CARDIOVASCULAR
DISORDERS
Prepared by: Vinz Tomboc, RN
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BASIC CONCEPTS
Cardiovascular Function:
Heart -
• Diastole -
• Systole -
• Chambers: ____
• Valves: ____
• __________ - amount of blood ejected per contraction
• Cardiac Output = ___ x ___ → per minute
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BASIC CONCEPTS
Auscultation Landmarks
1. All -
2. People -
3. Enjoy -
4. Time -
5. Magazine -
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BASIC CONCEPTS
Risk Factors
• Modifiable
• _______ control
• alcohol, smoking, diet, physical inactivity, obesity, hypertension,
hyperlipidemia, diabetes mellitus
• Non-modifiable
• _______ control
• age, gender, family history, race
#1 Cause of Death in the Philippines: ____________
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HYPERTENSION
Definition:
• Strongest risk factor: ___________
Diagnosis
• Systolic BP (SBP): _______ Diastolic BP (DPB): _______
• # of readings: _____ on ___________
• Position → Feet: ___________ Arm Level: ___________
• Errors:
• Too Tight: _________
• Too Loose: ___________
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HYPERTENSION
Diagnosis
• Patient Teaching:
• NO ___________ for at least ______
• Activity: ___________ for at least ______
Masked vs White Coat:
• _______________
• Home BP: High Clinic BP: Normal
• _______________
• Home BP: Normal Clinic BP: High
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HYPERTENSION
Stages:
SBP DPB
Normal
Elevated
Stage 1 HTN
Stage 2 HTN
Types:
• Primary/Essential
• Incidence: ________ Cause: ___________
• Secondary
• Incidence: ________ Cause: ___________
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HYPERTENSION
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HYPERTENSION
Management
Goal: ___________ → WOF: ___________
Initial: __________
• BMI: __________
• AVOID: ___________
• Diet: __________
• Na: _____
• K: _____
• Fat: _____
• Fruits, Vegetables: _____
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HYPERTENSION
Management
BP (>140/90) after 1-3 months: __________
• ACE Inhibitors, ARBs →
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HYPERTENSION
Management
• ACE Inhibitors - “-______” →
• Prototype: __________
• A/E:
• A - _________ → Priority: _________ → NI: _________
• C - _________ → NI: _________
• E - _________ → Diet: _________
• D - _________ → Risk for: _________ → Monitor: _________
• Angiotensin Receptor Blockers (ARBs) - “-______” →
• Prototype: __________
• CI: __________→ Women of Child-Bearing Age: _________
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HYPERTENSION
Sympathetic Receptors
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HYPERTENSION
Management
• α-1 Blocker - “-______” →
• Prototype: __________
• NOT: __________ → Risk for: __________
• α-2 Agonists →
• Prototypes: __________, __________
• DO NOT: __________ → Risk for: __________
• Not given with: __________
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HYPERTENSION
Management
• β-Blockers - “-______” →
• Prototype: __________
• Administer: __________
• HOLD:
• B–
• B–
• B–
• B–
• Antidote: __________
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HYPERTENSION
Management
• Calcium Channel Blockers
• Dihydropyridines: “-______” - __________
• S/E: __________ → Common: __________
• Non-Dihydropyridines: __________, __________
• S/E: __________
• AVOID: __________ Not given with: __________
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HYPERTENSION
Management
Diuretics
• Administration: __________
• Thiazide -
• Prototype: __________
• Electrolyte: __________ → Diet: __________
• Blood Sugar: __________ → Monitor: __________
• Eyes, Skin: __________ → Wear: __________
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HYPERTENSION
Diuretics
• Loop diuretics -
• Prototype: _________ → CI: _________ → Affix: “-_____”, “-_____”
• Electrolyte: __________ → Diet: __________
• Hearing: __________ → Push: __________
• “UO is not increasing within 5-20 mins”
• K-sparing -
• Prototype: __________
• AE: __________ → Diet: __________
• CI: __________ → Severe __________
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HYPERTENSION
Hypertensive Crisis
• BP → SBP: ______ DBP: ______
• Cause: __________
Types:
• Hypertensive Urgency -
• Hypertensive Emergency -
Clinical Manifestations:
• Headache: __________ Vision: __________
• Nose: __________ LOC: __________, __________
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HYPERTENSION
Hypertensive Crisis
Monitoring: __________
Treatment: __________
• Potent Vasodilator: __________
• Calcium Channel Blocker: __________
• β-Blockers: __________
Goal: __________
• Lower BP by: __________
• STOP at: __________
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CORONARY CIRCULATION
Coronary Circulation: Aorta → Phase: __________→
• Right Coronary Artery →
• Posterior Descending Artery →__________, __________
• Left Coronary Artery →
• Left Anterior Descending Artery → __________
• Circumflex Artery → __________
Coronary Artery Disease
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CORONARY ARTERY DISEASES
• Arteriosclerosis - Ischemia -
• Atheroma - Infarction -
• Atherosclerosis -
Diseases:
• Plaque + Exertion → __________
• Plaque + Clot →
• Partial → NO Damage→ __________
With Damage → Subendocardial → __________
• Complete → With Damage → Transmural → __________
• Vasospasms → __________
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CORONARY ARTERY DISEASES
Coronary Arteries →
Angina Pectoris Myocardial Infarction
S S
A A
V V
E O
R U
S G
E__________ E__________ E__________ E__________
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ANGINA
Types:
• Stable (Exertional) Angina -
• Rest, NTG: __________ Pattern: __________
• Duration: __________
• Unstable (Pre-infarction) Angina -
• Rest, NTG: __________ Pattern: __________
• Duration: __________
• Prinzmetal Angina - _______________ → ECG changes: ___________
• Intractable → ___________ to interventions
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ANGINA
Diagnostics:
• Troponin, cardiac enzymes: __________
• ECG: __________, __________
• Cardiac Catheterization (Coronary Angiography): __________
• Lipid Profile: __________
• Stress Testing: __________, __________
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CARDIAC CATHETERIZATION
Anesthesia: __________
Sedation: __________
Most common site: __________ → __________
Pre-procedure:
• Priority Assessment: __________, __________
• Renal Function: __________, __________
• Withhold: __________, __________
• Diet: __________
• Teaching: __________, _________
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CARDIAC CATHETERIZATION
Post-procedure
• Preventing Bleeding
• Activity: ________ Legs: __________
• Puncture Site: __________
• Perfusion:
• Assessment: __________
Discharged
• Ambulation Tub Baths
• Heavy Lifting Bending at waist
• “Bleeding, swelling, fever, bruising, pain”
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LIPID PROFILE
Lipid Values:
• Cholesterol: __________
• Triglycerides: __________
• Low Density Lipoprotein (LDL): __________
• High Density Lipoprotein (HDL): __________
• Teaching: __________
Treatment for Hyperlipidemia: ___________
• Taken: __________
• A/E: __________ → NI: __________
• WOF: __________ → Assessment: __________
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STRESS TESTING
Types:
• Exercise (physical) stress testing -
• Pharmacological (chemical) stress test -
Night Prior: __________
AVOID:
• False (+): __________
• False (-): __________
“Chest pain, ST changes”
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ANGINA
Management
Goal: __________, __________
Nitroglycerin -
• S/E: __________
• A/E: __________ → NI: __________
• STOP: __________
• CI: __________
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ANGINA
Sublingual NTG -
S
S
S
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ANGINA
NTG Patch (Transdermal)
• ____ patch at a time, ____ daily
• Max: __________
• Location: __________
• Most common: __________
• Area: __________, __________, __________
• Shower
• MRI
• Nurses: __________
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ANGINA
Management
• β-Blockers →
• Calcium Channel Blocker →
• Antiplatelet →
• Prototype: __________
• A/E: __________, __________ CI: __________
• Anticoagulants →
Nursing Interventions
• Position: __________ Activity: __________
• Administer: __________ Assess: __________ → __________
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MYOCARDIAL INFARCTION
Definition:
• #1 Complication: __________
Diagnostic Tests:
• Cardiac Biomarkers
• Troponin I/T CK-MB Myoglobin
• WBC, ESR, CRP: ___ Cardiac Catheterization: __________
• ECG - quickest test for MI → Zone Of:
• Ischemia: ________
• Injury: ________
• Necrosis: ________
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MYOCARDIAL INFARCTION
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MYOCARDIAL INFARCTION
Management
• M__________
• WOF: __________ Antidote: __________
• O__________ → Independent: __________
• N__________ → Route: __________
• A__________
• Given w/in: __________ Alternative: __________
• Thrombolytics:
• Prototype: U__________, S__________, A__________
• Given w/in: __________
• WOF: __________ Antidote: ________
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MYOCARDIAL INFARCTION
Management
• Position: __________
• Diet:
• Na/Fluids: ___ Cholesterol: ___
• Portion: __________
• AVOID: __________
• Activity: __________
• Elimination: __________
• Resume SEX:__________
• AVOID: __________
• Usual Cause: __________ → Drug: __________
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MYOCARDIAL INFARCTION
Surgery
• Angioplasty
• Atherectomy
• CABG
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HEART FAILURE
Definition:
Right Sided (Backward) HF
Hemodynamic Monitoring: __________
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HEART FAILURE
Left Sided (Forward) HF
Hemodynamic Monitoring: __________
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HEART FAILURE
Diagnostics
• Human B-Natriuretic Peptide (hBNP) - Confirms HF - __________
• Normal Value: __________
• 2D echo - Confirms HF - __________
• EF: ______
• CXR - _____________, _____________
Echocardiogram
• Transthoracic Echocardiogram -
• Teaching: __________
• Intra-procedure Position: __________
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HEART FAILURE
Echocardiogram
• Transesophageal Echocardiogram
• Pre-procedure
• NPO: __________
• Sedation: __________
• Anesthesia: __________
• Intra-procedure Position: __________, __________
• Post-procedure
• Priority: __________
• Position: __________
• Throat Soreness: __________
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HEART FAILURE
Management
Goal: __Preload __Afterload __Contractility
• ACE Inhibitors and ARBS →
• β-blockers →
• Diuretic →
• Digoxin -
• ___ Inotropic -
• Stroke Volume: _______
• ___ Chronotropic - ___ Dromotropic -
• 1st Assessment: ________
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HEART FAILURE
Management
• Digoxin
• Toxicity: __________ → Administer: __________
• N__________
• A__________
• V______________ → __________, __________
• D__________
• A__________
• Antidote: __________ K: __________ AVOID: __________
• Dilators →
• Dopamine, Dobutamine →
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HEART FAILURE
Nursing Interventions
• Priority: __________
• Monitoring:
• Daily Weights
• ______ per day or ______ per week
• UO: ______
• “Edema, Weight gain”
• “SOB, Crackles, Pink Frothy Sputum”
• Position:
• HOB: __________
• Legs: __________
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HEART FAILURE
Nursing Interventions
• Diet:
• Na: ______ → ______
• Fluid: ______ → ______ → Thirsty: __________
• Cholesterol: ______
• Activity:
• Rest -
• Activity -
• “Fatigue, dyspnea, chest pain”
• AVOID: __________
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