Chapter 3 Nursing Care of Patients with Cardiovascular and Circulatory Disorders

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Chapter 3Nursing Care of Patients with
Cardiovascular and Circulatory Disorders
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Coronary Artery Disease

• Atherosclerosis is an abnormal accumulation of
  lipids and fibrous tissues in the vessel wall.
• The atheromas (plaque) protrude into the lumen of
  the vessel, narrowing it and obstructing blood
  flow.
• The thrombus may obstruct blood flow leading to
  myocardial infarction or sudden death.

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Risk Factors

• 1. Modifiable risk factors
• - Cholesterol levels
• - Cigarette smoking
• - Hypertension
• - Diabetes mellitus
• 2. Nonmodifiable risk factors
• - Age
• - Gender
• - Family history
• - Race

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Myocardial Infarction

• Myocardial cells are permanently destroyed
• Caused by reduced blood flow in coronary artery
  due to embolus or thrombus
• Pharmacologic Therapy
• - Thrombolytic
• - Analgesics
• - ACE inhibitors
• Emergency percutaneous transluminal coronary
  angioplasty

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• Signs/Symptoms
• 1. Chest pain, substernally with radiation to
  arm, neck,
• jaw, or back and unrelieved by rest or
  nitrates.
• 2. Diaphoresis and cool, clammy, pale skin.
• 3. Nausea and vomiting.
• 4. Dyspnea.
• 5. Palpitations or syncope.
• 6. Restlessness and anxiety.
• 7. Tachycardia or bradycardia.
• 8. Decreased.

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Nursing Management

• 1.Administer prescribed medications, morphine,
  nitrates,
• thrombolytic, anticoagulants or stool
  softeners during
• rehabilitation.
• 2. Monitor ECG and cardiac enzymes( CPK,LDH)
• 3. Provide liquids or solid diet as tolerated
  (low sodium,
• low cholesterol, low fat)
• 4. Monitor and record vital signs.
• 5. Provide restful environment.
• 6. Psychological support.
• 7. Positioning.

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Congestive Heart Failure

• CHF is inability of the heart to pump adequate
  amount of blood to all vital organs. The
  incidence increases with aging.
• CHF Classification
• Left- sided (or left ventricular)
• Right- sided (or right ventricular)

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Left-Sided Heart Failure

• Signs/Symptoms
• 1. Dyspnea upon exertion, paroxysmal
  nocturnal
• dyspnea or orthopnea.
• 2. Pale, cool extremities.
• 3. Decreased peripheral pulses.
• 4. Tachycardia.
• 5. Oliguria(lt30 ml/hour)
• 6. Insomnia and restlessness.

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Right-Sided Heart Failure

• Signs/Symptoms
• 1. Dependent pitting edema.
• 2. Jugular vein distention.
• 3. Hepatomegaly.
• 4. Ascites.
• 5. Weakness, anorexia, and nausea.
• 6. Weight gain.

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Nursing Management

• 1. Administer prescribed medications, diuretics,
  digitalis, anticoagulants, vasodilators.
• 2. Check intake and output.
• 3. Weigh daily.
• 4. Provide a low- sodium diet.
• 5. Auscultate lung sounds.
• 6. Determine degree of JVD.
• 7. Assess dependent edema.
• 8. Monitor vital signs.
• 9. Administer oxygen as prescribed.
• 10 Psychological support.

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Peripheral Arterial Occlusive Disease

• Is a form of arteriosclerosis involving occlusion
  of arteries, most commonly in the lower
  extremities. It may be acute or chronic.
• Etiology
• 1. Acute occlusion may result from trauma,
  thrombosis
• or embolism.
• 2. Chronic occlusion may be caused by
• a. Atherosclerosis.
• b. Inflammation.
• c. Thrombosis.
• d. Trauma.

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Sign/Symptoms

• 1. Resting pain.
• 2. Paresthesia.
• 3. Intermittent claudication.
• 4. Paralysis.
• 5. Changes in skin and nails such as pale and
  cold dry skin
• and decreased or absent hair growth
  brittle and
• thickened nails.
• 6. Pulsenesness.

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Nursing Management

• 1. Administer prescribed medications, such as
  vasodilators,
• anticoagulant, antilipemic, thrombolytic and
  antiplatelets.
• 2. Provide proper positioning as prescribed by
  the physician.
• 3. Instruct the patient to avoid wear elastic
  socks.
• 4. Teach the patient about the vasoconstrictive
  effect of
• nicotine and caffeine, emotional stress, and
  teach skin foot care.
• 5. Provide care for undergoing surgical
  procedure.

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Venous Thrombus

• Types of Venous Thrombus
• 1. Phlebitis is an inflammation in the wall
  of a vein.
• 2. Superficial thrombophlebitis is a
  condition in which a
• clot forms in a a vein secondary to
  phlebitis or
• because of partial obstruction of the
  vein.
• 3. Phlebothrombosis is the formation of a
  thrombus or
• thrombi in a vein.
• 4. Deep vein thrombosis (DVT) is thrombosis
  of deep
• rather than superficial veins.

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High Risk Factors

• 1. Hypercoagulability associated with malignant
  disease
• blood dyscrasias.
• 2. Venous stasis-following operations,
  pregnancy, or bed
• rest for any prolonged illness.
• 3. Obesity, smoking, DM.
• Signs/Symptoms
• 1. DVT characterized by calf pain, fever,
  chills, malaise
• and swelling and cyanosis of affected leg.
• 2. Superficial thrombophlebitis characterized by
  visible
• and palpable signs, such as heat, pain,
  swelling,
• tenderness along the length of the affected
  vein.

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Nursing Management

• 1. Administer prescribed medications,
  anticoagulant,
• thrombolytic and analgesic therapy.
• 2. Provide bed rest with elevating legs to
  promote venous
• drainage reduce swelling.
• 3. Apply dry or moist warm compresses to promote
• circulation and reduce pain.
• 4. Instruct patient to wear elastic stocking,
  avoid sitting or
• standing for long period of time, and
  crossing legs.
• 5. Measure the calf circumference of the affected
  leg daily.
• 6. Encourage frequent changes of position.
• 7. Observe skin changes of lower limbs.

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Varicose Vein

• Bilateral dilatation and elongation of saphenous
  veins deeper veins are normal.
• Predisposing Factors
• 1. Hereditary weakness of vein wall or valves.
• 2. Prolonged standing.
• 3. pregnancy.
• 4. Obesity.
• 5. Advanced age- loss of vein wall elasticity.

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Signs/Symptoms

• 1. Dilated, twisting, discolored vein of the
  legs.
• 2. Easy leg fatigue, cramps in leg, heavy
  feeling, increased, pain during menstruation,
  nocturnal muscle cramps.
• Nursing Management
• 1. Administer analgesics as prescribed.
• 2. Maintain elastic stockings.
• 3. Elevate legs.
• 4. Instruct the patient to avoid prolonged
  standing, sitting
• or crossing legs to prevent obstruction.
• 5.Discuss the importance of losing weight if
  the patient is
• obese.
• 6.Provide care for undergoing surgical
  procedure.

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Hypertension

• Hypertension is intermittent or sustained
  elevation in systolic or diastolic blood
  pressure.
• There are two major types, primary (essential)
  hypertension and secondary hypertension. More
  than 90 of these cases are primary, and about
  10 are secondary.
• Etiology
• 1. Primary hypertension.
• a. Non modifiable risk factors.
• - Family history.
• - Gender. Men ? women.
• - Age.
• - Race.

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• b. Modifiable risk factors.
• - Stress.
• - Obesity.
• - High dietary intake of sodium or saturated
  fats.
• - Excessive caffeine, alcohol, or cigarette
  smoking.
• - Oral contraceptives use.
• 2. Secondary hypertension.
• - Renal vascular diseases.
• - Coarctation of aorta.
• - Primary hyperaldosteronism.
• - Hyperthyroidism.
• - Medications, such as estrogen,
  antidepressants,
• NSAIDs, steroids.

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Signs/Symptoms

• 1.Usually asymptomatic.
• 2. May cause headache, dizziness, blurred vision.
• Nursing Management
• 1. Administer medications as prescribed, such as
  diuretics, antihypertensiveetc
• 2. Provide patient and family teaching.
• - Advise the patient to reduce weight.
• - Instruct the patient to restrict sodium
  alcohol and caffeine intake.

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• - Smoking cessation.
• - Discuss the importance of regular blood
  pressure monitoring.
• - Discuss the importance of lifelong medical
  follow up examination.