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CARDIOVASCULAR SYSTEM
Understanding the Heart.
The Layers of the Heart Wall
Anatomy And Physiology – Essential layer of the heart
Epicardium
Normal Anatomy: Microscopic (visceral – Coronary arteries are found in this layer
pericardium)
– Consists of Three layers- epicardium, myocardium and
endocardium – Middle and thickest layer of the heart
Myocardium (CBQ)
– Responsible for contraction of the heart
– Innermost layer of the heart
Endocardium – Lines the inside of the myocardium
– Covers the heart valves
Myocardial Cell Types
Kinds of Where Found Primary Primary
Cardiac Cells Function Property
Myocardial Myocardium Contraction Contractility
cells and
Relaxation
Specialized Generation Automaticity
cells of the Electrical and Conductivity
electrical conduction conduction of
conduction system electrical
system impulses
– The epicardium covers the outer surface of the heart
– The myocardium is the middle muscular layer of the heart
– The endocardium lines the chambers and the valves
Normal Anatomy: Gross
– The layer that covers the heart is the PERICARDIUM
– There are two parts- parietal and visceral pericardium
– The space between the two pericardial layers is the
pericardial space
– The heart is located in the LEFT side of the mediastinum
How the heart works.
- The heart and circulation.
- The heart as a pump.
- Blood supply to the heart - the coronary arteries.
- The heart valves.
- The heart is a muscular pump.
- Circulating blood carries oxygen from the lungs and
nutrients from the liver.
CARDIOVASCULAR SYSTEM
The Heart has Four one-way Valves:
- Aortic Valve.
- Mitral Valve.
- Pulmonary Valve.
- Tricuspid Valve.
The heart also has four chambers- two atria and two ventricles
- The Left atrium and the right atrium
- The left ventricle and the right ventricle
The heart chambers are guarded by valves
- The atrio-ventricular valves- Tricuspid and bicuspid
- The semi-lunar valves- Pulmonic and aortic valves
The Valves of the Heart
Valve Type Name Location
Separates right
Tricuspid atrium and right
Atrio-ventricular ventricle
(AV) Separates left
Mitral (Bicuspid) atrium and left
ventricle
Between right
Pulmonic ventricle and
Semilunar pulmonary artery
Between left
Aortic
ventricle and aorta
CARDIOVASCULAR SYSTEM
The Blood supply of the heart comes from the Coronary
arteries
- Right coronary artery
- Left coronary artery
The Coronary Arteries
Portion of Portion of
Coronary Artery and
Myocardium Conduction
its Branches
Supplied System Supplied
Right Right atrium AV node (90%
Posterior Inferior wall of population)
descending of right SA node ( >
Right margin 55%) Bundle
ventricle
(AV nodal) of His
½ anterior Posterior
surface of left division of left
ventricle bundle branch
Left Anterior AV node
Anterior surface of left (10%)
descending ventricle SA node Cardio physiology
(LAD) Left atrium (45%)
Circumflex (LCX) Lateral wall of All bundle - Conduction system
left ventricle branches - Cardiac (heart) sounds
Part of right - Heart rate and Blood pressure
ventricle - Cardiac cycle
The main functions of this system are:
- to transport oxygen, hormones and nutrients to the
tissues
- and to transport waste products to the lungs and kidneys
for excretion
The CONDUCTING SYSTEM OF THE HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right and the Left
bundle branch
4. Purkinje fibers- fastest conduction
- The heart itself must receive enough oxygenated blood.
- Blood is supplied to the heart through the coronary
arteries, two main branches which originate just above the The Heart: Physiology
aortic valve. 1. The intrinsic conduction system causes the heart muscle
to depolarize in one direction
The venous drainage of the heart 2. The rate of depolarization is around 75 beats per minute
1. Cardiac veins 3. The SA node sets the pace of the conduction
2. Coronary sinus 4. This electrical activity is recorded by the
Electrocardiogram (ECG)
CARDIOVASCULAR SYSTEM
- Blood pressure
- Hormones- ADH, Adrenergic hormones, Aldosterone and
ANF
ADH increases water retention
Aldosterone increases sodium retention and water
retention secondarily
Epinephrine and NE increase HR and BP
ANP= causes sodium excretion
The Cardiac Cycle:
1. Systole: Contraction
2. Diastole: Relaxation
The Heart sounds
1. S1- due to closure of the AV valves
2. S2- due to the closure of the semi-lunar valves
3. S3- due to increased ventricular filling
4. S4- due to forceful atrial contraction
Heart rate
- Normal range is 60-100 beats per minute
- Tachycardia is greater than 100 bpm
- Bradycardia is less than 60 bpm
- Sympathetic system INCREASES HR
- Parasympathetic system (Vagus) DECREASES HR (CBQ)
The Heart: Physiology
- The amount of blood the heart pumps out in each beat is
called the STROKE VOLUME
- When this volume is multiplied by the number of heart
beat in a minute (heart rate), it becomes the CARDIAC
OUTPUT
- When the Cardiac Output is multiplied by the Total
Peripheral Resistance, it becomes the BLOOD PRESSURE
Blood pressure = Cardiac output X Peripheral resistance
Blood pressure
- Control is neural (central and peripheral) and hormonal
- Baroreceptors in the carotid and aorta
- Hormones - ADH, Adrenergic hormones, Aldosterone and
ANF
The Heart: Physiology
- The PRELOAD is the degree of stretching of the heart
muscle when it is filled-up with blood
- The AFTERLOAD is the resistance to which the heart must
pump to eject the blood
CARDIOVASCULAR SYSTEM
Terminology CARDIOVASCULAR ASSESSMENT
CHRONOTROPIC - Refers to a change in heart rate
EFFECT - A positive chronotropic effect
refers to an increase in heart rate
- A negative chronotropic effect
refers to a decrease in heart rate
DROMOTROPIC - Refers to a change in the speed of
EFFECT conduction through the AV
junction
- A positive dromotropic effect
results in an increase in AV
conduction velocity
- A negative dromotropic effect
results in a decrease in AV
conduction velocity
INOTROPIC - Refers to a change in myocardial
EFFECT contractility
- A postive inotropic effect results in
an increase in myocardial Cardiac History
contractility - Interview
- A negative inotropic effect results - Focused assessment
in a decrease in myocardial
contractility Cardiac Assessment
1. Health History
Vascular System - Obtain description of present illness and the chief
- The vascular system consists of the arteries, veins and complaint
capillaries - Chest pain, SOB, Edema, etc.
- The arteries are vessels that carry blood away from the - Assess risk factors
heart to the periphery
- The veins are the vessels that carry blood to the heart 2. Physical examination
- The capillaries are lined with squamos cells, they connect - Vital signs- BP, PP, MAP
the veins and arteries - Inspection of the skin
- The lymphatic system also is part of the vascular system - Inspection of the thorax
and the function of this system is to collect the - Palpation of the PMI, pulses
extravasated fluid from the tissues and returns it to the
blood - Auscultation of the heart sounds
CARDIOVASCULAR SYSTEM
3. Laboratory and diagnostic studies
- CBC
- Cardiac catheterization
- Lipid profile
- arteriography
- Cardiac enzymes and proteins
- CXR
- CVP
- ECG
- Holter monitoring
- Exercise ECG
Laboratory Test Rationale
- To assist in diagnosing MI
- To identify abnormalities
- To assess inflammation
- To determine baseline value
- To monitor serum level of medications
Surface Auscultation
Anatomy
- To assess the effects of medications
TRICUSPID VALVE lies behind right right half of the
CK- MB (creatine kinase)
half of the lower end of the
sternum; body of the sternum - Indicates myocardial damage
opposite the 4th - Elevates in MI within 4-6 hours
ICS - peaks in 18 hours and then declines till 3 days
MITRAL VALVE lies behind the apex beat (5th ICS - 0-5% of total CK (26-174U/L)
left half of the LMCL)
sternum;
- Normal value is 0-7 U/L
opposite the 4th
Lactate Dehydrogenase (LDH)
costal cartilage
PULMONARY Lies behind the Medial end of the - Elevates in MI in 24 hours
VALVE medial end of 2nd left ICS - peaks in 48-72 hours
the 3rd left - Normally LDH1 is greater than LDH2
costal cartilage & - MI- LDH2 greater than LDH1 (flipped LDH pattern)
the adjoining
part of the
- Normal value is 70-200 IU/L
sternum
Myoglobin
AORTIC VALVE Behind left half Medial end of the
of sternum; 2nd right ICS - Oxygen binding protein
opposite 3rd ICS - Found in both skeletal and cardiac
- Level rises 1 hour after cell death
- Peaks in 4-6 hours
- Returns to normal w/in 24-36 hours
- Not used alone
- Muscular and RENAL disease can have elevated myoglobin
Troponin I and T
- Troponin I has a high affinity for myocardial injury
- Elevates within 3-4 hours, peaks in 4-24 hours and
persists for 7 days to 3 weeks!
- Troponin I - <0.6 ng/mL
- Troponin T – 0-0.2ng/mL
- REMEMBER to AVOID IM injections before obtaining blood
sample!
- Early and late diagnosis can be made!
SERUM LIPIDS
- Lipid profile measures the serum cholesterol, triglycerides
and lipoprotein levels
- Cholesterol= 200 mg/dL
- Triglycerides- 40- 150 mg/dL
- LDL- 130 mg/dL
- HDL- 30-70- mg/dL
- NPO post midnight (usually 12 hours)
CARDIOVASCULAR SYSTEM
Echocardiogram
ELECTROCARDIOGRAM (ECG) – Non-invasive test that studies the structural and functional
- A non-invasive procedure that evaluates the electrical changes of the heart with the use of ultrasound
activity of the heart – No special preparation is needed
- Electrodes and wires are attached to the patient
- Tell the patient that there is no risk of electrocution
- Avoid muscular contraction/movement
Stress Test
– A non-invasive test that studies the heart during activity
and detects and evaluates CAD
– Exercise test, pharmacologic test and emotional test
– Treadmill testing is the most commonly used stress test
– Used to determine CAD, Chest pain causes, drug effects
and dysrhythmias in exercise
– Pre-test: consent may be required, adequate rest , eat a
light meal or fast for 4 hours and avoid smoking, alcohol
and caffeine
– Post-test: instruct client to notify the physician if any
chest pain, dizziness or shortness of breath
– Instruct client to avoid taking a hot shower for 10-12
hours after the test
– Pharmacological stress test
Use of dipyridamole
Maximally dilates coronary artery
Side-effect: flushing of face
Pre-test: 4 hours fasting, avoid alcohol, caffeine
Post test: report symptoms of chest pain
Holter Monitoring Cardiac Catheterization
- A non-invasive test in which the client wears a Holter – Insertion of a catheter into the heart and surrounding
monitor and an ECG tracing recorded continuously over a vessels
period of 24 hours – Obtains information about the structure and performance
- Instruct the client to resume normal activities and of the heart valves and surrounding vessels
maintain a diary of activities and any symptoms that may – Used to diagnose CAD, assess coronary artery patency
develop and determine extent of atherosclerosis
PRE PROCEDURE
Ensure Consent
assess for allergy to seafood and iodine
Withhold solid food 6-8 hours and liquids for 4 hours
document weight and height, baseline VS, blood tests
and document the peripheral pulses
inform client that a local anesthetic will be administered
before insertion
Client may feel fatigued because of the need to lie for 2
hours
Prepare IV line if prescribed
CARDIOVASCULAR SYSTEM
Prepare insertion site by shaving and cleaning with an
antiseptic solution if prescribed
Administer pre medication
INTRATEST
inform patient of a fluttery feeling as the catheter
passes through the heart
inform the patient that a feeling of warmth and metallic
taste may occur when dye is administered.
POST TEST
Monitor VS and cardiac rhythm
Monitor dysrrhytmia and chest pain
Monitor peripheral pulses, color and warmth and
sensation of the extremity distal to insertion site
Apply sandbag or compression device to insertion site if
required to maintain pressure
Maintain strict bed rest for 6-12 hours
Client may turn from side to side but bed should not be
elevated more than 15 degrees Cardiac Implementation
Notify physician if client complains of tingling, cool, pale, 1. Assess the cardio-pulmonary status
cyanosis and loss of peripheral pulses - VS, BP, Cardiac assessment
Keep the leg straight to prevent occlusion 2. Enhance cardiac output
Monitor for bleeding and hematoma formation - Establish IV line to administer fluids
Encourage fluid intake to flush out the dye 3. Promote gas exchange
Immobilize the arm if the antecubital vein is used - Administer O2
Monitor for dye allergy - Position client in SEMI-Fowler’s
Encourage fluid intake to promote renal excretion of dye - Encourage coughing and deep breathing exercises
Monitor nausea, vomiting, rash and other sign of HPS 4. Increase client activity tolerance
rxn
- Balance rest and activity periods
CVP - Assist in daily activities
– The CVP is the pressure within the SVC - Provide strict bed rest if indicated
– Reflects the pressure under which blood is returned to the - Soft foods
SVC and right atrium - Assistance in self-care
– is measured with a central venous line in the SVC and 5. Promote client comfort
balloon flotation catheter in the pulmonary artery - Assess the client’s description of pain and chest discomfort
– Normal CVP is 3 to 8 mmHg/ 4-10 cm H2O - Administer medication as prescribed
Morphine for MI
Increased CVP Nitroglycerine for Angina
1. increase in blood volume as a result of Na and water Diuretics to relieve congestion (CHF)
retention, excessive IVF or heart/renal failure 6. Promote adequate sleep
7. Prevent infection
Decreased CVP - Monitor skin integrity of lower extremities
2. May indicate decrease in circulating blood volume and - Assess skin site for edema, redness and warmth
may be to hypovolemia, hemorrhage and severe - Monitor for fever
vasodilatation
- Change position frequently
Measuring CVP
8. Minimize patient anxiety
1. Position the client supine with bed elevated at 45 Encourage verbalization of feelings, fears and
degrees (CBQ) concerns
2. Position the zero point of the CVP line at the level of Answer client questions. Provide information about
the right atrium. Usually this is at the MAL, 4th ICS procedures and medications
3. Instruct the client to be relaxed and avoid coughing
and straining.
note disease that activity that increases intra-thoracic
pressure such as coughing and straining
If the client is on the ventilator reading should be
taken at the point of end expiration
CARDIOVASCULAR SYSTEM
Activity Intolerance Monitor TPR and BP Most important MODIFIABLE factors:
Space activities in the - Smoking
day - Hypertension
Permit rest periods
before activity
- Diabetes
Limit activity 1 hour - Cholesterol abnormalities
before meals
Teach energy CAD: Pathophysiology
conservation measures
like bed rest - Fatty streak formation in the vascular intima
Edema Instruct patient to avoid - ↓
constricting garments - T-cells and monocytes ingest lipids in the area of
Instruct to elevate deposition
edematous areas
Instruct patient to avoid
- ↓
dependent positions - Atheroma
Teach patient to prepare - ↓
low sodium meals - narrowing of the arterial lumen
Apply anti-embolic
stockings
- ↓
Pain Instruct patient to stop - reduced coronary blood flow
activity when pain occurs - ↓
Administer nitroglycerine - myocardial ischemia
for angina
Pace activities within Pathophysiology
patient’s limits - There is decreased perfusion of myocardial tissue and
Instruct patient to avoid inadequate myocardial oxygen supply
cold temperatures and
smoking - If 50% of the left coronary arterial lumen is reduced or
Instruct to report 75% of the other coronary artery, this becomes significant
unrelieved pain - Potential for Thrombosis and embolism
immediately
Artery walls have three layers.
1. The inner layer provides a slippery surface.
Cardiac Diseases 2. The middle layer is strong, elastic and muscular.
Coronary Artery Disease 3. The outer, fibrous, layer adds strength and contains
Myocardial Infarction tiny blood vessels that supply blood to the arteries
Congestive Heart Failure themselves.
Infective Endocarditis
Cardiac Tamponade Narrowing or obstruction of the coronary arteries is the
Cardiogenic Shock main cause of a group of disorders known as ischaemic
heart disease.
Vascular Diseases Coronary Artery Disease.
Hypertension
Buerger’s disease
- Acute Coronary Syndrome (ACS) is the phrase used
when referring to any cardiac condition involving the
Aneurysm
coronary arteries.
Varicose veins
Deep vein thrombosis - Angina is a feeling of tightness or pain across the chest
that may spread outwards to the shoulders, upper arms
and back.
Coronary Artery Disease (CAD) May occur with exercise or strong emotion and can be
- results from the focal narrowing of the large and medium- worse after a meal or in cold weather. Symptoms usually
disappear after 1-2 minutes rest.
sized coronary arteries due to deposition of atheromatous
plaque in the vessel wall - Heart attack (myocardial infarction or MI) is when
part of the heart muscle dies. This is usually caused by a
Risk Factors blood clot (coronary thrombosis), which has blocked one
1. Age above 45/55 and Sex- Males and post-menopausal of the coronary arteries supplying the heart and depriving
females the tissues of oxygen.
2. Family History
3. Hypertension
4. DM
5. Smoking
6. Obesity
7. Sedentary lifestyle
8. Hyperlipedimia
CARDIOVASCULAR SYSTEM
Coronary Artery Disease treatment
Angioplasty & Stent
Coronary Artery Bypass Graft.
- Treatment for C.A.D involves the removal or treatment of
risk factors.
- Sometimes procedures to enlarge or bypass coronary
artery narrowing are required.
- If Coronary Disease is not treated and the coronary artery
becomes blocked the result may be a heart attack.
Angioplasty
- Coronary angioplasty involves inserting a balloon into a
diseased (blocked/narrowed) coronary artery through an
artery in the groin or arm.
- Commonly a metal support (stent) is inserted into the
artery to help keep it open.
CARDIOVASCULAR SYSTEM
A close up of a Stent.
Valve Replacements
- Aortic Valve Replacement (AVR)
- Mitral Valve Replacement (MVR)
C. A. B. G.
- Veins and sometimes arteries are grafted from the aorta
to a point on the coronary artery beyond the area of
disease. This enables an adequate blood supply to reach
those parts of the heart suffering from ischaemia
- An Assortment of Replacement Valves
CARDIOVASCULAR SYSTEM
Angina Pectoris: Clinical Syndromes
Artificial Valves
Three Common Types of Angina
1. Stable Angina
- The typical angina that occurs during exertion,
relieved by rest and drugs and the severity does not
change
2. Unstable angina
- Occurs unpredictably during exertion and emotion,
severity increases with time and pain may not be
relieved by rest and drug
Tissue Valves 3. Variant angina
- Prinzmetal angina, results from coronary artery
VASOSPASMS, may occur at rest
ASSESSMENT FINDINGS
1. Chest pain - ANGINA
- The most characteristic symptom
- PAIN is described as mild to severe retrosternal pain,
squeezing, tightness or burning sensation
- Radiates to the jaw and left arm
- Precipitated by Exercise, Eating heavy meals, Emotions
like excitement and anxiety and Extremes of
temperature
- Relieved by REST and Nitroglycerin
2. Diaphoresis
3. Nausea and vomiting
4. Cold clammy skin
5. Sense of apprehension and doom
6. Dizziness and syncope
LABORATORY FINDINGS
Mitral Valves 1. ECG may show normal tracing if patient is pain-free.
Ischemic changes may show ST depression and T wave
inversion
Tricuspid & Bicuspid
2. Cardiac catheterization
3. Provides the MOST DEFINITIVE source of diagnosis by
showing the presence of the atherosclerotic lesions
- Decreased cardiac output
- Impaired gas exchange
- Activity intolerance
- Anxiety
Angina Pectoris
- Chest pain resulting from coronary atherosclerosis or
myocardial ischemia
CARDIOVASCULAR SYSTEM
Nursing Management
1. Administer prescribed medications
Nitrates- to dilate the venous vessels decreasing
venous return and to some extent dilate the coronary
arteries
Aspirin- to prevent thrombus formation
Beta-blockers- to reduce BP and HR
Calcium-channel blockers- to dilate coronary artery and
reduce vasospasm
2. Teach the patient management of anginal attacks
Advise patient to stop all activities
Put one nitroglycerin tablet under the tongue
Wait for 5 minutes
If not relieved, take another tablet and wait for 5
minutes
Another tablet can be taken (third tablet)
If unrelieved after THREE tablets seek medical
attention
3. Obtain a 12-lead ECG
Myocardial infarction
- Death of myocardial tissue in regions of the heart with
abrupt interruption of coronary blood supply
4. Promote myocardial perfusion
Instruct patient to maintain bed rest
Administer O2 @ 3 lpm
Advise to avoid valsalva maneuvers
Provide laxatives or high fiber diet to lessen
constipation ETIOLOGY and Risk factors
Encourage to avoid increased physical activities 1. CAD
2. Coronary vasospasm
5. Assist in possible treatment modalities 3. Coronary artery occlusion by embolus and thrombus
PTCA- percutaneous transluminal coronary angioplasty 4. Conditions that decrease perfusion- hemorrhage, shock
To compress the plaque against the vessel wall,
increasing the arterial lumen Risk factors
CABG- coronary artery bypass graft 1. Hypercholesterolemia
To improve the blood flow to the myocardial tissue 2. Smoking
3. Hypertension
6. Provide information to family members to minimize 4. Obesity
anxiety and promote family cooperation 5. Stress
7. Assist client to identify risk factors that can be modified 6. Sedentary lifestyle
8. Refer patient to proper agencies
Pathophysiology
- Interrupted coronary blood flow myocardial ischemia
anaerobic myocardial metabolism for several hours
myocardial death depressed cardiac function
triggers autonomic nervous system response further
imbalance of myocardial O2 demand and supply
CARDIOVASCULAR SYSTEM
Assessment Findings 7. Monitor for complications of MI- especially
1. Chest Pain dysrhythmias, since ventricular tachycardia can happen
- Chest pain is described as severe, persistent, crushing in the first few hours after MI
substernal discomfort 8. Provide client teaching
- Radiates to the neck, arm, jaw and back
- Occurs without cause, primarily early morning
- NOT relieved by rest or nitroglycerin
- Lasts 30 minutes or longer
2. Dyspnea
3. Diaphoresis
4. cold clammy skin
5. N/V
6. restlessness, sense of doom
7. tachycardia or bradycardia
8. hypotension
9. S3 and dysrhythmias
Laboratory Findings
1. ECG- the ST segment is ELEVATED, T wave inversion,
presence of Q wave
2. Myocardial enzymes- elevated CK-MB, LDH and
Troponin levels
Medical Management
1. Analgesic
- The choice is MORPHINE
- It reduces pain and anxiety
- Relaxes bronchioles to enhance oxygenation
2. ACE inhibitors
- Prevents formation of angiotensin II
- Limits the area of infarction
3. Thrombolytic therapy
- Streptokinase, Alteplase
- Dissolve clots in the coronary artery allowing blood to
flow
Nursing Interventions After Acute Episode
3. CBC- may show elevated WBC count
1. Maintain bed rest for the first 3 days
4. Test after the acute stage - Exercise tolerance test,
2. Provide passive ROM exercises
thallium scans, cardiac catheterization
3. Progress with dangling of the feet at side of bed
Pain
4. Proceed with sitting out of bed, on the chair for 30
- Decreased cardiac output minutes TID
- Impaired gas exchange 5. Proceed with ambulation in the room toilet
- Activity intolerance hallway TID
- Altered tissue perfusion 6. Cardiac rehabilitation
- Constipation - To extend and improve quality of life
- Physical conditioning
Nursing Intevention - Patients who are able to walk 3-4 mph are usually
1. Provide Oxygen at 2 lpm, Semi-fowler’s ready to resume sexual activities
2. Administer medications
- Morphine to relieve pain Cardiomyopathies
- Nitrates, thrombolytics, aspirin and anticoagulants - Heart muscle disease associated with cardiac dysfunction
- Stool softener and hypolipidemics 1. Dilated Cardiomyopathy
3. Minimize patient anxiety 2. Hypertrophic Cardiomyopathy
3. Restrictive cardiomyopathy
- Provide information as to procedures and drug therapy
- Allow verbalization of feelings Dilated Cardiomyopathy
- Morphine can be administered Associated Factors
4. Provide adequate rest periods 1. Heavy alcohol intake
- Bed rest during acute stage 2. Pregnancy
5. Minimize metabolic demands
3. Viral infection
- Provide soft diet 4. Idiopathic
- Provide a low-sodium, low cholesterol and low fat diet
6. Assist in treatment modalities such as PTCA and CABG
CARDIOVASCULAR SYSTEM
Pathophysiology
Diminished contractile proteins poor contraction Risk factors
decreased blood ejection increased blood remaining 1. Prosthetic valves
in the ventricle ventricular stretching and dilatation.
2. Congenital malformation
Systolic Dysfunction
3. Cardiomyopathy
Hypertrophic Cardiomyopathy 4. IV drug users
Associated factors: 5. Valvular dysfunctions
1. Genetic
2. Idiopathic Pathophysiology
Direct invasion of microbes
Pathophysiology ↓
Increased size of myocardium reduced ventricular microbes adhere to damaged valve surface and proliferate
volume increased resistance to ventricular filling ↓
diastolic dysfunction damage attracts platelets causing clot formation
↓
Restrictive Cardiomyopathy erosion of valvular leaflets and the clot and vegetation can
Associated factors embolize
1. Infiltrative diseases like AMYLOIDOSIS Assessment findings
2. Idiopathic 1. Intermittent high grade fever
2. anorexia, weight loss
Pathophysiology 3. cough, back pain and joint pain
Rigid ventricular wall impaired stretch and diastolic 4. splinter hemorrhages under nails
5. Osler’s nodes- painful nodules on fingerpads
Diastolic dysfunction 6. Roth’s spots- pale hemorrhages in the retina
7. Heart murmurs
8. Heart failure= usually acute heart failure
Assessment findings Prevention
1. PND - Antibiotic prophylaxis if patient is undergoing
2. Orthopnea procedures like dental extractions, bronchoscopy,
3. Edema surgery, etc.
4. Chest pain
- Any invasive procedure that is associated with transient
5. Palpitations
bacteremia may cause the microrganism to lodge in the
6. Dizziness
damaged, irregular valves
7. Syncope with exertion
Laboratory Exam
Laboratory Findings - Blood Cultures to determine the exact organism
CXR- may reveal cardiomegaly Usually, 3 culture specimens are obtained and
Echocardiogram antibiotic sensitivity done
ECG
Myocardial Biopsy Nursing management
1. Regular monitoring of temperature, heart sounds
Medical Management 2. Manage infection
1. Surgery - heart transplant 3. Long-term antibiotic therapy is given to ensure
2. Pacemaker insertion eradication of bacteria
3. Pharmacological drugs for symptom relief
Medical management
Nursing Management 1. Pharmacotherapy
1. Improve cardiac output - IV antibiotic for 2-6 weeks
- Adequate rest - Antifungal agents are given – amphotericin B
- Oxygen therapy 2. Surgery
3. Valvular replacement
- Low sodium diet
2. Increase patient tolerance
Congestive Heart Failure (CHF)
- Schedule activities with rest periods in between - A syndrome of congestion of both pulmonary and systemic
3. Reduce patient anxiety
circulation caused by inadequate cardiac function and
- Support patient inadequate cardiac output to meet the metabolic demands
- Offer information about transplantations of tissues
- Support family in anticipatory grieving - Inability of the heart to pump sufficiently
- The heart is unable to maintain adequate circulation to
Infective endocarditis meet the metabolic needs of the body
- Infection of the heart valves and the endothelial surface
of the heart This can happen acutely or chronically
Can be acute, sub-acute or chronic - Acute in Myocardial infarction
- Chronic cardiomyopathies
Etiologic factors
1. Bacteria- Organism depends on several factors
2. Fungi
CARDIOVASCULAR SYSTEM
Classified according to the major ventricular PATHOPHYSIOLOGY
dysfunction LEFT Ventricular pump failure
1. Left Ventricular failure ↓
2. Right ventricular failure back up of blood into the pulmonary veins
↓
increased pulmonary capillary pressure
↓
pulmonary congestion (edema)
↓
Pulmonary manifestations
LEFT ventricular failure
↓
Decreased cardiac output
↓
Decreased perfusion to the brain, kidney and other tissues
↓
Cerebral anoxia, fatigue, oliguria, dizziness
RIGHT ventricular failure
↓
blood pooling in the venous circulation
↓
increased hydrostatic pressure
↓
Etiology of CHF peripheral edema
1. CAD ↓
2. Valvular heart diseases RIGHT ventricular failure
3. Hypertension ↓
4. MI Venous blood pooling
5. Cardiomyopathy ↓
6. Lung diseases venous congestion in the kidney, liver and GIT
7. Post-partum Left Sided CHF Assessment Findings
8. Pericarditis and cardiac tamponade 1. Dyspnea on exertion, activity intolerance
2. PND
New York Heart Association 3. Orthopnea
Class 1 4. Pulmonary crackles/rales
- Ordinary physical activity does NOT cause chest pain 5. Cough with Pinkish, frothy sputum
and fatigue 6. Tachycardia
- No pulmonary congestion 7. Cool extremities
- Asymptomatic 8. Cyanosis
9. decreased peripheral pulses
- NO limitation of ADLs
10. Fatigue
11. Oliguria
Class 2
12. signs of cerebral anoxia
- SLIGHT limitation of ADLs
- NO symptom at rest Right Sided CHF Assessment Findings
- Symptoms with INCREASED activity 1. Peripheral dependent, pitting edema
- Basilar crackles and S3 2. Weight gain
3. Distended neck vein
- New York Heart Association
4. hepatomegaly
5. Ascites
6. Body weakness
Class 3
7. Anorexia, nausea
- Markedly limitation on ADLs 8. Pulsus alternans
- Comfortable at rest BUT symptoms present in LESS than 9. Nocturia= urination at night at frequent intervals as
ordinary activity the blood moves from interstitial space to the
intravascular space and is excreted
Class 4
- SYMPTOMS are present at rest Laboratory Findings
1. CXR may reveal cardiomegaly
2. ECG may identify Cardiac hypertrophy
3. Echocardiogram may show hypokinetic heart
4. ABG and Pulse oximetry may show decreased O2
saturation
5. PCWP is increased in LEFT sided CHF and CVP is
increased in RIGHT sided CHF
CARDIOVASCULAR SYSTEM
Nursing Interventions Laboratory Findings
1. Assess patient's cardio-pulmonary status - Increased CVP due to pooling of blood in the venous
2. Assess VS, CVP and PCWP. Weigh patient daily to system
monitor fluid retention Normal is 4-10 cmH2O
3. Administer medications- usually cardiac glycosides are
given- DIGOXIN or DIGITOXIN, Diuretics, vasodilators
- Metabolic acidosis
and hypolipidemics are prescribed
Nursing Interventions
1. Place patient in a modified Trendelenburg (shock )
Cardiotonics To increase cardiac
position
Positive inotropic agents contractility
2. Administer IVF, vasopressors and inotropics such as
Diuretics To decrease the intravascular DOPAMINE and DOBUTAMINE
volume in the circulation 3. Administer O2
Low Sodium Diet To minimize water retention 4. Morphine is administered to decreased pulmonary
Hypolipidemics To decrease the lipid levels of congestion and to relieve pain, relieve anxiety
high risk patients 5. Assist in intubation, mechanical ventilation, PTCA,
CABG, insertion of Swan-Ganz cath and IABP
Digoxin Health teaching 6. Monitor urinary output, BP and pulses
- Oral tablet usually once a day 7. Cautiously administer diuretics and nitrates
- Increases force of contraction
- DECREASES heart rate CARDIAC TAMPONADE
- Assess: Apical pulse, ECG, hypokalemia - A condition where the heart is unable to pump blood due
to accumulation of fluid in the pericardial sac (pericardial
- Withhold the drug if apical pulse is less than 60 effusion)
- Note for early signs of toxicity: NAVDA - This condition restricts ventricular filling resulting to
- Provide potassium supplements decreased cardiac output
- Acute tamponade may happen when there is a sudden
4. Provide a LOW sodium diet. Limit fluid intake as
accumulation of more than 50 ml fluid in the pericardial
necessary
sac
5. Provide adequate rest periods to prevent fatigue
Causative factors
6. Position on semi-fowler’s to fowler’s for adequate
1. Cardiac trauma
chest expansion
2. Complication of Myocardial infarction
7. Prevent complications of immobility
3. Pericarditis
4. Cancer metastasis
Nursing Intervention after the Acute Stage
1. Provide opportunities for verbalization of feelings
Assessment Findings
2. Instruct the patient about the medication regimen-
1. BECK’s Triad- Jugular vein distention, hypotension and
digitalis, vasodilators and diuretics
distant/muffled heart sound
3. Instruct to avoid OTC drugs, Stimulants, smoking and
2. Pulsus paradoxus
alcohol
3. Increased CVP
4. Provide a LOW fat and LOW sodium diet
4. decreased cardiac output
5. Provide potassium supplements
5. Syncope
6. Instruct about fluid restriction
6. anxiety
7. Provide adequate rest periods and schedule activities
7. dyspnea
8. Monitor daily weight and report signs of fluid retention
8. Percussion- Flatness across the anterior chest
Cardiogenic Shock
Laboratory Findings
- Heart fails to pump adequately resulting to a decreased 1. Echocardiogram= shows accumulate fluid in the
cardiac output and decreased tissue perfusion pericardial sac
2. Chest X-ray
Etiology
1. Massive MI Nursing Interventions
2. Severe CHF 1. Assist in PERICARDIOCENTESIS
3. Cardiomyopathy 2. Administer IVF
4. Cardiac trauma 3. Monitor ECG, urine output and BP
5. Cardiac tamponade 4. Monitor for recurrence of tamponade
Assessment Findings Pericardiocentesis
1. HYPOTENSION
- Patient is monitored by ECG
2. Oliguria (less than 30 ml/hour)
3. Tachycardia - Maintain emergency equipments
4. Narrow pulse pressure - Elevate head of bed 45-60 degrees
5. weak peripheral pulses - Monitor for complications- coronary artery rupture,
6. cold clammy skin dysrhythmias, pleural laceration and myocardial trauma
7. changes in sensorium/LOC
8. pulmonary congestion
CARDIOVASCULAR SYSTEM
Vascular Diseases Pathophysiology
- Multi-factorial etiology
o BP= CO (SV X HR) x TPR
Any increase in the above parameters will increase BP
Risk factors for Cardiovascular Problems in
Hypertensive patients
Major Risk factors
1. Smoking
2. Hyperlipidemia
3. DM
4. Age older than 60
5. Gender- Male and post menopausal women
6. Family History
General Measures to Improve Peripheral Circulation
1. Implement Regular Physical Activity – to facilitate
movement of venous blood
2. Eliminate cigarette smoking- to prevent vasoconstriction
3. Control hyperlipidemia and cholesterol levels- to prevent
the progression of atherosclerosis
4. Avoid cold environmental temperature
5. Teach clients to assess fingers and toes daily for
circulatory adequacy: Check the peripheral pulses,
capillary refill and temp
6. Report break in the skin
Hypertension
- A systolic BP greater than 140 mmHg and a diastolic
pressure greater than 90 mmHg over a sustained period,
Any increase in the above parameters will increase BP
based on two or more BP measurements.
1. Increased sympathetic activity
2. Increased absorption of Sodium, and water in the
Types of Hypertension
kidney
1. Primary or Essential
3. Increased activity of the RAAS
- Most common type 4. Increased vasoconstriction of the peripheral vessels
2. Secondary 5. Insulin resistance
- Due to other conditions like Pheochromocytoma,
renovascular hypertension, Cushing’s, Conn’s , SIADH Assessment Findings
1. Headache
Classification Of Hypertension By Jnc-Vii 2. Visual changes
3. chest pain
4. dizziness
5. N/V
Diagnostic Studies
1. Health history and PE
2. Routine laboratory- urinalysis, ECG, lipid profile, BUN,
serum creatinine , FBS
3. Other lab- CXR, creatinine clearance, 24-huour urine
protein
Medical Management
1. Lifestyle modification
2. Diet therapy
3. Drug therapy
MEDICAL MANAGEMENT
Drug therapy
- Diuretics
- Beta blockers
- Calcium channel blockers
- ACE inhibitors
- A2 Receptor blockers
- Vasodilators
CARDIOVASCULAR SYSTEM
Nursing Interventions Peripheral Arterial Occlusive Disease
1. Provide health teaching to patient - Refers to arterial insufficiency of the extremities usually
- Teach about the disease process secondary to peripheral atherosclerosis.
- Elaborate on lifestyle changes - Usually found in males age 50 and above
- Assist in meal planning to lose weight - The legs are most often affected
- Provide list of LOW fat , LOW sodium diet of less than 2-
3 grams of Na/day Risk factors for Peripheral Arterial occlusive disease
- Limit alcohol intake to 30 ml/day Non-Modifiable
1. Age
- Regular aerobic exercise 2. gender
- Advise to completely Stop smoking 3. family predisposition
2. Provide information about anti-hypertensive drugs Modifiable
- Instruct proper compliance and not abrupt cessation of 1. Smoking
drugs even if pt becomes asymptomatic/ improved 2. HPN
condition 3. Obesity
- Instruct to avoid over-the-counter drugs that may 4. Sedentary lifestyle
interfere with the current medication 5. DM
6. Stress
3. Promote Home care management
Assessment Findings
- Instruct regular monitoring of BP
1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
- Involve family members in care
- This is PAIN described as aching, cramping or fatiguing
- Instruct regular follow-up discomfort consistently reproduced with the same
4. Manage hypertensive emergency and urgency properly degree of exercise or activity
Aneurysm
- This pain is RELIEVED by REST
- Dilation involving an artery formed at a weak point in the - This commonly affects the muscle group below the
arterial occlusion
vessel wall
2. Progressive pain on the extremity as the disease
- Saccular= when one side of the vessel is affected advances
- Fusiform= when the entire segment becomes dilated 3. Sensation of cold and numbness of the extremities
4. Skin is pale when elevated and cyanotic and ruddy
Risk Factors when placed on a dependent position
1. Atherosclerosis 5. Muscle atrophy, leg ulceration and gangrene
2. Infection= syphilis
3. Connective tissue disorder Diagnostic Findings
4. Genetic disorder= Marfan’s Syndrome 1. Unequal pulses between the extremities
2. Duplex ultrasonography
Pathophysiology 3. Doppler flow studies
- Damage to the intima and media
outpouching of vessel wall Medical Management
- 1. Drug therapy
dissection of blood through the layers - Pentoxyfylline (Trental) reduces blood viscosity and
improves supply of O2 blood to muscles
Assessment - Cilostazol (Pletaal) inhibits platelet aggregation and
1. Asymptomatic increases vasodilatation
2. Pulsatile sensation on the abdomen 2. Surgery- Bypass graft and anastomoses
3. Palpable bruit
Nursing Interventions
Laboratory: 1. Maintain Circulation to the extremity
- CT scan - Evaluate regularly peripheral pulses, temperature,
- Ultrasound sensation, motor function and capillary refill time
- X-ray - Administer post-operative care to patient who
- Aortography underwent surgery
- Administer heat modalities to the leg cautiously to
Medical Management: promote vasodilatation
- Anti-hypertensives
2. Monitor and manage complications
- Synthetic graft
- Note for bleeding, hematoma, and decreased urine
Nursing Management: output
- Administer medications - Elevate the legs to diminish edema
- Emphasize the need to avoid increased abdominal - Encourage exercise of the extremity while on bed
pressure - Teach patient to avoid leg-crossing
- No deep abdominal palpation
- Remind patient the need for serial ultrasound to detect
diameter changes.
CARDIOVASCULAR SYSTEM
3. Promote Home management Raynaud’s Disease
- Encourage lifestyle changes - A form of intermittent arteriolar VASOCONSTRICTION that
- Instruct to AVOID smoking results in coldness, pain and pallor of the fingertips or toes
- Instruct to avoid leg crossing - Cause : UNKNOWN
- Most commonly affects WOMEN, 16- 40 years old
BUERGER’S DISEASE
Thromboangiitis obliterans
- A disease characterized by recurring inflammation of the
medium and small arteries and veins of the lower
extremities
- Occurs in MEN ages 20-35
- RISK FACTOR: SMOKING!
Pathophysiology
- Cause is UNKNOWN
- Probably an Autoimmune disease
- Inflammation of the arteries and veins thrombus
formation occlusion of the vessels
Assessment Findings
1. Raynaud’s phenomenon
- A localized episode of vasoconstriction of the small
arteries of the hands and feet that causes color and
temperature changes
W-B-R is the acronym for the color change
- Pallor- due to vasoconstriction, then
- Blue- due to pooling of Deoxygenated blood
- Red- due to exaggerated reflow or hyperemia
2. Tingling sensation
3. Burning pain on the hands and feet
Medical management
- Drug therapy with the use of CALCIUM channel blockers
To prevent vasospasms
Assessment Findings Nursing Interventions
1. Leg PAIN 1. Instruct patient to avoid situations that may be
- Foot cramps in the arch stressful
2. Instruct to avoid exposure to cold and remain indoors
- (INSTEP CLAUDICATION) after exercise when the climate is cold
- Relieved by rest 3. Instruct to avoid all kinds of nicotine
- Aggravated by smoking, emotional disturbance and cold 4. Instruct about safety. Careful handling of sharp objects
chilling
Venous diseases
2. Digital rest pain not changed by activity or rest
3. Intense RUBOR (reddish-blue discoloration),
progresses to CYANOSIS as disease advances
4. Paresthesias
Diagnostic Studies
1. Duplex ultrasonography
2. Contrast angiography
Nursing Interventions
1. Assist in the medical and surgical management
- Bypass graft
- amputation
2. Strongly advise to AVOID smoking
3. Manage complications appropriately
Post-operative care: after amputation
- Elevate stump for the FIRST 24 HOURS to minimize
edema and promote venous return
- Place patient on PRONE position after 24 hours several
times a day
- Assess skin for bleeding and hematoma
- Wrap the extremity with elastic bandage
CARDIOVASCULAR SYSTEM
Varicose Veins Medical management
- THESE are dilated veins usually in the lower extremities - Antiplatelets- aspirin
- Anticoagulants
Predisposing Factors - Vein stripping and grafting
Pregnancy
Prolonged standing or sitting - Anti-embolic stockings
Incompetent venous valves
Nursing management
Pathophysiology 1. Provide measures to avoid prolonged immobility
Factors venous stasis - Repositioning Q2
- Provide passive ROM
- Early ambulation
Assessment findings 2. Provide skin care to prevent the complication of leg
- Tortuous superficial veins on the legs ulcers
- Leg pain and Heaviness 3. Provide anti-embolic stockings
- Dependent edema 4. Administer anticoagulants as prescribed
5. Monitor for signs of pulmonary embolism sudden
Laboratory findings respiratory distress
- Venography
- Duplex scan pletysmography
Medical management
- Pharmacological therapy
- Leg vein stripping and ligation
- Anti-embolic stockings
Nursing management
1. Advise patient to elevate the legs with pillow to
increase venous return
2. Caution patient to avoid prolonged standing or sitting
3. Provide high-fiber foods to prevent constipation
4. Teach simple exercise to promote venous return Blood disorders
5. Caution patient to avoid constrictive clothing Anemia
6. Apply anti-embolic stockings as directed Nutritional anemia
7. Avoid massage on the affected area Hemolytic anemia
Aplastic anemia
DVT- Deep Vein Thrombosis Sickle cell anemia
- Inflammation of the deep veins of the lower extremities
and the pelvic veins Anemia
- The inflammation results to formation of blood clots in the - A condition in which the hemoglobin concentration is lower
area than normal
Predisposing factors
Three broad categories
- Prolonged immobility 1. Loss of RBC- occurs with bleeding
- Varicosities 2. Decreased RBC production
- Traumatic procedures 3. Increased RBC destruction
- Increased age
- Malignancy Hypoproliferative Anemia
Iron Deficiency Anemia
- Estrogen therapy
- Results when the dietary intake of iron is inadequate to
- Smoking produce hemoglobin
Complication
Etiologic Factors
- PULMONARY thromboembolism 1. Bleeding- the most common cause
2. Mal-absorption
Assessment findings 3. Malnutrition
- Leg tenderness 4. Alcoholism
- Leg pain and edema
- Positive HOMAN’s SIGN Pathophysiology
HOMAN’s SIGN - The body stores of iron decrease, leading to depletion
The foot is FLEXED upward (dorsiflexed) , there is a sharp of hemoglobin synthesis
pain felt in the calf of the leg indicative of venous - The oxygen carrying capacity of hemoglobin is
inflammation reduced tissue hypoxia
Laboratory findings
- Venography
- Duplex scan
CARDIOVASCULAR SYSTEM
Assessment Findings - splenomegaly
1. Pallor of the skin and mucous membrane - retinal hemorrhages
2. Weakness and fatigue
3. General malaise
Laboratory Findings
4. Pica
1. CBC- decreased blood cell numbers
5. Brittle nails
2. Bone marrow aspiration confirms the anemia-
6. Smooth and sore tongue
hypoplastic or acellular marrow replaced by fats
7. Angular cheilosis
Medical Management
Laboratory findings
1. Bone marrow transplantation
1. CBC- Low levels of Hct, Hgb and RBC count
2. Immunosupressant drugs
2. Low serum iron, low ferritin
3. Rarely, steroids
3. Bone marrow aspiration- MOST definitive
4. Blood transfusion
Medical management
Nursing management
1. Hematinics
1. Assess for signs of bleeding and infection
2. Blood transfusion
2. Instruct to avoid exposure to offending agents
Nursing Management
Megaloblastic Anemias
1. Provide iron rich-foods
- Anemias characterized by abnormally large RBC
- Organ meats (liver) secondary to impaired DNA synthesis due to deficiency
- Beans of Folic acid and/or vitamin B12
- Leafy green vegetables Folic Acid deficiency
- Raisins and molasses Causative factors
1. Alcoholism
2. Administer iron 2. Mal-absorption
- Oral preparations tablets- Fe fumarate, sulfate and 3. Diet deficient in uncooked vegetables
gluconate
Pathophysiology of Folic acid deficiency
- Advise to take iron ONE hour before meals Decreased folic acid
- Take it with vitamin C ↓
- Continue taking it for several months impaired DNA synthesis in the bone marrow
- Oral preparations- liquid ↓
Impaired RBC development, impaired nuclear maturation but
- It stains teeth
CYTOplasmic maturation continues
- Drink it with a straw ↓
- Stool may turn blackish- dark in color large size
- Advise to eat high-fiber diet to counteract constipation
- IM preparation
Vitamin B12 deficiency
- Administer DEEP IM using the Z-track method
Causative factors
- Avoid vigorous rubbing 1. Strict vegetarian diet
- Can cause local pain and staining 2. Gastrointestinal mal-absorption
3. Crohn's disease
Aplastic Anemia 4. Gastrectomy
- A condition characterized by decreased number of RBC Vitamin B12 deficiency: Pernicious Anemia
as well as WBC and platelets - Due to the absence of intrinsic factor secreted by the
parietal cells
Causative Factors - Intrinsic factor binds with Vit. B12 to promote
1. Environmental toxins- pesticides, benzene absorption
2. Certain drugs- Chemotherapeutic agents,
chloramphenicol, phenothiazines, Sulfonamides Assessment findings
3. Heavy metals 1. weakness
4. Radiation 2. fatigue
3. listless
Pathophysiology 4. neurologic manifestations are present only in Vit.
Toxins cause a direct bone marrow depression B12 deficiency
↓
Acellular bone marrow Assessment findings
↓ Pernicious Anemia
decreased production of blood elements
PANCYTOPENIA
- Beefy, red, swollen tongue
- Mild diarrhea
Assessment Findings - Extreme pallor
- fatigue - Paresthesias in the extremities
- pallor
- dyspnea
- bruising
CARDIOVASCULAR SYSTEM
Laboratory findings - Allow patient to verbalize her concerns about
1. Peripheral blood smear- shows giant RBCs, WBCs with medication, prognosis and future pregnancy
giant hyper-segmented nuclei 4. Monitor and prevent potential complications
2. Very high MCV - Provide always adequate hydration
3. Schilling’s test
4. Intrinsic factor antibody test - Avoid cold, temperature that may cause
vasoconstriction
Medical Management - Leg ulcer
1. Vitamin supplementation Aseptic technique
2. Folic acid 1 mg daily - Priapism
3. Diet supplementation Sudden painful erection
4. Vegetarians should have vitamin intake Instruct patient to empty bladder, then take a
5. Lifetime monthly injection of IM Vit B12 warm bath
Polycythemia
Refers to an INCREASE volume of RBCs
Nursing Management The hematocrit is ELEVATED to more than 55%
1. Monitor patient Classified as Primary or Secondary
2. Provide assistance in ambulation
3. Oral care for tongue sore Primary Polycythemia
4. Explain the need for lifetime IM injection of vit B12 - A proliferative disorder in which the myeloid stem
cells become uncontrolled
Hemolytic Anemia: Sickle Cell
- A severe chronic incurable hemolytic anemia that Causative factor
results from heritance of the sickle hemoglobin gene. - unknown
Causative factor
- Genetic inheritance of the sickle gene- HbS gene Pathophysiology
Pathophysiology - The stem cells grow uncontrollably
Decreased O2, Cold, Vasoconstriction can precipitate
- The bone marrow becomes HYPERcellular and all
sickling process
the blood cells are increased in number
Factors cause defective hemoglobin to acquire a
rigid, crystal-like C-shaped configuration Sickled - The spleen resumes its function of hematopoiesis
RBCs will adhere to endothelium pile up and plug and enlarges
the vessels ischemia results pain, swelling and - Blood becomes thick and viscous causing sluggish
fever circulation
- Overtime, the bone marrow becomes fibrotic
Assessment Findings
1. jaundice (hemolytic jaundice) Assessment findings
2. enlarged skull and facial bones - Skin is ruddy
3. tachycardia, murmurs and cardiomegaly
- Splenomegaly
- Primary sites of thrombotic occlusion: spleen, lungs - headache
and CNS
- dizziness, blurred vision
- Chest pain, dyspnea
- Angina, dyspnea and thrombophlebitis
Assessment Findings
1. Sickle cell crises Laboratory findings
1. CBC- shows elevated RBC mass
- Results from tissue hypoxia and necrosis 2. Normal oxygen saturation
2. Acute chest syndrome
3. Elevated WBC and Platelets
- Manifested by a rapidly falling hemoglobin level,
tachycardia, fever and chest infiltrates in the CXR Complications
1. Increased risk for thrombophlebitis, CVA and MI
Medical Management 2. Bleeding due to dysfunctional blood cells
1. Bone marrow transplant
2. Hydroxyurea Medical Management
3. Increases the HbF
1. To reduce the high blood cell mass- PHLEBOTOMY
4. Long term RBC transfusion
2. Allopurinol
Nursing Management 3. Dipyridamole
1. manage the pain 4. Chemotherapy to suppress bone marrow
Support and elevate acutely inflamed joint
Relaxation techniques Nursing Management
analgesics 1. Primary role of the nurse is EDUCATOR
2. Prevent and manage infection 2. Regularly asses for the development of
Monitor status of patient complications
Initiate prompt antibiotic therapy 3. Assist in weekly phlebotomy
3. Promote coping skills 4. Advise to avoid alcohol and aspirin
- Provide accurate information 5. Advise tepid sponge bath or cool water to manage
pruritus
CARDIOVASCULAR SYSTEM
Leukemia Medical Management
- Malignant disorders of blood forming cells 1. Chemotherapy
characterized by UNCONTROLLED proliferation of 2. Bone marrow transplantation
WHITE BLOOD CELLS in the bone marrow-
replacing marrow elements . Nursing Management
- The WBC can also proliferate in the liver, spleen 1. Manage AND prevent infection
and lymph nodes. - Monitor temperature
- The leukemias are named after the specific lines of - Assess for signs of infection
blood cells afffected primarily - Be alert if the neutrophil count drops below 1,000
Myeloid cells/mm3
Lymphoid 2. Maintain skin integrity
Monocytic 3. Provide pain relief
4. Provide information as to therapy- chemo and
- The leukemias are named also according to the bone marrow transplantation
maturation of cells
- ACUTE
The cells are primarily immature
- CHRONIC
The cells are primarily mature or differentiated
- ACUTE myelocytic leukemia
- ACUTE lymphocytic leukemia
- CHRONIC myelocytic leukemia
- CHRONIC lymphocytic leukemia
Etiologic Factors
- UNKNOWN
- Probably exposure to radiation
- Chemical agents
- Infectious agents
- Genetic
Pathophysiology of ACUTE Leukemia
- Uncontrolled proliferation of immature cells
suppresses bone marrow function severe
anemia, thrombocytopenia and granulocytopenia
- Uncontrolled proliferation of DIFFERENTIATED
cells slow suppression of bone marrow function
milder symptoms
Assessment Findings
Acute Leukemia
- Pallor
- Fatigue
- Dyspnea
- Hemorrhages
- Organomegaly
- Headache
- vomiting
- Leukemia
Chronic Leukemia
- Less severe symptoms
- Organomegaly
- Leukemia
Laboratory Findings
- Peripheral WBC count varies widely
- Bone marrow aspiration biopsy reveals a large
percentage of immature cells- BLASTS
- Erythrocytes and platelets are decreased
