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1.1 Cardiovascular system, Kathy M._ccby.pptx
- 1. CNA 2 OSBN Curriculum
- 2. This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance Community CollegeandCareerTraining Grants, as implementedby the U.S. Department of Labor’s Employment and Training Administration. Rogue Community Collegeis an equal opportunity employer/program. Auxiliary aids and services, alternate form and language services are available to individuals with disabilities andlimitedEnglish proficiency free of cost upon request. This work is licensed under a Creative Commons Attribution 4.0 International License.
- 3. Heart Blood Vessels Blood Lymphatic System
- 4. Hollow Organ Four Chambers ◦ R & L atriums ◦ R&L ventricles http://www.medcomrn.com//dev/flash/flvplayer/movi e.php?movie=http://ss1.medcomrn.com/flv/78715r_s ec02_300k.flv&title=&detectflash=false&detectflash=f alse
- 5. Arteries Veins Arterioles Capillaries http://www.medcomrn.com/dev/flash/flvplayer/movie.php ?movie=http://ss1.medcomrn.com/flv/78715r_sec04_300k .flv&title=&detectflash=false&detectflash=false
- 8. Liquid: Plasma Solid: ◦ Erythrocytes RBC’s ◦ Leukocytes WBC’s ◦ Thrombocytes Platelets http://www.medcomrn.com/dev/flash/flvplayer/m ovie.php?movie=http://ss1.medcomrn.com/flv/78 715r_sec05_300k.flv&title=&detectflash=false&det ectflash=false
- 9. One Way System Asst w/ Fluid Balance Fights Infection Lymph Nodes Empty into Lg. veins http://www.medcomrn.com/dev/flash /flvplayer/movie.php?movie=http://ss 1.medcomrn.com/flv/78715r_sec06_3 00k.flv&title=&detectflash=false&detec tflash=false
- 10. Coronary Artery Disease (CAD) ◦ Acute Coronary syndrome (ACS) Angina Myocardial Infarction (MI) Cardiovascular System Conclusion:Takes food and oxygen in, takes away waste. It seems so simple, but as we've seen, it's really a complex task that takes four body parts - the heart, blood vessels, blood, and lymph vessels - all working together to do this "simple" job, that keeps us alive.
- 11. Hearts blood supply Arteries may narrow Could eventually occlude Risk Factors Treatment: ◦ Stent ◦ CABG
- 13. Tightness/Pressure/Discomfort/radiation Dyspnea Nausea Pale Diaphoresis Weakness
- 14. AKA: Heart Attack
- 15. Angina: more intense, longer SOB Anxiety/ feeling of “doom” Irregular heartbeat Changes in BP
- 16. Report c/o of angina to RN STAT VS STAT or as directed Stay w/patient & call for help Calm patient Stop/Limit physical activity
- 18. Diagnostic Treatment ◦ Stent Femoral dressing ◦ CABG Sternal Precautions Post-care ◦ Care of the Surgical Patient”
- 19. AKA: ◦ HF ◦ Congestive Heart Failure ◦ CHF Inability of the heart to pump enough blood for the bodies needs Right-sided vs. Left-sided
- 20. Venous Back-up ◦ Feet, ankle, legs are swollen ◦ Urinary frequency esp at noc
- 21. Lungs Backed-up ◦ Congestion ◦ Coughing ◦ SOB
- 22. SOB w/activity Fatigue w/exertion Cyanosis Sudden Wt. gain Edema Vertigo Diaphoresis Confusion and memory lapses
- 23. Report to nurse Accurate I&O Daily weights as ordered Low sodium diet restrictions Fluid restrictions as ordered Prevent fatigue
- 24. Abnormal Heart beat Electrical Condition May be life-threatening Treatment depends on type EKG/ECG: ◦ Electrical activity of the heart
- 25. Sinus Rhythm: 60-100 per min. “normal” Bradycardia: <60 ◦ slow Tachycardia: >100 ◦ fast
- 26. Atrial Fibrillation ◦ Atria quivers ◦ At risk for block clots Heart Block: ◦ Stimulus can’t get through ◦ Sx’s depend on level of block
- 27. Ventricular Tachycardia ◦ vents too fast ◦ Can’t fill all the way Ventricular Fibrillation: ◦ vents quiver Asystole: ◦ NO HEART BEAT ◦ Start CPR
- 28. Palpitations c/o pounding chest Dizziness Light-headedness Fainting/weakness SOB Chest discomfort Slow pulse
- 29. Report S/S to nurse NOW If S/S severe call RRT or CODE and stay with patient.
- 30. Bedside Tele: http://www.medcomrn.com/dev/flash/flvplayer/movie.php?movie=http: //ss1.medcomrn.com/flv/m109_sec09_300k.flv&title=&detectflash=fal se&detectflash=false 12 Lead video: http://www.medcomrn.com/dev/flash/flvplayer/movie.php?movie=http: //ss1.medcomrn.com/flv/m109_sec07_300k.flv&title=&detectflash=fal se EKG Education video: http://www.youtube.com/watch?v=MSc0Trc_d88 EKG lead placement video http://www.youtube.com/watch?v=1n5f0qtQOp8
- 31. Thrombus in veins Blood pools Clot forms Blocks circulation OR Embolus ◦ Can be fatal
- 32. Swelling in Leg May be Warm to Touch Pain or tenderness Report STAT: ◦ Chest Pain ◦ SOB ◦ Dyspnea
- 33. Prevention: TEDS SCDS ROM Ambulation Present All activity directed by nurse Elevate extremity if directed Do not massage leg
- 34. Classification SBP mmHg DBP mmHg Normal <120 or <80 Prehypertension 120-139 or 80-89 Stage 1 HTN 140-159 or 90-99 Stage 2 HTN > 160 or > 100 Hypertension (HTN)
- 35. Confirm reading White Coat HTN Silent Killer Can lead to: ◦ CVA ◦ MI ◦ Kidney Failure ◦ Blindness
- 36. Obesity Atherosclerosis Chronic Kidney Disease (CKD) Drug Related Inactivity Smoking ETOH Abuse Other
- 37. HTN checked x2 in both R & L Headache Blurred Vision Dizzy Chest Pain Nosebleeds
- 38. Check BP x2 in both arms ◦ Manual Report to nurse ASAP Low sodium diet
- 39. Consistently: ◦ SBP< 90 mmHg ◦ DBP< 60 mmHg Causes: ◦ Low bld vol. ◦ Irreg. HR ◦ Medications Orthostatic Hypotension
- 40. Low BP Rapid HR Rapid/shallow breathing C/O ◦ Vertigo ◦ Syncope ◦ Blurred vision ◦ Nausea ◦ Diaphoresis
- 41. Check BP x2 in both arms: Manual Report to nurse STAT Lie down/elevate feet
- 42. Discontinue saline lock (Does not have fluids running)https://www.youtube.com/watc h?v=73tYvGurGE4
- 43. This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance Community CollegeandCareerTraining Grants, as implementedby the U.S. Department of Labor’s Employment and Training Administration. Rogue Community Collegeis an equal opportunity employer/program. Auxiliary aids and services, alternate form and language services are available to individuals with disabilities andlimitedEnglish proficiency free of cost upon request. This work is licensed under a Creative Commons Attribution 4.0 International License.
Notas del editor
- The cardiovascular system is composed of the heart and the network of arteries, veins, and capillaries that transport blood throughout the body. The average adult male has between 5 to 6 liters of blood or blood volume, while the average adult female has between 4 to 5 liters. The blood carries oxygen and essential nutrients to all of the living cells in the body, and also carries waste products from the tissues to the systems of the body through which they are eliminated. Most of the blood is made up of a watery, protein-laden fluid called plasma. A little less than half of this blood volume is composed of red and white blood cells, and other solid elements called platelets
- • Hollow, muscular organ about the size of a fist • Lies to left of center chest, behind the sternum • Four chambers: R & L atriums (plural is atria)- upper R & L ventricles- lower • Four valves- help blood to flow in one direction • Pumps blood to lungs and body • Has internal pacemaker, in right atrium- causes contraction of heart muscle- Normal heart beats 60-100 times per minute
- • Carry blood to and from all the tissues in the body Arteries- away from the heart with oxygenated blood Veins- to the heart with deoxygenated blood Arterioles- the smallest arteries Capillaries- branch off the arterioles- where oxygen exchange happens
- • Plasma is the liquid part • Solid parts Erythrocytes- red blood cells to carry oxygen Leukocytes- white blood cells to fight infection Thrombocytes- platelets to help blood clot
- • A one-way, open-ended circulatory system of lymph fluid • Helps keep bodily fluid levels in balance and defends the body against infections • Clear lymph fluid moves through the tissues, to the lymph nodes, and then to the bloodstream • Lymph nodes (masses of lymph tissue) clean the lymph fluid, removing bacteria • All lymphatics empty into the large veins in the shoulder area, then return to the general circulation
- CAD is the most common type of CV disease and accounts for the majority of these deaths. Patient s w/CAD can be asymptomatic of develop chronic stable angina. Unstable angina and MI are more serious manifestations of CAD and are termed ACS
- Coronary Artery Disease (CAD) • Coronary arteries supply blood to the heart • Coronary arteries narrow as a result of atherosclerosis- (plaque build up in arteries) • When coronary arteries become narrow, no blood can get through causing areas of heart muscle to die (infarct: death of heart tissue due to lack of oxygen) • Risk Factors for CAD: Smoking, obesity, hypertension, elevated cholesterol, lack of exercise, stress, family history., sex/age of patient, race • Cardiac Catheterization may be performed to diagnose or treat blockages (refer Care of the Surgical Patient (Cardiac) regarding femoral dressing, etc) • Coronary Bypass surgery is done- Sternal precautions post-op (refer Care of the Surgical Patient (Cardiac) regarding Sternal Precautions)
- Angina (Pectoris) • Results from heart muscle being deprived of oxygen (O2) • Blood flow to heart increases when need for O2 increases • Exertion, stress and excitement increase heart’s need for oxygen. Narrow arteries (from fatty deposits/plaque) prevent increased blood flow- may cause chest discomfort/pain or “angina” Responsive Observations: Often described as a tightness, pressure or discomfort in the chest complaints of heartburn/indigestion Some complaints of pain in chest, jaw, neck, back, between shoulder blades, or down one or both arms-often with numbness Dyspnea (difficulty breathing) is common Nausea, diaphoresis (sweating), change in skin color- pale, grayish or bluish Weakness CNA Actions: Report to nurse STAT Obtain vital signs STAT, or as directed by nurse Encourage person to stop activity and rest
- Responsive Observations: Often described as a tightness, pressure or discomfort in the chest complaints of heartburn/indigestion Some complaints of pain in chest, jaw, neck, back, between shoulder blades, or down one or both arms-often with numbness Dyspnea (difficulty breathing) is common Nausea, diaphoresis (sweating), change in skin color- pale, grayish or bluish Weakness CNA Actions: Report to nurse STAT Obtain vital signs STAT, or as directed by nurse Encourage person to stop activity and rest
- Myocardial Infarction (MI) • Heart Attack • Can lead to cardiac arrest- no heart beat (asystole) • Occurs when one or more of the coronary arteries become completely blocked preventing blood from reaching areas of heart • Lack of blood and oxygen causes the tissue to die • Infarct refers to area of dead heart tissue • Risk factors for MI: Excessive stress, smoking, high-fat diet, high LDL and low HDL, family history of early MI, diabetes, hypertension, obesity, history of substance abuse, age, female (menopause), sedentary lifestyle
- Responsive Observations: Uncomfortable pressure; fullness in chest; pain; squeezing feeling in the chest, under the sternum/mid back, or arms Pain is more extreme/intense/lasts longer than in angina Shortness of breath (SOB), heartburn, nausea, vomiting Anxiety or feeling of “doom” Irregular heartbeat; high (or low) blood pressure
- CNA Actions: Report complaints of chest pain/jaw pain or chest discomfort to nurse STAT Obtain vital signs STAT, or as directed by nurse Stay with patient and call for help Try to calm patient and relieve anxiety if possible Limit patient’s physical activity as directed by nurse
- Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.
- The heart is not able to pump enough blood to meet all needs of the body • Fluid backs up into the lungs and throughout the body • Causes (can include): hypertension, myocardial infarction (MI), coronary artery disease (CAD), abnormal heart/valves/heart rhythm recent or previous heart surgery rheumatic fever, severe lung disease, infection of heart valves- endocarditis or myocarditis
- • Right-sided failure Blood backs up in the venous system- feet/ankles and legs are swollen (peripheral edema) Edema can be “pitting”, leaving a temporary indentation in skin when pressed with finger Urinary frequency, particularly at night
- • Left-sided failure From CHF- blood backs up in the lungs Fluid leaks into the lungs causing congestion and coughing, shortness of breath, fatigue
- Responsive Observations: Shortness of breath with regular activities Increased fatigue with exertion Cyanosis, (Bluish color of the Skin) especially on ears and nose Increased weight; sudden weight gain Edema in legs, feet and ankles Sitting in chair to sleep or with more pillows Rapid and irregular heart rate Vertigo (dizziness) Diaphoresis (sweating) Confusion and memory lapses
- CNA Actions: Report to nurse Accurate I & O Maintain diet restrictions (low salt) Maintain fluid restrictions as ordered Organize ADL activities to prevent fatigue Daily weights per orders
- Dysrhythmia • An abnormal heart beat (or rhythm)- also called “arrhythmia” • May be life-threatening and require immediate action • Treatment depends on cause and type of dysrhythmia • Definition of EKG: to obtain the pattern of electrical activity in the heart (electrocardiogram)
- Tachycardia- rapid heart rate= tachyarrhythmia of more than 100 • Bradycardia- slow heart rate= brady arrhythmias of less than 60
- • Atrial flutter- patient’s pulse can be regular • Atrial fibrillation- the atria quiver- causes inadequate blood pumped to rest of body • Heart Block- heart rate is very slow; life-threatening
- • Ventricular tachycardia- ventricles beat too fast; life threatening • Ventricular fibrillation- the ventricles quiver; lethal (there is NO blood being pumped at all) • Asystole- no heart rate- person is in cardiac arrest • Definition of EKG: to obtain the pattern of electrical activity in the heart (electrocardiogram)
- Responsive Observations: Palpitations (feels like skipped heart beats) Complaints of pounding in chest Dizziness or light-headed Fainting, weakness or fatigue Short of breath; chest discomfort
- CNA Actions: Report S/S to nurse promptly If S/S severe (ie. . .pt. loses consciousness) call for help immediately and stay with patient
- Deep Vein Thrombosis (DVT) • Development of a thrombus (blood clot) in the deep veins of the legs, pelvis or arms • Blood pools in the legs • Blood clots form in the veins • Blocks circulation in the vein -OR- • Becomes an embolus (traveling blood clot) Can break away and travel to lung Pulmonary artery blocked Can be fatal
- Responsive Observations: Swelling in leg The leg may be larger in size than the other leg Leg may feel warm or be red Pain or tenderness on calf or thigh Chest pain, shortness of breath and/or dyspnea (difficulty breathing)- Report immediately!
- CNA Actions: Prevention: TEDs, SCDs (sequential compression devices- foot or calf pumps), rangeof- motion after surgery and early ambulation as ordered If deep vein thrombosis present- all activity under direction of nurse Elevation of extremity if directed. Use bed controls vs pillow Do not massage the leg
- HTN Defined: Persistent: SBP > 140mmHg DBP > 90mmHg Current use of antihypertensive Rx’s Primary or "essential” or idiopathic is elevated BP w/o an identified cause and accounts for 90-95% Secondary (5%) – adrenal, renal Causes see Table 33-3 pg 742 BP relies on a balance btwn CO and PVR Most essential HTN pts have increased PVR and normal CO There is a direct relationship btwn htn and CVD, and a proportional increase in the risk of MI HF, stroke, and renal disease with higher BP. 1/3 adults have high BP Additional 28% are at risk for developing hypertension+ An elevated SBP is a more important risk factor for developing htn than an elevated DBP in individuals older than 50
- Confirm: take two resting BP readings, sitting in chair for 5 minutes • Confirm elevated reading in contralateral arm • Patients are treated for hypertension by their physician if BP is over 140/90 • Evaluation of “white coat hypertension:” this is a phenomenon in which patients exhibit elevated blood pressure in a clinical setting but not in other settings. It is believed that this is due to the anxiety some people experience during a clinic visit. Repeat BP in 15-20 minutes in calm, quiet environment. • Hypertension is the “Silent Killer”; often does not have symptoms, and if not treated, can cause damage to organs. • Can lead to stroke, heart attack, kidney failure and blindness
- Common Causes of Hypertension: Sleep apnea Drug induced-related Chronic kidney disease, Reno vascular disease Primary aldosteronism Cushing’s syndrome or steroid therapy (steroids prescribed for breathing) Coarctation of aorta Thyroid/parathyroid disease Narrowed blood vessels (atherosclerosis) Obesity; high salt/fat diet Alcohol abuse Smoking Inactive lifestyle Can occur in pregnancy
- Responsive Observations: High blood pressure readings Headache, blurred vision, dizziness, chest pain, nosebleeds
- CNA Actions: Report high blood pressure readings Re-check BP in both arms, obtain resting BPs Encourage pt. to follow special diet as ordered (NAS: no added salt)
- Hypotension • Low Blood Pressure • Consistently lower than 90 mm Hg systolic and/or 60 mm Hg diastolic • May be caused by weak or irregular heart rate, or anemia • Lack of blood volume: dehydration or hemorrhage • Medication may lower BP: Pain medications, angina meds, anesthesia Orthostatic Hypotension • Sudden decrease in BP occurring when a pt. stands from sitting or lying position Standing the body compensates for change in position by heart beating harder Patient may feel lightheaded and faint from lack of oxygen to brain May be caused by medication or aging Allow time for adjustment of BP- stand patient up slowly
- Responsive Observations: Low BP readings, complaints of dizziness (vertigo) or syncope (fainting), lightheadedness, blurred vision, nausea, diaphoresis Rapid, shallow breathing
- CNA Actions: (see Skills Checklist: how to take orthostatic BPs) Check BP in opposite arm; recheck as ordered Report abnormal findings to nurse Elevate feet as ordered Assist patient to lie down if dizzy