and poor tissue perfusion. HF was often referred to as congestive heart failure (CHF) because many patients experience pulmonary or peripheral congestion. Etiology Cardiomyopathy. Hypertension. Valvular disorders. Diabetes mellitus. Coronary artery disease (Ischemia causes myocardial dysfunction) Several systemic conditions, including progressive renal failure.

17. Heart failure may be: Left ventricular (sided) or right ventricular (sided) failure • Acute or chronic failure Left-sided Heart Failure (Left Ventricular Failure): The left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation to meet the needs of the body tissues for oxygen and nutrients. The increased left ventricular blood volume and pressure, which decreases blood flow from the left atrium into the left ventricle during diastole. The left atrium blood volume and pressure increases that lead to the pulmonary congestion, forcing fluid from the pulmonary capillaries into the pulmonary tissues and alveoli.  

18. Manifestations of left-sided heart failure. Fatigue and activity intolerance. Dizziness and syncope also may result from decreased cardiac output. Pulmonary congestion causes dyspnea, shortness of breath, and a cough. Orthopnea (difficulty breathing while lying down). Cyanosis from impaired gas exchange. Inspiratory crackles and wheezes, on auscultation of the lungs.

19. Right-sided Heart Failure (Right Ventricular Failure): Inability of the right ventricle to fill or pump (empty) sufficient blood to the pulmonary circulation Increased pressures in the pulmonary vasculature, or right ventricular muscle damage impair the right ventricle’s ability to pump blood into the pulmonary circulation. The right ventricle and atrium become distended, and blood accumulates in the systemic venous system. Increased venous pressures cause abdominal organs to become congested and peripheral tissue edema to develop. Because of the effects of gravity; edema develops in the feet and legs. Congestion of gastrointestinal tract vessels causes anorexia and nausea. Right upper quadrant pain may result from liver engorgement. Neck veins distend and become visible even when the patient is upright due to increased venous pressure.

20. Acute Versus Chronic Failure Acute failure is the abrupt onset of a myocardial injury (such as a massive MI) resulting in suddenly decreased cardiac function and signs of decreased cardiac output. Chronic failure is a progressive deterioration of the heart muscle due to cardiomyopathies, valvular disease, or coronary heart disease (CHD).

21. Endocarditis The heart’s wall is composed of three layers: Epicardium includes the outer layer of the heart wall and the visceral layer of the serous pericardium. Myocardium is the middle and largest portion of the heart wall. This layer of muscle tissue contracts with each heartbeat. Endocardium is the innermost layer of the heart wall. It contains endothelial tissue made up of small blood vessels and bundles of smooth muscle. Endocarditis : - inflammation of the endocardium, heart valves, or cardiac prosthesis, results from bacterial or fungal invasion. ◊ It usually develops in people with prosthetic heart valves or structural cardiac defect ( eg , valve disorders), invasive catheters (e.g., a central venous catheter, or an indwelling urinary catheter), dental procedures or, it is more common in older people.

22. Clinical Manifestations 1. Chills and Fever 2. Heart murmur 3. Cardiomegaly, heart failure, tachycardia. 4. Headache 5. Weakness 6. Valvular stenosis or regurgitation, myocardial damage 7. Embolic phenomena 8. Cough, dyspnea

23. Rheumatic fever Rheumatic fever is an inflammatory disease that can develop when streptococcal throat infection or scarlet fever isn't properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria. Rheumatic fever most often affects children ages 5 to 15. Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatment can ease pain, reduce damage from inflammation and prevent a recurrence of rheumatic fever.

24. Rheumatic fever symptoms result from inflammation in the heart, joints, skin or central nervous system. The onset of rheumatic fever usually occurs about 2 to 4 weeks after a strep throat infection. Rheumatic fever signs and symptoms can include: Fever Painful and tender joints — most often in the knees, ankles, elbows and wrists Pain in one joint that migrates to another joint Red, hot or swollen joints Chest pain Fatigue Flat or slightly raised, painless rash with a ragged edge Heart murmur Jerky, uncontrollable body movements (Sydenham chorea ) — most often in the hands, feet and face Small, painless bumps beneath the skin

25. Causes Rheumatic fever can occur after a throat infection from a bacteria called group A streptococcus. Group A streptococcus infections of the throat cause strep throat, The body's immune system typically targets infection-causing bacteria. In rheumatic fever, the immune system mistakenly attacks healthy tissue, particularly in the heart, joints, skin and central nervous system. This faulty immune system reaction results in swelling of the tissues (inflammation).

26. Diagnosis of rheumatic fever: Blood tests:   Sometimes, providers order a blood test to confirm a strep infection( ASOT, blood culture, ESR, CRP). Heart tests:   Heart tests help providers check your child’s heart function. These may include an  electrocardiogram  (EKG) or an  echocardiogram (ultrasound of the heart, also known as an echo).

27. What are the Jones criteria for rheumatic fever? Healthcare providers use the Jones criteria to diagnose rheumatic fever. There must be two major criteria or one major and two minor criteria from the following lists. In addition, there must be laboratory evidence of a previous group A streptococcal infection. Major criteria include: Arthritis of several joints. Heart inflammation  ( carditis). Bumps ( nodules ) under their skin. Rapid, jerky movements ( chorea ). Skin rash  (erythema marginatum ).

28. Minor criteria include: Fever. Elevated  erythrocyte sedimentation rate (ESR)  or  C-reactive protein (CRP)   levels. Joint pain  ( arthralgia) . EKG (electrocardiogram) changes. History of previous rheumatic fever or rheumatic heart disease.

29. Management and Treatment Treatment for rheumatic fever may include: Antibiotics:  Healthcare providers prescribe antibiotics to treat the underlying bacterial infection. Some antibiotics are one injection (shot). Others your child takes by mouth for a week or more. Anti-inflammatory medications:   medication to reduce inflammation. This medication may also relieve symptoms such as joint pain. For severe symptoms, stronger medication ( corticosteroids ), may be prescribed. Other therapies:  Rheumatic fever can affect people in different ways. Your child’s provider may recommend other treatments based on how the condition affects them. In severe cases, your child may need heart surgery or joint treatments to treat serious complications.

30. Prevention Treating strep throat and scarlet fever early is essential. If your child has strep throat or scarlet fever, make sure you follow their provider’s instructions carefully. finish the full course of antibiotics, even if they feel better. If your child’s been diagnosed with rheumatic fever, their provider may prescribe a long-term antibiotic (monthly injections of penicillin). This can help prevent future bouts of strep throat and prevent recurrences of rheumatic fever.

31. Hypertension Blood pressure is the force exerted by the blood against the walls of the blood vessels. How great the pressure is depending on the work being done by the heart and the resistance of the blood vessels. Blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension

32. Potential Complications of hypertension Long-standing elevated blood pressure may result in increased stiffness of the vessel walls, Leading to vessel injury and a resulting inflammatory response within the intima. Inflammatory mediators then lead to the release of growth-promoting factors that cause vessel hypertrophy and hyperresponsiveness. These changes result in acceleration and aggravation of atherosclerosis. Hypertension also increases the work of the left ventricle, which must pump harder to eject blood into the arteries. Over time, the increased workload causes the heart to enlarge and thicken ( ie , hypertrophy) and may eventually lead to heart failure.  

33. Many factors have been implicated as causes of hypertension: Increased sympathetic nervous system activity. Increased renal reabsorption of sodium, chloride, and water. Increased activity of the renin–angiotensin–aldosterone system. Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium Resistance to insulin action, which may be a common factor linking hypertension, type 2 diabetes mellitus, obesity, and glucose intolerance

34. Nursing management of cardiovascular disease Nursing Diagnoses: Activity intolerance and fatigue related to decreased cardiac output. Excess fluid volume related to the HF syndrome Anxiety related to breathlessness from inadequate oxygenation Ineffective Breathing Pattern related to heart failure Ineffective therapeutic regimen management related to lack of knowledge  

35. Planning and Goals Major goals for the patient may include: Promoting activity and reducing fatigue, Relieving fluid overload symptoms and improve respiration, Decreasing anxiety or increasing the patient’s ability to manage anxiety, Teaching the patient about the self-care program.