Med Surg Cardio
Med Surg Cardio
Med Surg Cardio
Cardiovascular System
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Ventricles
2 thick-walled chambers; major responsibility for
forcing blood out of the heart; lie below the atria
Lower Chamber (contracting or pumping)
Right Ventricle: contracts & propels deoxygenated
blood into pulmonary circulation via the aorta
during ventricular systole; Right atrium has
decreased pressure which is 60 – 80 mmHg
Left Ventricle: propels blood into the systemic
circulation via aortaduring ventricular systole; Left
ventricle has increased pressure which is 120 – 180
mmHg in order to propel blood to the systemic
circulation
Heart Valves
Tricuspid
Pulmonic
Mitral
Aortic
Nodal tissues
SA Node( Sino-atrial, Keith and Flack)
Primary Pacemaker
Between SVC and RA
Vagal and symphatetic innervation
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Medical and Surgical Nursing 2 Abejo
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Frank-Starling Law of the Heart - critical factor for stroke heart & distribute oxygenated blood throughout the body
volume is "degree of stretch of cardiac muscle cells"; Arterioles
more stretch = more contraction force
Small arteries that distribute blood to the capillaries &
increased EDV = more contraction force function in controlling systemic vascular resistance &
slow heart rate = more time to fill
exercise = more venous blood return therefore arterial pressure
Capilliaries
Regulation of Heart Rate (Autonomic, Chemical, Other) The following exchanges occurs in the capilliaries
O2 & CO2
1. Autonomic Regulation of Heart Rate (HR)
Solutes between the blood & tissue
Sympathetic - NOREPINEPHRINE (NE) increases heart Fluid volume transfer between the plasma &
rate (maintains stroke volume which leads to increased
Cardiac Output) interstitial space
Venules
Parasympathetic - ACETYLCHOLINE (ACh) decreases
heart rate Small veins that receive blood from capillaries &
function as collecting channels between the capillaries &
Vagal tone - parasympathetic inhibition of inherent rate
of SA node, allowing normal HR veins
Veins
Baroreceptors, pressoreceptors - monitor changes in
blood pressure and allow reflex activity with the Low-pressure vessels with thin small & less muscles than
autonomic nervous system
arteries; most contains valves that prevent retrograde
blood flow; they carry deoxygenated blood back to the
2. Hormonal and Chemical Regulation of Heart Rate (HR)
heart. When the skeletal surrounding veins contract, the
epinephrine - hormone released by adrenal medulla veins are compressed, promoting movement of blood
during stress; increases heart rate
back to the heart.
thyroxine - hormone released by thyroid; increases heart
rate in large quantities; amplifies effect of epinephrine
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stop heart on lethal injection
hypokalemia - lower K+ levels; leads to
abnormal heart rate rhythms
hypocalcemia - depresses heart function
hypercalcemia - increases contraction phase
Medical and Surgical Nursing 4 Abejo
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Palpation:
Nursing History
Risk Factors
Common Clinical Manifestations of Cardiovascular Disorders S2 - due to the closure of the semi-lunar (pulmonic/aortic) valves
- timing: diastole
a. Dyspnea - loudest at the base
- Exertional
- Orthopnea
- Paroxysmal Noctural Dyspnea
- Cheyne-stokes
b. Chest Pain
c. Edema
- Ascites
- Hydrothorax
- Anasarca
d. Palpitation S3 – Ventricular Diastolic Gallop
e. Hemoptysis Mechanism: vibration resulting from resistance to rapid
f. Fatigue ventricular filling secondary to poor compliance
g. Syncope and Fainting Timing: early diastole
h. Cyanosis Location: Apex (LV) or LLSB (RV)
i. Abdominal Pain Pitch: faint and low pitched
j. Clubbing of fingers
k. Jaundice S4 - Atrial Diastolic Gallop
Mechanism: vibration resulting from resistance to late
Physical Assessment ventricular filling during atrial systole
Timing: late diastole ( before S1)
Inspection: Location: Apex ( LV) or LLSB (RV)
– Skin color Pitch: low ( use bell)
– Neck vein distention
Heart Murmurs
Murmur - sounds other than the typical "lub-dub"; typically caused
by disruptions in flow
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– Pulsations Pericardial Friction Rub
– Clubbing
– Capillary refill It is an extra heart sound originating from the pericardial sac
Mechanism: Originates from the pericardial sac as it moves
Timing: with each heartbeat
Medical and Surgical Nursing 5 Abejo
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
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Agranulocytes HDL- 30-70- mg/dL
Lymphocytes: 20-40% NPO post midnight (usually 12 hours)
Monocytes: 2-8%
Platelets: 150,000-450,000/mm3
Medical and Surgical Nursing 6 Abejo
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
B. Non-Invasive Procedure
a. Limb Leads
b. Precordial Leads
The precordial leads VI –V6 are part of the 12 lead EKG. 3. T Wave - repolarization of the ventricles (0.16 s)
They are not monitored with the standard limb leads
4. PR (PQ) Interval - time period from beginning of atrial
contraction to beginning of ventricular contraction (0.16 s)
c. 12 lead ECG
5. QT Interval - the time of ventricular contraction (about 0.36 s);
from beginning of ventricular depolarization to end of
repolarization.
2. Holter Monitoring
A non-invasive test in which the client wears a Holter
monitor and an ECG tracing recorded continuously over
a period of 24 hours
Instruct the client to resume normal activities and
maintain a diary of activities and any symptoms that may
develop
ECG Paper
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Medical and Surgical Nursing 7 Abejo
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
3. Stress Test
A non-invasive test that studies the heart during C. Invasive Procedure
activity and detects and evaluates CAD
Exercise test, pharmacologic test and emotional test 1. Cardiac Catheterization ( Coronary Angiography /
Treadmill testing is the most commonly used stress Arteriography )
test Insertion of a catheter into the heart and surrounding
Used to determine CAD, Chest pain causes, drug vessels
effects and dysrhythmias in exercise Is an invasive procedure during which physician
Pre-test: consent may be required, adequate rest , eat injects dye into coronary arteries and immediately
a light meal or fast for 4 hours and avoid smoking, takes a series of x-ray films to assess the structures
alcohol and caffeine of the arteries
During the test: secure electrodes to appropriate Determines the structure and performance of the
location on chest, obtain baseline BP and ECG heart valves and surrounding vessels
tracing, instruct client to exercise as instructed and Used to diagnose CAD, assess coronary atery
report any pain, weakness and SOB, monitor BP and patency and determine extent of atherosclerosis
ECG continuously, record at frequent interval Pretest: Ensure Consent, assess for allergy to
Post-test: instruct client to notify the physician if seafood and iodine, NPO, document weight and
any chest pain, dizziness or shortness of breath . height, baseline VS, blood tests and document the
Instruct client to avoid taking a hot shower for 10-12 peripheral pulses
hours after the test Pretest: Fasting for 8-12 hours, teachings,
medications to allay anxiety
Intra-test: inform patient of a fluttery feeling as the
4. Pharmacological stress test catheter passes through the heart; inform the patient
Use of dipyridamole that a feeling of warmth and metallic taste may
Maximally dilates coronary artery occur when dye is administered
Side-effect: flushing of face Post-test: Monitor VS and cardiac rhythm
Pre-test: 4 hours fasting, avoid alcohol, caffeine Monitor peripheral pulses, color and warmth and
Post test: report symptoms of chest pain sensation of the extremity distal to insertion site
Maintain sandbag to the insertion site if required to
maintain pressure
Monitor for bleeding and hematoma formation
5. ECHOCARDIOGRAM
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Lecture Notes on Cardiovascular System
Prepared By: Mark Fredderick R Abejo R.N, MAN
C. TREATMENT
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Intravascular Stenting
Mechanical dilation of the coronary vessel wall by
compresing the atheromatous plaque.
It is recommended for clients with single-vessel
coronary artery disease.
Medical and Surgical Nursing 9 Abejo
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