Cardiac 3

Caring for Clients With Disorders of Coronary and Peripheral Blood Vessels Chapter 28 Heart Disease Coronary artery disease (CAD) is the most common type Leading

cause of death in U.S. Coronary Artery Disease (CAD) Is when the arteries that supply blood to the heart are narrowed and hardened. Due to the build up of plaque Atherosclerosis Cause of plaque build up? Begins in childhood Excessive fat in the blood, hyperlipidemia High serum cholesterol or high levels of low-density lipoproteins (LDL) Diet high in saturated fat cause increased blood cholesterol level Genetics Good vs. Bad Lipoproteins Low density (LDL) Bad Transfers fat to arteries High density (HDL) Good Transfers fat to liver to be processed and used

Cholesterol Lab Values Atheroscl erosis Risk Factors Modifiable risk factors Cholesterol levels Cigarette smoking Hypertension Diabetes mellitus Sedentary lifestyles

Obesity Competitive, aggressive personality High fat diet Nonmodifiable risk factors Age Gender Family history Race Prevention Cigarette smoking should be discouraged. Regular aerobic exercise that lasts 30–60 minutes on most days of the week should be encouraged. Diet high in veggies High blood pressure should be identified and treated. Obesity should be avoided or reduced. Diabetes mellitus should be diagnosed and treated. Foods to avoid Red meat Fried chicken Whole milk Egg yolks Butter Ice cream Pastry 

Atherosclerosis Summary Narrow the arteries so that less blood can flow to the heart muscle Completely block the arteries and the flow of blood Cause blood clots to form and block the arteries. Potential Complication of CAD Angina Myocardial infarction Heart attack Heart Failure Arrhythmias Myocardial Ischemia Angina Pectoris Pain in the chest When

the myocardial oxygen demand exceeds the supply, ischemia of the heart muscle occurs, resulting in chest pain or angina

Symptoms Pain Dull or tightness under the sternum May radiate down right arm SOB Pallor or flushing Profuse sweating Apprehension Treatment The signs and symptoms of angina are often very similar to those of MI. Temporary Often relieved by rest and medication Nitroglycerin dilates the coronary arteries and increases the blood flow; but does not affect MI pain. Nursing Process Assess chest pain and vital signs Administer oxygen, drugs and encourage rest Notify physician Prevention Eliminating modifiable risk factors Avoid precipitating events Physical exertion Emotional excitement Eating a heavy meal Exposure to cold Medications Nitroglycerin Statins Antiplatelets Medical and Surgical Management Medical management Drug therapy Nitrates Educate on lifestyle changes

Surgical

management PTCA (balloon angioplasty) Coronary stent

CABG

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Percutaneous Transluminal Coronary Angioplasty Nursing interventions for PTCA Cleanses and remove hair from cath site Withholds anticoagulants therapy before procedure Monitors all vascular sites for bleeding (hematoma) Assess all distal pulses Monitor urine output Reports chest pain, or abnormal vital signs Coronary Stent Coronary Artery Bypass Graft (CABG) Coronary artery revascularization utilizes another vein to bypass diseased coronary artery

Heart Attack “a.k.a.” Myocardial Infarction Atherosclerosis or Embolus Occludes major artery of blood flow No oxygen to cells Infarcted areas Heart muscles die Pain Signs and Symptoms Heavy pressure or squeezing Pain, left arm and to the neck, jaw and teeth Anxiety Dyspnea Weakness, faintness Nausea Pallor Erratic behavior Hypotension, shock Cardiac rhythm changes Vomiting Fever Diaphoresis

Pa in with a myoca rdial infarction Diagnostic Findings Elevated serum cardiac markers Troponin Ck-MB (cardiac muscle-specific enzymes) ECG changes T-wave inversion Medical Management Increase tissue perfusion Decrease workload of the heart Promoting tissue oxygenation Oxygen Nitroglycerin Relieving pain Morphine Preventing complications Limit the size of the infarct Thrombolytic therapy PTCA CABG

Thrombolytic Therapy Dissolve clots in occluded artery, reopening the vessel and allowing perfusion of the heart muscle. 3-6 hours of the onset of symptoms st Most effective in 1 1hour Excluded Internal bleeding Aneurysm Recent head trauma Hx of hemorrhagic stroke Surgery within the past 10 days Nursing Intervention Administer oxygen Administer medications IV Morphine Heparin Antiplatelets Stool softeners Bed rest

Teaching Treatment regimen Cardiac rehab Medications Lifestyle changes Dietary restrictions Sexual activity Warning symptoms Nursing Process for MI Assessment Client’s description of pain Vital signs Cardiac rhythm Nursing Process for MI Nursing Diagnosis Acute pain related to diminished myocardial oxygenation Ineffective tissue perfusion (cardiovascular) related to ____________________ Anxiety or Fear Nursing Process for MI Interventions Administer prescribed nitroglycerin Administer morphine Administer oxygen Pain will be within client’s identified comfort level within 30minutes Occlusive Disorders of Peripheral Blood Vessels Peripheral Vascular Disease “PVD” What is peripheral vascular disease? Peripheral vascular disease, or PVD, is a condition in which the blood vessels that carry blood to the arms or legs become narrowed or clogged. Arterial Venous Symptoms of PVD Intermittent claudication- pain with exercises, particularly walking, causes excruciating pain in limb that disappears at rest. Tingling and numbness – extremity becomes numb, or the feeling of a persistent tingling sensation, caused by poor circulation

Symptoms of PVD Coldness and difference in size- extremities feel cold to touch, one leg may be colder and larger than the other. Lack of tissue growth- skin becomes paper thin, shiny, and easily subject to breakdown Venous stasis ulcers- breakdown from inflamed skin causing fluid to ooze causing skin to be impaired Arteriosclerosis Goals for peripheral arterial disease Increased arterial blood supply to the extremities Promotion of vasodilation Prevention of vascular compression Relief of pain Maintaining tissue integrity Interventions Positioning the part below the level of heart Reclining position Walking Not with pain Promoting vasodilation Warmth, avoid cold temperatures Warm clothes, warm drink Pt should test temp first Nursing care for PVD Protect the client’s feet and legs from undue pressure of linens Take great care in trimming toenails Be sure to dry carefully between the toes after washing them Be very careful about application of heat. Use extra clothing rather external heat Use warm baths to increase circulation Postoperative Treatment Pulses Color and temperature Capillary refill Sensory and motor function Allow

no leg crossing, LOC, UO,VS, Bleeding, elevate extremity, monitor incision site for infection

Notify

surgeon of any changes immediately Raynaud’s Disease Constriction Brief spasms Females that get upset, cold, or smokes Fingers turn blue, then white, then red Painful and cause ulceration Avoid cause, use warmth. Peripheral thrombosis (arterial embolism) Embolus lodges in a blood vessel causing blockage Severe pain at site Distal portion pale, cold, numb, and no pulse Without circulation gangrene occurs Amputation Endarterectomy Embolectomy Venous Disorders Venous insufficiency Varicose veins Venous Insufficiency Blood pools in the lower extremity Fluid leaves the blood vessel Causing edema and the skin to become shiny and hard Unoxygenated cells die causing release of inflammatory chemicals Skin becomes red and hot, tissue appears dark brown, deep purple, or black Chronic Venous Insufficiency Results from obstruction of venous valves in legs or reflux of blood back through valves Venous ulceration is serious complication Pharmacological therapy is antibiotics for infections Venous stasis ulcer Medical Management Promote wound healing and preventing infection Diet Protein intake Albumin is lost through ulcers Vitamin A& C, zinc needed to promote tissue healing Debridement of necrotic tissue Wet-to-dry dressing Enzyme ointments

Surgical debridement Unna’s paste boot Disorders of blood vessel walls Varicose veins results from weakening of the valves of the veins so that blood pools in the legs. The congestion stretches the veins and over time they cannot recoil and remain distended. Prolonged standing Elevate the legs for a few minutes throughout day Avoid constricted clothing Stripping and ligation of surgical therapy Early ambulation is important after surgery. 

Varicose Veins