ALTERED OXYGENATION:

CARDIOVASCULAR

DISTURBANCES IN OXYGEN TRANSPORT MECHANISM

Structural Cardiac Disorders

HEART VALVES

MITRAL VALVE

MITRAL VALVE PROLAPSE

MITRAL VALVE PROLAPSE

• Directed at controlling the symptoms• Nitrates • Calcium-channel blockers• Beta-blockers• For heart failure, it is treated as it

would be for any other heart with heart failure

MITRAL REGURGITATION

MITRAL REGURGITATION

• Systolic murmur• Dyspnea• Fatigue• Palpitations• Shortness of breath on exertion• Cough due to pulmonary congestion

MITRAL STENOSIS

MITRAL STENOSIS

• Dyspnea on exertion = 1st symptom• Progressive fatigue• Hemoptysis• Repeated respiratoty infections

MITRAL STENOSIS

Colleen C. Flores, RN

• Antibiotic prophylaxis• Anticoagulants• Valvuloplasty• Percutaneous transluminal

valvuloplasty• Mitral valve replacement

AORTIC REGURGITATION

AORTIC REGURGITATION

• Asymptomatic• Clients may be aware of forceful heartbeats (head &

neck)– Visible or palpable on carotid or temporal arteries

• Exertional dyspnea followed by fatigue• Diastolic murmur • Widened pulse pressure• Water-hammer pulse• Breathing difficulties (Progressive signs and symptoms)

AORTIC STENOSIS

AORTIC STENOSIS

• Asymptomatic• Exertional dyspnea• Dizziness and syncope• Rough systolic murmur

Surgical Management

• Valvuloplasty

Surgical Management

• Valvuloplasty

Surgical Management

• Valve Repair and Replacement:

Surgical Management• Valve Repair and Replacement:

NURSING MANAGEMENT

• Education on diagnosis (it may be hereditary), symptoms that may develop

• Need for prophylactic antibiotics before any invasive procedure

• Diet :

DISTURBANCES IN OXYGEN TRANSPORT MECHANISM

Infectious Disorders

Rheumatic Heart Disease

Rheumatic Heart DiseaseStrep Throat S/Sx

• sudden onset of sore throat

• pain on swallowing• fever, usually 101–104°F• headache• red throat/tonsils• abdominal pain, nausea

and vomiting may also occur, especially in children

Rheumatic Fever S/Sx• fever• painful, tender, red swollen

joints• pain in one joint that

migrates to another one• heart palpitations• chest pain, SOB• skin rashes• fatigue• small, painless nodules under

the skin

Rheumatic Heart Disease

• Best defense = prevent rheumatic fever from occurring

• Treat strep throat with penicillin or other antibiotics

• People with history of rheumatic fever are more susceptible to recurrent attacks and heart damage.

Infective Endocarditis (Bacterial Endocarditis)

Colleen C. Flores, RN

• Manifestations:– Remittent fever (high or low) accompanied by chills*– Malaise, fatigue, anorexia, weight loss – Headache & musculoskeletal complaints (arthralgia)– Murmurs– Petichiae (conjunctiva), splinter hemorrhages (dark red

lines) under the nails, Painful finger or toe tip (Osler’s node – pea-sized nodules)

• Dx: blood culture – at least 6 (taken during chills or at height of fever), ECG, CBC

• Tx: antimicrobials – depend on organism involved (Penicillin & Streptomycin commonly used)– IV 4-6wks– Prosthetic heart valves may need to be replaced

Splinter Hemorrhages

Osler’s nodes

Roth’s Spots

Myocarditis

Pericarditis

Manifestations & Management:1. Acute: chest pain exacerbated with respirations– Pericardial friction rub (classic sign)– MGT: tx of underlying cause, NSAID (ASA), morphine, provide

reassurance on temporary nature of disease2. Cardiac tamponade: narrow pulse pressure– Tachycardia (compensatory) → shock & death– Hypotension, jugular vein distention, cyanosis, muffled heart

sounds, paradoxic pulse– MGT: pericardiocentesis; prompt intervention needed to

prevent shock & death3. Constrictive: RV failure & ↓cardiac output– Fatigue on exertion, dyspnea, low pulse pressure, distended

neck veins, delayed capillary refill time– leg edema, ascites– MGT: digitalis, diuretics, Na+ restriction; pericardiectomy

Colleen C. Flores, RN

DISTURBANCES IN OXYGEN TRANSPORT MECHANISM

Vascular and

Peripheral Disorders

Colleen C. Flores, RN

Vascular System

Aortic Aneurysm

Clinical ManifestationThoracic Aortic Aneurism May be asymptomatic

Pain is usually constant and boring (when patient is supine)Dyspnea, brassy cough, hoarseness of voice

Abdominal Aortic Aneurism (AAA)

Feels that heart is beating in the abdomen while lying downMay feel abdominal mass or abdominal throbbing

Dissecting Aneurism of the Aorta

Sudden severe and persistent pain described as tearing or ripping in the anterior chest or back and extends to the shoulders, epigastric area or abdomen

Buerger’s Disease

Raynaud’s Disease

Raynaud’s Disease

Management

Veins Cause/s Clinical Manifestations

Superficial (Thrombo-phlebitis)- Saphenous- Median cephalic & basilic

Varicose veins, IVs injections, Buerger’s, cancer, blood dyscrasias

Tender, indurated, visible, & palpable vein; ovoid nodules in skin

Deep Vein (DVT)- Femoral, iliac, tibial, popliteal

Immobility, CHF, cancer, blood dyscrasias, fracture, dislocation, obesity, oral contraceptives

(+)Homan’s sign, tenderness, warmth, superficial venous distention, cyanosis (severe occlusion)

Pharmacological Management

• Anti-coagulants - prevents clot formation–Heparin (Liquaemin) –Warfarin (Coumadin

• Thrombolytics = Streptokinase - dissolves clot

Surgical Management

Venous Thrombectomy

Umbrella Procedure

Nursing Management

• Superficial thrombophlebitis – local measures (i.e. warm pack, extremity elevation); sometimes anti-inflammatory meds are required

• DVT – CBR until local signs of inflammation subsides; after 7-15days = ambulate with elastic stockings

Colleen C. Flores, RN