Cardio Nursing - Course Audit 2

Cardiovascular
System
By:
Ms. Irene M. Magbanua

FOUR STAGES OF LIFE
CARDIOVASCULAR SYSTEM
IMPORTANT FUNCTION:
- provide oxygen in every
tissue in the body which
is essential in performing
its function
CONSISTS of:
 HEART
 BLOOD VESSEL
 BLOOD
HEART
 Hollow, muscular
 4-chambered
 Located in middle of thoracic cavity
between lungs in space called
mediastinum ( The space between the
lungs, which includes the heart,
pericardium, aorta and vena cava)
 “Inverted cone”
The Cardiovascular System
HEART
Normal Anatomy: Microscopic
 Consists of Three layers- epicardium,
myocardium and endocardium
 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
 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
PERICARDIAL EFFUSION
Normal Anatomy: Gross
 The heart is located in the LEFT side of
the mediastinum
The heart chambers are guarded by
valves
 The Atrio-ventricular valves-
 The Semilunar valves-

BLOOD VESSELS
 Great vessels:
large veins and
arteries leading
directly to and
away from heart
 SUPERIOR VENA CAVA
AND INFERIOR VENA
CAVA
 PULMONARY ARTERY
 PULMONARY VEIN
 AORTA
LAUGH BREAK
BOY: Isang babaeng siopao nga!
LEA: Babaeng siopao?
BOY: Oo, yung may saping papel, may
napkin!
LEA: Ah ganun ba? Mayrun kaming
siopao na bading
BOY: Bading na siopao?
LEA: May sapin din, pero may itlog sa
loob!
LAUGH BREAK
 AMO: Day, gamitin mo sa pader itong
chalk pamatay ng ipis.
MAID: Yis ati!
NEXT DAY
... nagulat ang amo, nakasulat sa
pader:
EPES MAMATAY KAYUNG LAHAT!
SYET! PAKYO!
LAUGH BREAK
 PASYENTE: Dok bakit pag tuwing
umiinm ako ng alak sumasakit ang tyan
ko? Pero pag libre, di naman?
 DKTOR: Normal yan, manipis kasi atay
mo. Tapos makapal mukha mo!
LAUGH BREAK
 BUS HINOLDAP!
Holdaper: Re-reypin ko lahat ng babae
dito!
 Prosti: Ako na lang po, maawa kayo sa

iba..
 Lola: Sinabi na ngang LAHAT eh!

Sasagot pa!
CORONARY ARTERIES
The Blood supply of
the heart comes
from the Coronary
arteries
2. Right coronary
artery
3. Left coronary
artery
Cardiophysiology
 Conduction system
 Cardiac (heart) sounds
 Heart rate and Blood pressure
 Cardiac cycle
CHARACTERISTICS OF THE
CARDIAC MUSCLE
Inherent abilities of cardiac muscle cells:

 Automaticity
 Conductivity
 Excitability
 Refractoriness
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
LAUGH BREAK
HONEYMOON:
Wife: Hon wag mo ako bibiglain ha?

I'm still a virgin
Husband: You mean ako ang una?
Wife: Yes, do it na please!
Husband: I did it na, kanina pa!!
Wife: Ah ganon ba? Aray pala, shit!!!
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
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 is:

Cardiac output X peripheral
resistance
Cardiac Output Regulation
 The heart pumps approximately 5 L of
blood every minute
 The heart rate increases with exercise;
therefore cardiac output increases
 The cardiac output will vary according to
the amount of venous return.
Blood pressure
 Control is neural (central and
peripheral) and hormonal
 Baroreceptors in the carotid and aorta
 Hormones- ADH, Adrenergic
hormones, Aldosterone and ANF
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
 ANF= causes sodium excretion

LAUGH BREAK
 Bakla at Macho nagkasabay sa CR...
 Bakla: Ang laki naman nyan sayo...
 Macho: Wala na tong silbi kasi iniwan
na ako ng GF ko... puputulin ko na
lang at ipapakain ko sa aso!
 Bakla: aw! aw! aw!
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
Terminology
Anatomy
Chronotropic
& Physiology
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
 Refers to a change in the speed of conduction
Dromotropic through the AV junction
effect  A positive dromotropic effect results in an
increase in AV conduction velocity
 A negative dromotropic effect results in a
decrease in AV conduction velocity
 Refers to a change in myocardial contractility
 A postive inotropic effect results in an
Inotropic
effect increase in myocardial contractility
 A negative inotropic effect results in a
decrease in myocardial contractility
LAUGH BREAK
PATIENT: Nurse bakit TAE ko may
kasamang plema?
NURSE: Ok lang yan! Mas delikado kung

pag singa mo may kasamang TAE!
Factors regulating Stroke
Volume
 1. Degree of stretch of the cardiac muscle
before contraction (Starling’s Law);
determined by the volume of blood in the
ventricle at the end of diastole or diastolic
filling.
 2. Contactility: ability of the myocardium
to contract; contractility is increased by
circulating catecholamines and
medications like digitalis
Volume
 3. Preload : the filling of the ventricles at
the end of diastole. The more the
ventricles fill, the more the cardiac
muscles are stretched, and the greater the
force of the contraction during systole
(Starling’s Law). If there is a decrease in
contractility and in cardiac output.
Volume
 4. Afterload: the pressure in the aorta that
the ventricles must overcome to pump
blood into the systemic circulation.
 A decrease in the afterload causes a
decrease in the workload of the ventricles;
this in turn will assist to increase the
stroke volume and the cardiac output
Factors that increase
myocardial oxygen demands
 Increased heart rate
 Increased force of contractions
 Increased afterload
Cardiac compensatory
mechanisms
 When the normal compensatory
mechanisms cannot maintain cardiac
output to meet body needs, the client is
in a state of cardiac
decompensation.
SUKO SA MISTER:
Misis 1: Suko na ako sa mister ko, lagi
na lang ako binubugbog bago
niroromansa. ..
Misis 2: Mas grabe yung mister ko.

Binubugbog ako tapos si Inday ang
niroromansa.
 The vascular system consists of the
arteries, veins and capillaries
 The arteries are vessels that carry blood
away from the heart to the periphery
 The veins are the vessels that carry blood
to the heart
 The capillaries are lined with squamous
cells, they connect the veins and arteries
 The lymphatic system also is part of the
vascular system and the function of this
system is to collect the extravasated fluid
from the tissues and returns it to the blood
Differences Between Blood Vessel
Types
• Walls of arteries are the thickest
• Lumens of veins are larger
• Skeletal muscle “milks” blood in veins
toward the heart
• Walls of capillaries are only one cell
layer thick to allow for exchanges
between blood and tissue
Slide 11.26
Movement of Blood Through
Vessels
• Most arterial blood is

pumped by the heart
• Veins use the milking
action of muscles to
help move blood
Figure 11.9
Slide 11.27
Tutpik!
Kustomer: Ano ba naman itong
tutpik nyo, iisa na nga lang, ang
dali pang mabali!
Waiter (inis): Alam nyo, sir, ang

dami nang gumamit nyan, pero
kayo lang nakabali!
Major Arteries of Systemic Circulation
Figure 11.11
Slide 11.30
Blood Supply to:
 Bone – Haversian canal and Volkmann’s canal
 Blood Vessel – vasa vasorum
 Heart – coronary arteries
 Brain – common carotid artery – external and
internal carotid artery,
anterior, middle and posterior cerebral artery
(Circle of Willis)
 Upper Extremities – basillic – cephalic – brachial
– radial and ulnar
 Lower Extremities –iliac – femoral popliteal –
saphenous – tibial
Blood Supply to:
 Eyes – choroids (between sclera and retina)
cornea gets 02 from the atmosphere
 Kidneys – renal artery – interlobar artery –
arcuate artery – interlobular artery – afferent
arteriole – glomerulus – efferent arteriole - vasa
recta – back to the heart
 Liver – celiac artery – hepatic artery and hepatic
portal vein (food laden) - liver sinusoids (mixed
blood) – hepatic cells extract 02, nutrients and
detoxify toxic substances.
 Organs of the GIT – celiac trunk
 Lungs – bronchial arteries
Major Veins of Systemic Circulation
Figure 11.12
Slide 11.31
Arterial Supply of the Brain
Figure 11.13
Slide 11.32
Hepatic Portal Circulation
Figure 11.14
Slide 11.33
Circulation to the Fetus
Slide 11.34
LAUGH BREAK
DALAWANG MADRE NIREREYP:

MADRE 1: Jusko! Patawarin nyo po
sya, di po nya alam ang ginagawa
nya!
MADRE 2: Sister yung akin
marunong!!!! Whooooo! Yeeaahhh!!!
Blood Pressure
 Measure of force exerted by blood against
the wall
 Blood moves through vessels because of
blood pressure
 Measured by listening for Korotkoff
sounds produced by turbulent flow in
arteries as pressure released from blood
pressure cuff
Blood Pressure: Effects of Factors
• Temperature
• Heat has a vasodilation effect
• Cold has a vasoconstricting effect
• Chemicals
• Various substances can cause increases or
decreases
• Diet
Slide 11.39b
Factors Determining Blood Pressure
Figure 11.19
Slide 11.40
Pulse
• Pulse –
pressure wave
of blood
• Monitored at
“pressure
points” where
pulse is easily
palpated
Figure 11.16
Slide 11.35
Pulse Pressure
 Difference between
systolic and diastolic
pressures
 Increases when
stroke volume
increases or vascular
compliance
decreases
 Pulse pressure can
be used to take a
pulse to determine
heart rate and
rhythmicity
Variations in Blood Pressure
• Human normal range is variable
• Normal
• 140–110 mm Hg systolic
• 80–75 mm Hg diastolic
• Hypotension
• Low systolic (below 110 mm HG)
• Often associated with illness
• Hypertension
• High systolic (above 140 mm HG)
• Can be dangerous if it is chronic
Slide 11.41
Effects of Aging on the
Heart
 Gradual changes in heart function,
minor under resting condition, more
significant during exercise
 Hypertrophy of left ventricle
 Maximum heart rate decreases
 Increased tendency for valves to
function abnormally and arrhythmias to
occur
 Increased oxygen consumption
required to pump same amount of blood
Cardiac
Assessment
Cardiac History
 Interview
 Focused assessment
CARDIAC ASSESSMENT
Health History
 Obtain description of
present illness and the chief
complaint
 Chest pain, DOB, Edema,
etc.
 Assess risk factors
CARDIAC ASSESSMENT
Physical examination
 Vitalsigns- BP, PP,
 Inspection of the skin
 Inspection of the thorax
 Palpation of the PMI, pulses
 Auscultation of the heart
sounds
Fig. 13.23
WHY NURSING?
 Do you know why I took up nursing? It
was in 4th year high school that I saw a
vision of a great woman bearing a light
in her right hand wearing a long gown
and a headress calling me to serve
her…….
STATUE OF LIBERTY
CARDIAC ASSESSMENT
Laboratory and diagnostic
studies
 CBC
 Cardiac catheterization
 Lipid profile
 Arteriography
 Cardiac enzymes and proteins
 CXR
 CVP
 ECG
 Holter monitoring
 Exercise ECG
Laboratory Test Rationale

 1. To assist in diagnosing MI
 2. To identify abnormalities
 3. To assess inflammation
Laboratory Test Rationale

 4. To determine baseline value
 5. To monitor serum level of
medications
 6. To assess the effects of
medications
LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
 CK-MB ( creatine kinase)
Elevates in MI within 4
hours, peaks in 18 hours
and then declines till 3
days
CK- MB ( creatine kinase)
Normal value is 0-7 U/L

 Lactic
Dehydrogenase (LDH)
Elevates in MI in 24 hours,
peaks in 48-72 hours
 Lactic
Dehydrogenase (LDH)
Normal value is 70-200 IU/L

Myoglobin
 Rises within 1-3 hours
 Peaks in 4-12 hours
 Returns to normal in a day
Troponin I and T
 Troponin I is usually utilized for
MI
 Elevates within 3-4 hours, peaks
in 4-24 hours and persists for 7
days to 3 weeks!
 Normal value for Troponin I is
less than 0.6 ng/mL
Troponin I and T
 REMEMBER to AVOID IM
injections before obtaining
blood sample!
 Early and late diagnosis can be
made!
Myoglobin
 Not seen alone in cardiac
problems
 Muscular and RENAL disease
can have elevated myoglobin
SERUM LIPIDS
 Lipid profile measures the
serum cholesterol,
triglycerides and lipoprotein
levels
 Cholesterol= <200 mg/dL
 Triglycerides- 40- 150 mg/dL
SERUM LIPIDS
LDL- 130 mg/dL
HDL- 30-70- mg/dL
NPO post midnight

(usually 12 hours)
AFTER THE WEDDING:
Husband: Sinungaling ka, sabi mo

virgin ka! Bakit kagabi maluwag
na!
Wife: Ulol ka! Dahil lasing ka,

katabi mo kagabi si mama!
ELECTROCARDIOGRAM
(ECG)
 A non-invasive procedure
that evaluates the electrical
activity of the heart
 Electrodes and wires are
attached to the patient
ELECTROCARDIOGRAM
(ECG)
 Tell the patient that there is
no risk of electrocution
 Avoid muscular
contraction/movement
Holter Monitoring
A non-invasive test in
which the client wears a
Holter monitor and an
ECG tracing recorded
continuously over a
period of 24 hours
Holter Monitoring
 Instruct
the client to resume
normal activities and
maintain a diary of activities
and any symptoms that may
develop
ECHOCARDIOGRAM
 Non-invasive test that
studies the structural and
functional changes of the
heart with the use of
ultrasound
 No special preparation is
needed
Stress Test
 A non-invasive test that
studies the heart during
activity and detects and
evaluates CAD
 Exercise test,
pharmacologic test and
emotional test
Stress Test
 Treadmill testing is the most
commonly used stress test
 Used to determine CAD,
Chest pain causes, drug
effects and dysrhythmias in
exercise
Stress Test
 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
Pharmacological stress
test
 Pre-test:4 hours fasting,
avoid alcohol, caffeine
 Post test: report symptoms
of chest pain
CARDIAC catheterization
 Insertion of a catheter into
the heart and surrounding
vessels
 Determines the structure and
performance of the heart
valves and surrounding
vessels
CARDIAC catheterization
Used to diagnose CAD,
assess coronary artery
patency and determine
extent of atherosclerosis
Pretest: Ensure Consent,
assess for allergy to
seafood and iodine, NPO,
document weight and
height, baseline VS, blood
tests and document the
peripheral pulses
Pretest: Fast for 8-12

hours, teachings,
medications to allay
anxiety
 Intra-test: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 peripheral pulses, color and
warmth and sensation of the
extremity distal to insertion site
 Maintain sandbag to the insertion
site if required to maintain pressure
 Monitor for bleeding and hematoma
formation
 Maintain strict bed rest for 6-12 hours
 Client may turn from side to side but
bed should not be elevated more than
30 degrees and legs always straight
 Encourage fluid intake to flush out the
dye
 Immobilize the arm if the antecubital
vein is used
 Monitor for dye allergy
CVP
 The CVP is the pressure
within the SVC
 Reflects the pressure
under which blood is
returned to the SVC and
right atrium
CVP
 NormalCVP is 0 to 8 mmHg/ 4-
10 cm H2O
CVP
 ElevatedCVP indicates
increase in blood volume,
excessive IVF or heart/renal
failure
CVP
 LowCVP may indicate
hypovolemia, hemorrhage
and severe vasodilatation
Measuring CVP
 1. Position the client supine with
bed elevated at 45 degrees (CBQ)
 2. Position the zero point of the
CVP line at the level of the right
atrium. Usually this is at the MAL,
4th ICS
 3. Instruct the client to be relaxed
and avoid coughing and straining.
CARDIAC IMPLEMENTATION
1. Assess the cardio-pulmonary

status
VS, BP, Cardiac assessment
2. Enhance cardiac output
 Establish IV line to administer
fluids
3. Promote gas exchange

 Administer O2
 Position client in SEMI-Fowler’s
 Encourage coughing and deep

breathing exercises
4. Increase client activity tolerance

 Balance rest and activity
periods
 Assist in daily activities
 Provide strict bed rest if
indicated
 Soft foods
 Assistance in self-care
5. Promote client comfort
 Assess the client’s description
of pain and chest discomfort
 Administer medication as
prescribed
Morphine for MI
Nitroglycerine for Angina
Diuretics to relieve congestion
(CHF)
6. Promote adequate sleep
7. Prevent infection
 Monitor skin integrity of lower
extremities
 Assess skin site for edema,
redness and warmth
 Monitor for fever
 Change position frequently
8. Minimize patient anxiety

Encourage verbalization of
feelings, fears and concerns
Answer client questions.
Provide information about
procedures and medications
Activity Monitor TPR and BP
Intolerance Space activities in the day
Permit rest periods before activity
Limit activity 1 hour before meals
Teach energy conservation measures like bed rest
Edema Instruct patient to avoid constricting garments

Instruct to elevate edematous areas
Instruct patient to avoid dependent positions
Teach patient to prepare low sodium meals
Apply anti-embolic stockings
Pain Instruct patient to stop activity when pain occurs

Administer nitroglycerine for angina
Pace activities within patient’s limits
Instruct patient to avoid cold temperatures and
smoking
Instruct to report unrelieved pain immediately
CARDIAC DISEASES
 Coronary Artery Disease
 Myocardial Infarction
 Congestive Heart Failure
 Infective Endocarditis
 Cardiac Tamponade
 Cardiogenic Shock
VASCULAR DISEASES
 Hypertension
 Buerger’s disease
 Aneurysm
 Varicose veins
 Deep vein thrombosis
CAD
 CORONARY ARTERY DSE
results from the focal
narrowing of the large and
medium-sized coronary
arteries due to deposition of
atheromatous plaque in the
vessel wall
CAD
RISK FACTORS
 1. Age above 45/55 and Sex- Males and
post-menopausal females
 2. Family History
 3. Hypertension
 4. DM
 5. Smoking
 6. Obesity
 7. Sedentary lifestyle
 8. Hyperlipedimia
CAD
RISK FACTORS
Most important MODIFIABLE
factors:
 Smoking
 Hypertension
 Diabetes
 Cholesterol abnormalities
CAD: Pathophysiology
Fatty streak formation in the vascular intima
T-cells and monocytes ingest lipids in the area of

deposition
Atheroma
narrowing of the arterial lumen
reduced coronary blood flow
myocardial ischemia
CAD
Pathophysiology
 There is decreased perfusion of
myocardial tissue and inadequate
myocardial oxygen supply
 If 50% of the left coronary arterial
lumen is reduced or 75% of the
other coronary artery, this
becomes significant
CAD
Pathophysiology
 Potential for Thrombosis and
embolism
Angina Pectoris
Chest pain resulting from
coronary atherosclerosis
or myocardial ischemia
Angina Pectoris: Clinical Syndromes
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
Angina Pectoris: Clinical Syndromes
Three Common Types of ANGINA
2. Unstable angina
Occurs unpredictably
during exertion and
emotion, severity increases
with time and pain may not
be relieved by rest and drug
Angina Pectoris: Clinical
Syndromes
Three Common Types of ANGINA
3. Variant angina
Prinzmetal angina, results
from coronary artery
VASOSPASMS, may occur
at rest
Angina Pectoris
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
Angina Pectoris
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
 Precipitated by Exercise, Eating
heavy meals, Emotions like
excitement and anxiety and
Extremes of temperature
 Relieved by REST and Nitroglycerin
Angina Pectoris
ASSESSMENT FINDINGS
 2. Diaphoresis
 3. Nausea and vomiting
 4. Cold clammy skin
 5. Sense of apprehension and
doom
 6. Dizziness and syncope
Angina Pectoris
LABORATORY FINDINGS
 ECG may show normal tracing if
patient is pain-free.
- Ischemic changes may show ST
depression and T wave inversion
Angina Pectoris
LABORATORY FINDINGS
2. Cardiac catheterization
 Provides the MOST DEFINITIVE
source of diagnosis by showing the
presence of the atherosclerotic
lesions
Angina Pectoris
NURSING DIAGNOSES:
Decreased cardiac output
Impaired gas exchange
Activity intolerance
Anxiety
Angina Pectoris
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
Angina Pectoris
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
Angina Pectoris
3. Obtain a 12-
lead ECG
Angina Pectoris
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
 Encourage to avoid increased
physical activities
Angina Pectoris
5. Assist in possible treatment
modalities
 PTCA- percutaneous transluminal
coronary angioplasty
 To compress the plaque against the
vessel wall, increasing the arterial
lumen
 CABG- coronary artery bypass graft
 To improve the blood flow to the
myocardial tissue
Angina Pectoris
6. Provide information to family
members to minimize anxiety
and promote family
cooperation
7. Assist client to identify risk
factors that can be modified
8. Refer patient to proper
agencies
Myocardial infarction
Death of myocardial
tissue in regions of the
heart with abrupt
interruption of coronary
blood supply
ETIOLOGY and Risk factors
 1. CAD
 2. Coronary vasospasm
 3. Coronary artery occlusion by
embolus and thrombus
 4. Conditions that decrease
perfusion- hemorrhage, shock
Risk factors
 1. Hypercholesterolemia
 2. Smoking
 3. Hypertension
 4. Obesity
 5. Stress
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
ASSESSMENT findings
1. CHEST PAIN
 Chest pain is described as
severe, persistent, crushing
substernal discomfort
 Radiates to the neck, arm, jaw
and back
ASSESSMENT findings
1. CHEST PAIN
 Occurs without cause, primarily
early morning
 NOT relieved by rest or
nitroglycerin
 Lasts 30 minutes or longer
Assessment findings
 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
Laboratory findings
 3. CBC- may show elevated
WBC count
 4. Test after the acute stage-
Exercise tolerance test,
thallium scans, cardiac
catheterization
Pain
Impaired gas exchange
Activity intolerance
Altered tissue perfusion
Constipation
Nursing Interventions
1. Provide Oxygen at 2 lpm, Semi-
fowler’s
2. Administer medications
 Morphine to relieve pain
 Nitrates, thrombolytics, aspirin
and anticoagulants
 Stool softener and hypolipidemics
3. Minimize patient anxiety
 Provide information as to
procedures and drug therapy
 Allow verbalization of feelings
 Morphine can be administered
4. Provide adequate rest periods

 Bed rest during acute stage
5. Minimize metabolic demands

 Provide soft diet
 Provide a low-sodium, low

cholesterol and low fat diet
6. Assist in treatment modalities
such as PTCA and CABG
7. Monitor for complications of MI-
especially dysrhythmias, since
ventricular tachycardia can happen
in the first few hours after MI
8. Provide client teaching
MI
Medical Management
 1. ANALGESIC
 The choice is MORPHINE
 It reduces pain and anxiety
 Relaxes bronchioles to enhance

oxygenation
MI
Medical Management
 2. ACE inhibitors
 Prevents formation of
angiotensin II
 Limits the area of infarction
MI
Medical Management
 3. Thrombolytic therapy
 Streptokinase, Alteplase
 Dissolve clots in the coronary
artery allowing blood to flow
NURSING INTERVENTIONS AFTER ACUTE
EPISODE
 1. Maintain bed rest for the first 3
days
 2. Provide passive ROM exercises
 3. Progress with dangling of the feet

at side of bed
NURSING INTERVENTIONS AFTER
ACUTE EPISODE
 4. Proceed with sitting out of bed,
on the chair for 30 minutes TID
 5. Proceed with ambulation in the
room toilet hallway TID
NURSING INTERVENTIONS AFTER ACUTE
EPISODE
Cardiac rehabilitation
 To extend and improve quality of life
 Physical conditioning
 Patients who are able to walk 3-4 mph
are usually ready to resume sexual
activities
CARDIOMYOPATHIES
 Heartmuscle disease
associated with cardiac
dysfunction
CARDIOMYOPATHIES
 1. Dilated Cardiomyopathy
 2. Hypertrophic
Cardiomyopathy
 3. Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY
ASSOCIATED FACTORS
 1. Heavy alcohol intake
 2. Pregnancy
 3. Viral infection
 4. Idiopathic
DILATED CARDIOMYOPATHY
PATHOPHYSIOLOGY
 Diminished contractile proteins
poor contraction decreased
blood ejection increased blood
remaining in the ventricle
ventricular stretching and
dilatation.
 SYSTOLIC DYSFUNCTION
HYPERTROPHIC
CARDIOMYOPATHY
Associated factors:
1. Genetic
2. Idiopathic
HYPERTROPHIC
CARDIOMYOPATHY
Pathophysiology
 Increased size of myocardium
 reduced ventricular volume
 increased resistance to
ventricular filling diastolic
dysfunction
RESTRICTIVE
CARDIOMYOPATHY
Pathophysiology
 Rigid ventricular wall
impaired stretch and diastolic
filling decreased output
 Diastolic dysfunction
CARDIOMYOPATHIES
Assessment findings
 1. PND
 2. Orthopnea
 3. Edema
 4. Chest pain
 5. Palpitations
 6. dizziness
 7. Syncope with exertion

CARDIOMYOPATHIES
Laboratory Findings
 1. CXR- may reveal
cardiomegaly
 2. ECHOCARDIOGRAM
 3. ECG
 4. Myocardial Biopsy
CARDIOMYOPATHIES
Medical Management
 1. Surgery= heart transplant
 2. pacemaker insertion
 3. Pharmacological drugs for

symptom relief
CARDIOMYOPATHIES
Nursing Management
1. Improve cardiac output
 Adequate rest
 Oxygen therapy
 Low sodium diet

CARDIOMYOPATHIES
Nursing Management
2. Increase patient tolerance
 Schedule activities with rest
periods in between
CARDIOMYOPATHIES
Nursing Management
3. Reduce patient anxiety
 Support patient
 Offer information about
transplantations
 Support family in anticipatory
grieving
Infective endocarditis
Infectionof the heart

valves and the endothelial
surface of the heart
Can be acute, sub-acute

or chronic
Etiologic factors
 1. Bacteria- Organism
depends on several factors
 2. Fungi
Infective Endocarditis
Risk factors
 1. Prosthetic valves
 2. Congenital malformation
 3. Cardiomyopathy
 4. IV drug users
 5. Valvular dysfunctions
Pathophysiology
Direct invasion of microbes
microbes adhere to damaged valve surface

and proliferate
damage attracts platelets causing clot

formation
erosion of valvular leaflets and the clot and

vegetation can embolize
Assessment findings
 1. Intermittent high grade fever
 2. anorexia, weight loss
 3. cough, back pain and joint

pain
 4. splinter hemorrhages under
nails
Assessment findings
 5. Osler’s nodes- painful
nodules on fingerpads
 6. Roth’s spots- pale
hemorrhages in the retina
Assessment findings
 7. Heart murmurs
 8. Heart failure= usually

acute heart failure
Prevention
 Antibiotic prophylaxis if
patient is undergoing
procedures like dental
extractions, bronchoscopy,
surgery, etc.
Prevention
 Any invasive procedure that is
associated with transient
bacteremia may cause the
microrganism to lodge in the
damaged, irregular valves
LABORATORY EXAM
 Blood Cultures to determine
the exact organism
Usually, 3 culture specimens
are obtained and antibiotic
sensitivity done
Nursing management
 1. Regular monitoring of
temperature, heart sounds
 2. Manage infection
 3. Long-term antibiotic therapy
is given to ensure eradication
of bacteria
Medical management
1. Pharmacotherapy
 IV antibiotic for 2-6 weeks
 Antifungal agents are given –

amphotericin B
Medical management
2. Surgery
 Valvular replacement
CHF
A syndrome of congestion
of both pulmonary and
systemic circulation caused
by inadequate cardiac
function and inadequate
cardiac output to meet the
metabolic demands of
tissues
CHF
 Inabilityof the heart to
pump sufficiently
 The heart is unable to
maintain adequate
circulation to meet the
metabolic needs of the
body
CHF
This can happen acutely or
chronically
 Acute in Myocardial infarction
 Chronic cardiomyopathies
CHF
Classified according to the
major ventricular
dysfunction:
2. Left Ventricular failure
3. Right ventricular failure
CHF
Etiology of CHF
1. CAD
2. Valvular heart diseases
3. Hypertension
4. MI
5. Cardiomyopathy
6. Lung diseases
7. Post-partum
8. Pericarditis and cardiac tamponade
New York Heart Association
Class 1
 Ordinary physical activity does
NOT cause chest pain and
fatigue
 No pulmonary congestion
 Asymptomatic
 NO limitation of ADLs
Class 2
 SLIGHT limitation of ADLs
 NO symptom at rest
 Symptoms with INCREASED
activity
 Basilar crackles and S3
Class 3
 Markedly limitation on ADLs
 Comfortable at rest BUT

symptoms present in LESS
than ordinary activity
Class 4
 SYMPTOMS are present at
rest
CHF
PATHOPHYSIOLOGY
LEFT Ventricular pump failure
back up of blood into the pulmonary

veins
increased pulmonary capillary

pressure
pulmonary congestion (edema)

CHF
PATHOPHYSIOLOGY
LEFT ventricular failure
Decreased perfusion to the brain,

kidney and other tissues
Cerebral anoxia, fatigue, oliguria,

dizziness
CHF
PATHOPHYSIOLOGY
RIGHT ventricular failure
blood pooling in the venous

circulation
increased hydrostatic pressure
peripheral edema
CHF
PATHOPHYSIOLOGY
RIGHT ventricular failure
Venous blood pooling
venous congestion in the kidney,

liver and GIT
LEFT SIDED CHF
ASSESSMENT FINDINGS
 1. Dyspnea on exertion, activity
intolerance
 2. PND
 3. Orthopnea
 4. Pulmonary crackles/rales
 5. Cough with Pinkish, frothy
sputum
 6. Tachycardia
LEFT SIDED CHF
ASSESSMENT FINDINGS
 7. Cool extremities
 8. Cyanosis
 9. decreased peripheral
pulses
 10. Fatigue
 11. Oliguria
 12. signs of cerebral anoxia
RIGHT SIDED CHF
ASSESSMENT FINDINGS
 1. Peripheral dependent,
pitting edema
 2. Weight gain
 3. Distended neck vein
 4. hepatomegaly
 5. Ascites
RIGHT SIDED CHF
ASSESSMENT FINDINGS
 6. Body weakness
 7. Anorexia, nausea
 8. Pulsus alternans
 9. Nocturia= urination at night at
frequent intervals as the blood
moves from interstitial space to
the intravascular space and is
excreted
CHF
LABORATORY FINDINGS
 1. CXR may reveal
cardiomegaly
 2. ECG may identify Cardiac
hypertrophy
 3. Echocardiogram may show
hypokinetic heart
CHF
LABORATORY FINDINGS
 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
CHF
NURSING INTERVENTIONS
 1. Assess patient's cardio-
pulmonary status
 2. Assess VS, CVP and
PCWP. Weigh patient daily to
monitor fluid retention
CHF
 3. Administer medications-
usually cardiac glycosides are
given- DIGOXIN or DIGITOXIN,
Diuretics, vasodilators and
hypolipidemics are prescribed
CHF
Cardiotonics To increase cardiac
Positive contractility
inotropic
agents
Diuretics To decrease the
intravascular volume
in the circulation
Low Sodium To minimize water
Diet retention
Hypolipidemic To decrease the lipid
s levels of high risk
CHF
Digoxin Health teaching
 Oral tablet usually once a day
 Increases force of contraction
 DECREASES heart rate
 Assess: Apical pulse, ECG,

hypokalemia
CHF
Digoxin Health teaching
 Withhold the drug if apical
pulse is less than 60
 Note for early signs of toxicity:
NAVDA
 Provide potassium
supplements
CHF
 4. Provide a LOW sodium diet.
Limit fluid intake as necessary
 5. Provide adequate rest
periods to prevent fatigue
CHF
 6. Position on semi-fowler’s to
fowler’s for adequate chest
expansion
 7. Prevent complications of
immobility
CHF
NURSING INTERVENTION AFTER THE
ACUTE STAGE
 1. Provide opportunities for
verbalization of feelings
 2. Instruct the patient about the
medication regimen- digitalis,
vasodilators and diuretics
 3. Instruct to avoid OTC drugs,
Stimulants, smoking and alcohol
CHF
ACUTE STAGE
 4. Provide a LOW fat and LOW
sodium diet
 5. Provide potassium
supplements
 6. Instruct about fluid restriction
CHF
ACUTE STAGE
 7. Provide adequate rest periods
and schedule activities
 8. Monitor daily weight and report
signs of fluid retention
CARDIOGENIC SHOCK
 Heartfails to pump
adequately resulting to a
decreased cardiac output
and decreased tissue
perfusion
CARDIOGENIC SHOCK
ETIOLOGY
 1. Massive MI
 2. Severe CHF
 3. Cardiomyopathy
 4. Cardiac trauma
 5. Cardiac tamponade
CARDIOGENIC SHOCK
ASSESSMENT FINDINGS
 1. HYPOTENSION
 2. Oliguria (less than 30 ml/hour)
 3. Tachycardia
 4. Narrow pulse pressure
 5. weak peripheral pulses
 6. cold clammy skin
 7. changes in sensorium/LOC
 8. pulmonary congestion
CARDIOGENIC SHOCK
LABORATORY FINDINGS
 Increased CVP due to pooling of
blood in the venous system
 Normal is 4-10 cmH2O
 Metabolic acidosis
CARDIOGENIC SHOCK
 1. Place patient in a modified
Trendelenburg (shock ) position
 2. Administer IVF, vasopressors and

inotropics such as DOPAMINE and
DOBUTAMINE
CARDIOGENIC SHOCK
 3. Administer O2
 4.
Morphine is administered to
decreased pulmonary congestion
and to relieve pain, relieve
anxiety
CARDIOGENIC SHOCK
 5. Assist in intubation,
mechanical ventilation, PTCA,
CABG, insertion of Swan-Ganz
cath and IABP
 6. Monitor urinary output, BP and
pulses
 7. cautiously administer diuretics
and nitrates
CARDIAC TAMPONADE
A condition where the heart
is unable to pump blood
due to accumulation of fluid
in the pericardial sac
(pericardial effusion)
CARDIAC TAMPONADE
Causative factors
 1. Cardiac trauma
 2. Complication of Myocardial
infarction
 3. Pericarditis
 4. Cancer metastasis
CARDIAC TAMPONADE
 This condition restricts

ventricular filling resulting to
decreased cardiac output
 Acute tamponade may happen
when there is a sudden
accumulation of more than 50
ml fluid in the pericardial sac
CARDIAC TAMPONADE
ASSESSMENT FINDINGS
 1. BECK’s Triad- Jugular vein
distention, hypotension and
distant/muffled heart sound
 2. Pulsus paradoxus
 3. Increased CVP
 4. Decreased cardiac output

CARDIAC TAMPONADE
ASSESSMENT FINDINGS
 5. Syncope
 6. Anxiety
 7. Dyspnea
 8. Percussion- Flatness across

the anterior chest
CARDIAC TAMPONADE
Laboratory FINDINGS
 1. Echocardiogram= shows
accumulated fluid in the
pericardial sac
 2. Chest X-ray
CARDIAC TAMPONADE
 1. Assist in
PERICARDIOCENTESIS
 2. Administer IVF
 3. Monitor ECG, urine output and

BP
 4. Monitor for recurrence of
tamponade
Pericardiocentesis
 Patientis monitored by ECG
 Maintain emergency equipments
 Elevate head of bed 45-60

degrees
 Monitor for complications-
coronary artery rupture,
dysrhythmias, pleural laceration
and myocardial trauma
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
HYPERTENSION
Asystolic BP greater than
140 mmHg and a diastolic
pressure greater than 90
mmHg over a sustained
period, based on two or more
BP measurements.
HYPERTENSION
Types of Hypertension
1. Primary or ESSENTIAL
 Most common type
2. Secondary
 Due to other conditions like
Pheochromocytoma, renovascular
hypertension, Cushing’s, Conn’s ,
SIADH
HYPERTENSION
PATHOPHYSIOLOGY
 Multi-factorial etiology
BP= CO (SV X HR) x TPR

Any increase in the above
parameters will increase BP
HYPERTENSION
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
HYPERTENSION
PATHOPHYSIOLOGY
Any increase in the above
parameters will increase BP
 1. Increased sympathetic activity
 2. Increased absorption of Sodium,

and water in the kidney
HYPERTENSION
PATHOPHYSIOLOGY
Any increase in the above parameters
will increase BP
 3. Increased activity of the RAAS
 4. Increased vasoconstriction of the

peripheral vessels
 5. Insulin resistance
HYPERTENSION
ASSESSMENT FINDINGS
 1. Headache
 2. Visual changes
 3. chest pain
 4. dizziness
 5. N/V
HYPERTENSION
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
HYPERTENSION
MEDICAL MANAGEMENT
 1. Lifestyle modification
 2. Diet therapy
 3. Drug therapy
HYPERTENSION
MEDICAL MANAGEMENT
Drug therapy
 Diuretics
 Beta blockers
 Calcium channel blockers
 ACE inhibitors
 A2 Receptor blockers
 Vasodilators
HYPERTENSION
1. Provide health teaching to
patient
 Teach about the disease
process
 Elaborate on lifestyle changes
 Assist in meal planning to lose
weight
HYPERTENSION
1. Provide health teaching to the
patient
 Provide list of LOW fat , LOW
sodium diet of less than 2-3
grams of Na/day
 Limit alcohol intake to 30 ml/day
 Regular aerobic exercise
 Advise to completely stop
smoking
HYPERTENSION
2. Provide information about anti-
hypertensive drugs
 Instruct proper compliance and not
abrupt cessation of drugs even if pt
becomes asymptomatic/ improved
condition
 Instruct to avoid over-the-counter
drugs that may interfere with the
current medication
HYPERTENSION
Nursing Intervention
3. Promote Home care management
 Instruct regular monitoring of BP
 Involve family members in care
 Instruct regular follow-up

HYPERTENSION
Nursing Intervention
4. Manage hypertensive emergency
and urgency properly
ANEURYSM
 Dilation
involving an artery
formed at a weak point in
the vessel wall
ANEURYSM
 Saccular= when one side of the vessel
is affected
 Fusiform= when the entire segment

becomes dilated
ANEURYSM
RISK FACTORS
2. Atherosclerosis
3. Infection= syphilis
4. Connective tissue disorder
5. Genetic disorder= Marfan’s

Syndrome
ANEURYSM
PATHOPHYSIOLOGY
Damage to the intima and media
weakness outpouching of vessel
wall
Dissecting aneurysm tear in the

intima and media with dissection
of blood through the layers
ANEURYSM
ASSESSMENT
2. Asymptomatic
3. Pulsatile sensation on the

abdomen
4. Palpable bruit
ANEURYSM
LABORATORY:
 CT scan
 Ultrasound
 X-ray
 Aortography
ANEURYSM
Medical Management:
 Anti-hypertensives
 Synthetic graft
ANEURYSM
Nursing Management:
 Administer medications
 Emphasize the need to avoid

increased abdominal pressure
 No deep abdominal palpation
 Remind patient the need for serial

ultrasound to detect diameter
changes
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
 Refers to arterial insufficiency of
the extremities usually
secondary to peripheral
atherosclerosis.
 Usually found in males age 50
and above
 The legs are most often affected
ARTERIOSCLEROSI
S OF THE
EXTREMITIES
Arteriosclerosis of the extremities is a disease of the peripheral blood

vessels that is characterized by narrowing and hardening of the
arteries that supply the legs and feet. The narrowing of the arteries
causes a decrease in blood flow. Symptoms include leg pain,
numbness, cold legs or feet and muscle pain in the thighs, calves or
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Non-Modifiable
 1. Age
 2. gender
 3. family predisposition
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Modifiable
 1. Smoking
 2. HPN
 3. Obesity
 5. DM
 6. Stress
WALANG
ORIGINA-
LITY!
HHMMPP!
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
 1. INTERMITTENT
CLAUDICATION- the hallmark of
PAOD
 This is PAIN described as
aching, cramping or fatiguing
discomfort consistently
reproduced with the same
degree of exercise or activity
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
 1. INTERMITTENT
CLAUDICATION- the hallmark of
PAOD
 This pain is RELIEVED by REST
 This commonly affects the
muscle group below the arterial
occlusion
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Assessment Findings
 2. Progressive pain on the
extremity as the disease
advances
 3.
Sensation of cold and
numbness of the extremities
ARTERIOSCLEROSIS OF THE EXTREMITIES
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Assessment Findings
 4. Skin is pale when elevated
and cyanotic and ruddy when
placed on a dependent position
 5.
Muscle atrophy, leg ulceration
and gangrene
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Diagnostic Findings
 1. Unequal pulses between the
extremities
 2. Duplex ultrasonography
 3. Doppler flow studies

PAOD
Medical Management
1. Drug therapy
 Pentoxyfylline (Trental) reduces
blood viscosity and improves
supply of O2 blood to muscles
 Cilostazol (Pletaal) inhibits platelet
aggregation and increases
vasodilatation
2. Surgery- Bypass graft and
anastomoses
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
1. Maintain Circulation to the extremity
 Evaluate regularly peripheral pulses,
temperature, sensation, motor function
and capillary refill time
 Administer post-operative care to patient
who underwent surgery
 Administer heat modalities to the leg
cautiously to promote vasodilatation
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
2. Monitor and manage
complications
 Note for bleeding, hematoma, and
decreased urine output
 Elevate the legs to diminish edema
 Encourage exercise of the extremity
while on bed
 Teach patient to avoid leg-crossing
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
3. Promote Home management
 Encourage lifestyle changes
 Instruct to AVOID smoking
 Instruct to avoid leg crossing

BUERGER’S DISEASE
Thromboangiitis obliterans
 A disease characterized by
recurring inflammation of the
medium and small arteries and
veins of the lower extremities
BUERGER’S DISEASE
Thromboangiitis obliterans
 Occurs in MEN ages 20-35
 RISK FACTOR: SMOKING!

BUERGER’S DISEASE
PATHOPHYSIOLOGY
 Cause is UNKNOWN
 Probably an Autoimmune
disease
 Inflammation of the arteries
and veins thrombus
formation occlusion of the
vessels
BUERGER’S DISEASE
ASSESSMENT FINDINGS
1. Leg PAIN
 Foot cramps in the arch
(INSTEP CLAUDICATION) after

exercise
 Relieved by rest
 Aggravated by smoking, emotional
disturbance and cold chilling
BUERGER’S DISEASE
ASSESSMENT FINDINGS
2. Digital rest pain not changed by
activity or rest
BUERGER’S DISEASE
ASSESSMENT FINDINGS
 3. Intense RUBOR (reddish-blue
discoloration), progresses to
CYANOSIS as disease advances
 4. Paresthesias
BUERGER’S DISEASE
Diagnostic Studies
 1. Duplex ultrasonography
 2. Contrast angiography
BUERGER’S DISEASE
1. Assist in the medical and surgical
management
 Bypass graft
 amputation
2. Strongly advise to AVOID smoking

3. Manage complications
appropriately
BUERGER’S DISEASE
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
RAYNAUD’S DISEASE
 A form of intermittent arteriolar
VASOCONSTRICTION that results in
coldness, pain and pallor of the
fingertips or toes
RAYNAUD’S DISEASE
 Cause : UNKNOWN
 Most commonly affects WOMEN, 16-
40 years old
RAYNAUD’S DISEASE
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
RAYNAUD’S DISEASE
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
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
2. Tingling sensation
3. Burning pain on the hands
and feet
RAYNAUD’S DISEASE
Medical management
 Drug therapy with the use of
CALCIUM channel blockers
 To prevent vasospasms
RAYNAUD’S DISEASE
 1. instruct patient to avoid situations
that may be stressful
 2. instruct to avoid exposure to cold and
remain indoors when the climate is cold
 3. instruct to avoid all kinds of nicotine
 4. instruct about safety. Careful handling
of sharp objects
LAUGH BREAK
Bisaya 1: " Gara ng kutsi, siguro kay Miyur

iyan."!
Bisaya 2: " Dili bay!"
Bisaya 1: " Kay Hipi?"
Bisaya 2: " Tuntu ka man. Kay FATHER
iyan. Gisulat niya sa
likud o,"'SAFARI'."
VARICOSE VEINS
THESE are dilated veins
usually in the lower
extremities
VARICOSE VEINS
 Predisposing Factors
Pregnancy
Prolonged standing or
sitting
Incompetent venous valves
VARICOSE VEINS
Pathophysiology
Factors venous stasis
 increased hydrostatic
pressure  edema
VARICOSE VEINS
Assessment findings
Tortuous superficial veins
on the legs
Leg pain and Heaviness
Dependent edema
VARICOSE VEINS
Laboratory findings
Venography
Duplex scan
pletysmography
VARICOSE VEINS
Medical management
Pharmacological therapy
Leg vein stripping and
ligation
Anti-embolic stockings

VARICOSE VEINS
Nursing management
 1. Advise patient to elevate
the legs with pillow to
increase venous return
 2. Caution patient to avoid
prolonged standing or
sitting
VARICOSE VEINS
Nursing management
 3. Provide high-fiber foods
to prevent constipation
 4. Teach simple exercise to
promote venous return
VARICOSE VEINS
Nursing management
5. Caution patient to
avoid constrictive
clothing
VARICOSE VEINS
Nursing management
6. Apply anti-embolic
stockings as directed
7. Avoid massage on the
affected area
DVT- Deep Vein Thrombosis
 Inflammation of the deep
veins of the lower
extremities and the pelvic
veins
 The inflammation results to
formation of blood clots in
the area
 Predisposing factors
 Prolonged immobility
 Varicosities
 Traumatic procedures
 Increased age
 Malignancy
 Estrogen therapy
 Smoking
Complication
PULMONARY
thromboembolism
Assessment findings
Leg tenderness
Leg pain and edema
Positive HOMAN’s SIGN

HOMAN’s SIGN
 The foot is FLEXED upward
(dorsiflexed) , there is a sharp pain
felt in the calf of the leg
indicative of venous inflammation
Laboratory findings
Venography
Duplex scan
Medical management
Antiplatelets-aspirin
Anticoagulants
Vein stripping and

grafting
Anti-embolic stockings
Nursing management
1. Provide measures to avoid
prolonged immobility
Repositioning Q2
Provide passive ROM
Early ambulation
Nursing management
2. Provide skin care to
prevent the complication of
leg ulcers
3. Provide anti-embolic
stockings
Nursing management
4. Administer anticoagulants as
prescribed
5. Monitor for signs of

pulmonary embolism
sudden respiratory distress
The End
Thank You!

Cardio Nursing - Course Audit 2

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Cardio Nursing - Course Audit 2

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Cardiovascular

Ms. Irene M. Magbanua

 The Semilunar valves-

 Prosti: Ako na lang po, maawa kayo sa

 Lola: Sinabi na ngang LAHAT eh!

Inherent abilities of cardiac muscle cells:

Wife: Hon wag mo ako bibiglain ha?

Blood pressure is:

 ANF= causes sodium excretion

 The AFTERLOAD is the resistance

effect  A positive chronotropic effect refers to an

NURSE: Ok lang yan! Mas delikado kung

Misis 2: Mas grabe yung mister ko.

• Most arterial blood is

Waiter (inis): Alam nyo, sir, ang

DALAWANG MADRE NIREREYP:

Laboratory Test Rationale

Laboratory Test Rationale

CARDIAC Proteins and enzymes

CARDIAC Proteins and enzymes

HDL- 30-70- mg/dL

NPO post midnight

Husband: Sinungaling ka, sabi mo

Wife: Ulol ka! Dahil lasing ka,

 Maximally dilates coronary

Pretest: Fast for 8-12

1. Assess the cardio-pulmonary

3. Promote gas exchange

 Position client in SEMI-Fowler’s

 Encourage coughing and deep

4. Increase client activity tolerance

8. Minimize patient anxiety

Edema Instruct patient to avoid constricting garments

Pain Instruct patient to stop activity when pain occurs

T-cells and monocytes ingest lipids in the area of

narrowing of the arterial lumen

reduced coronary blood flow

 Advise to avoid valsalva maneuvers

 Provide laxatives or high fiber diet

4. Provide adequate rest periods

5. Minimize metabolic demands

 Provide a low-sodium, low

 Relaxes bronchioles to enhance

 3. Progress with dangling of the feet

 7. Syncope with exertion

 3. Pharmacological drugs for

 Low sodium diet

Infectionof the heart

Can be acute, sub-acute

microbes adhere to damaged valve surface

damage attracts platelets causing clot

erosion of valvular leaflets and the clot and

 2. anorexia, weight loss

 3. cough, back pain and joint

 8. Heart failure= usually

 Antifungal agents are given –

 Comfortable at rest BUT

back up of blood into the pulmonary

increased pulmonary capillary

pulmonary congestion (edema)

Decreased cardiac output

Decreased perfusion to the brain,