OXY-Cardio Care Management

8/8/2019 OXY-Cardio Care Management

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Nursing CareNursing Care

ManagementManagementPatients with Cardiovascular CarePatients with Cardiovascular Care

NeedsNeeds


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The CARDIOVASCULARThe CARDIOVASCULAR

SYSTE

MSYSTE

M


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Importance of Studying the CVS forImportance of Studying the CVS for

NursesNurses1._________________________________1._________________________________

2._________________________________2._________________________________

3._________________________________3._________________________________


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Cardiac assessmentCardiac assessment InspectionInspection

Palpation of the apical pulse and PMI atPalpation of the apical pulse and PMI atthe 5the 5thth ICS LMCLICS LMCL

Auscultation for the heart soundsAuscultation for the heart sounds S1 and S2S1 and S2

Auscultation for the heart valvesAuscultation for the heart valves

TVTVMVMV

PVPV

AVAV


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Anatomy & PhysiologyAnatomy & Physiology

The Valves of the HeartThe Valves of the Heart

Valve TypeValve Type

AtrioventricularAtrioventricular

(AV)(AV)

SemilunarSemilunar

NameName

TricuspidTricuspid

MitralMitral(Bicuspid)(Bicuspid)

PulmonicPulmonic

AorticAortic

LocationLocation

Separates right atrium andSeparates right atrium and

right ventricleright ventricle

Separates left atrium andSeparates left atrium andleft ventricleleft ventricle

Between right ventricleBetween right ventricle

and pulmonary arteryand pulmonary arteryBetween left ventricle andBetween left ventricle and

aortaaorta


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The Heart: PhysiologyThe Heart: Physiology

Heart sounds can be auscultatedHeart sounds can be auscultated

S1, S2, S3, and S4S1, S2, S3, and S4

S1 is due to the closure of the AV valvesS1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valvesS2 is due to the closure of the semilunar valves

S3 is due to the rushing of blood through theS3 is due to the rushing of blood through the

AV openingAV opening S4 is due to contraction of the atriumS4 is due to contraction of the atrium


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Surface AnatomySurface Anatomy AuscultationAuscultation

TricuspidTricuspid ValveValve lieslies behindbehind rightright halfhalf of of thethesternumsternum;; oppositeopposite thethe 44thth ICSICS

LEFTLEFT halfhalf of of thethe lowerlower endend ofofthethe bodybody of of thethe sternumsternum ((44thth

ICS)ICS)

MitralMitral ValveValve lieslies behindbehind thethe leftleft halfhalf of of thethe

sternumsternum;; oppositeopposite thethe 44thth costalcostal

cartilagecartilage

apexapex beatbeat ((55thth ICSICS LMCL)LMCL)

PulmonaryPulmonary ValveValve LiesLies behindbehind thethe medialmedial endend ofof thethe

33rdrd leftleft costalcostal cartilagecartilage && thetheadjoiningadjoining partpart ofof thethe sternumsternum

MedialMedial endend ofof thethe 22ndnd leftleft ICSICS

AorticAortic ValveValve BehindBehind leftleft halfhalf of of sternumsternum;;

oppositeopposite 33rdrd ICSICS

MedialMedial endend ofof thethe 22ndnd rightright ICSICS


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The CARDIOVASCULARThe CARDIOVASCULAR

SYSTEMSYSTEM

This system is composed of the heart and theThis system is composed of the heart and the

blood vesselsblood vessels The main functions of this system are:The main functions of this system are:

to transport oxygen, hormones andto transport oxygen, hormones and

nutrients to the tissuesnutrients to the tissuesand to transport waste products to theand to transport waste products to the

lungs and kidneys for excretionlungs and kidneys for excretion


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The Gross Anatomy of the HeartThe Gross Anatomy of the Heart

The heart is located within theThe heart is located within the

thorax behind the sternum in thethorax behind the sternum in the

compartment calledcompartment calledMEDIASTINUMMEDIASTINUM

Th

eh

eart is commonly describedTh

eh

eart is commonly describedas the size of a clenched fistas the size of a clenched fist


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The Gross Anatomy of the HeartThe Gross Anatomy of the Heart

The shape is conical, with a baseThe shape is conical, with a base

and an apexand an apex

The base is directed upwardThe base is directed upward

The apex is directed downward toThe apex is directed downward to

th

e left at th

e level of th

e 5th

e left at th

e level of th

e 5thth

ICSICSLMCLLMCL


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Heart SurfaceHeart Surface

ANTERIOR SURFACEANTERIOR SURFACE

Right ventricleRight ventricle

POSTERIOR SURFACEPOSTERIOR SURFACE

Left ventricleLeft ventricle


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Fig. 12.4Fig. 12.4


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The Heart: AnatomyThe Heart: Anatomy

The heart has four chambersThe heart has four chambers

The right atriumThe right atrium

The right ventricleThe right ventricle The left atriumThe left atrium

The left ventricleThe left ventricle


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The Heart: AnatomyThe Heart: Anatomy

The blood supply of the heart:The blood supply of the heart:

The coronary arteries are the blood supplyThe coronary arteries are the blood supply

There are two main coronary arteriesThere are two main coronary arteries-- thetheright coronary artery and the left coronaryright coronary artery and the left coronaryarteryartery

The venous drainage of the heart is theThe venous drainage of the heart is thecoronary sinus; the anterior cardiac vein andcoronary sinus; the anterior cardiac vein andthe smallest cardiac veinthe smallest cardiac vein


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Blood SupplyBlood Supply


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Venous DrainageVenous Drainage

Coronary sinus will collect all the venousCoronary sinus will collect all the venous

blood from the heart into the RIGHT atriumblood from the heart into the RIGHT atrium

The anterior cardiac vein drains NOT intoThe anterior cardiac vein drains NOT into

the coronary sinus but DIRECTLY into thethe coronary sinus but DIRECTLY into the

right atriumright atrium


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CirculationCirculation


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Fig. 12.11Fig. 12.11


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Cardiovascular AssessmentCardiovascular Assessment


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The Cardiovascular SystemThe Cardiovascular System

Cardiac HistoryCardiac History

InterviewInterview

Focused assessment

Focused assessment


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CARDIAC ASSESSMENTCARDIAC ASSESSMENT

Health HistoryHealth History

During the healthhistory, theDuring the healthhistory, the

nurse should assess fornurse should assess forsignificant past diseases andsignificant past diseases andrecent illnessrecent illness

Family history may highlightFamily history may highlightrisk factorsrisk factors


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Health HistoryHealth History

Obtain description of presentObtain description of present

illness and the chief complaintillness and the chief complaintChest pain, Edema, etc.Chest pain, Edema, etc.

Assess risk factorsAssess risk factors


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Physical examinationPhysical examination

Vital signsVital signs-- BP, PPBP, PP

Inspection of the skinInspection of the skin Inspection of the thoraxInspection of the thorax

Palpation of the PMI, pulsesPalpation of the PMI, pulses

Auscultation of the heart soundsAuscultation of the heart sounds


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Cardiac assessmentCardiac assessment InspectionInspection Palpation of the apical pulse and PMI atPalpation of the apical pulse and PMI at

the 5the 5thth ICS LMCLICS LMCL

Auscultation for the heart soundsAuscultation for the heart sounds S1 and S2S1 and S2

Auscultation for the heart valvesAuscultation for the heart valves

TVTVMVMV

PVPV

AVAV


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Surface AnatomySurface Anatomy AuscultationAuscultation

TricuspidTricuspid ValveValve lieslies behindbehind rightright halfhalf of of thethesternumsternum;; oppositeopposite thethe 44thth ICSICS

LEFTLEFT halfhalf of of thethe lowerlower endend ofofthethe bodybody of of thethe sternumsternum ((44thth

ICS)ICS)

MitralMitral ValveValve lieslies behindbehind thethe leftleft halfhalf of of thethe

sternumsternum;; oppositeopposite thethe 44thth costalcostal

cartilagecartilage

apexapex beatbeat ((55thth ICSICS LMCL)LMCL)

PulmonaryPulmonary ValveValve LiesLies behindbehind thethe medialmedial endend ofof thethe

33rdrd leftleft costalcostal cartilagecartilage && thetheadjoiningadjoining partpart ofof thethe sternumsternum

MedialMedial endend ofof thethe 22ndnd leftleft ICSICS

AorticAortic ValveValve BehindBehind leftleft halfhalf of of sternumsternum;;

oppositeopposite 33rdrd ICSICS

MedialMedial endend ofof thethe 22ndnd rightright ICSICS


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Determining the pulsesDetermining the pulses


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3. Laboratory and diagnostic studies3. Laboratory and diagnostic studies CBCCBC

Lipid profileLipid profile

arteriographyarteriography

Cardiac enzymesCardiac enzymes

CXRCXR

ECGECG

HolterHolter monitoringmonitoring Exercise ECGExercise ECG


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The Normal CardiovascularThe Normal Cardiovascular

PatternPatternFactors that identify the normal function of theFactors that identify the normal function of the

heartheart

1.1. T

he heart rateT

he heart rate2.2. Blood pressureBlood pressure

3.3. Skin temperature and skin colorSkin temperature and skin color

4.4. Urine outputUrine output5.5. Sensorium or Level of consciousnessSensorium or Level of consciousness


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PatternPattern Heart rateHeart rate-- the normal heart rate variesthe normal heart rate varieson the average of 60 to 100 beats peron the average of 60 to 100 beats per

minute.minute.

This is reflected by the pulses determinedThis is reflected by the pulses determined

by palpating them in areas of the body.by palpating them in areas of the body.

The heart rate is highest in the newbornThe heart rate is highest in the newborn

and decreases with age.and decreases with age.


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PatternPattern Blood pressureBlood pressure-- the force with which thethe force with which theblood is pushed through the arterial system.blood is pushed through the arterial system.

Normal BP also varies with age. The adultNormal BP also varies with age. The adult

average is 120/80 mmHgaverage is 120/80 mmHg

It varies during the day,It varies during the day, being highest during latebeing highest during late

afternoon.afternoon.


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PatternPattern Skin temperature and colorSkin temperature and color-- the personthe person

with good circulatory status is warm,with good circulatory status is warm,

with

fairly uniform skin temperaturewith

fairly uniform skin temperature Skin color can reflect the level of bloodSkin color can reflect the level of blood

oxygenation and adequacy of bloodoxygenation and adequacy of blood

flow.flow.


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PatternPatternOther indicators:Other indicators:

Absence of pain in the chestAbsence of pain in the chest

Normal urine output of more than 30Normal urine output of more than 30ml/hourml/hour

Normal cognitive functionNormal cognitive function


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The Factors Affecting NormalThe Factors Affecting NormalCardiovascular FunctionCardiovascular Function

AGEAGE-- the rapid metabolic rate of thethe rapid metabolic rate of thenewborns demands tremendous bloodnewborns demands tremendous blood

flow to the developing tissues.flow to the developing tissues. Heart rate is considerably faster in theHeart rate is considerably faster in theyoung.young.

In old age, the vascular system hasIn old age, the vascular system hasnaturally narrowed and stiffened, thusnaturally narrowed and stiffened, thusBP somewhat increases.BP somewhat increases.


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ACTIVITY and EXERCISEACTIVITY and EXERCISE--

Increased metabolic demands from theIncreased metabolic demands from theexercising muscles will force the heart toexercising muscles will force the heart to

beat faster.beat faster.

The increased temperature causes

The increased temperature causesvasodilatation increasing local blood flow.vasodilatation increasing local blood flow.


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GENDERGENDER-- heart rate and BP varyheart rate and BP vary

slightly among men and women.slightly among men and women. Menopause women however haveMenopause women however have

comparable increase in BPcomparable increase in BP


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TEMPERATURETEMPERATURE--

When body temperature begins to rise, theWhen body temperature begins to rise, the

autonomic system signals th

e periph

eralautonomic system signals th

e periph

eralarterioles to open wide (dilate) to allowarterioles to open wide (dilate) to allow

heat loss.heat loss.

The opposite occurs when the body isThe opposite occurs when the body is

exposed to coldexposed to coldVASOCONSTRICTIONVASOCONSTRICTION


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LIFE STYLE AND HABITSLIFE STYLE AND HABITS--

smoking increases heart rate and BPsmoking increases heart rate and BP


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Common Altered CardiacCommon Altered Cardiac

FunctionsFunctions

Decreased Pumping ability of the heartDecreased Pumping ability of the heart(decreased cardiac output)(decreased cardiac output)

Altered blood flow (Impaired tissueAltered blood flow (Impaired tissueperfusion)perfusion)

Altered blood composition (BloodAltered blood composition (Bloodalterations)alterations)


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Altered Cardiac FunctionsAltered Cardiac Functions

Decreased Pumping ability of the heart (decreasedDecreased Pumping ability of the heart (decreasedcardiac output)cardiac output) -- a healthy heart is able to createa healthy heart is able to createtremendous pressure and eject blood through thetremendous pressure and eject blood through thearteries to the lungs and body tissues.arteries to the lungs and body tissues.

Decreased pumping action can be the result ofDecreased pumping action can be the result ofconduction problems termed asconduction problems termed as cardiaccardiacarrhythmias.arrhythmias.

Another cause of pump failure isAnother cause of pump failure isvalvularvalvulardysfunctiondysfunction. The valves which guard the chambers. The valves which guard the chambersmay be damaged by infection, trauma ormay be damaged by infection, trauma orinflammation.inflammation.

Muscle damageMuscle damage such as in myocardial infarctionsuch as in myocardial infarctioncan weaken the pump action of the heart.can weaken the pump action of the heart.


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Altered Cardiac FunctionsAltered Cardiac Functions Altered blood flow (Impaired tissue perfusion)Altered blood flow (Impaired tissue perfusion)--blood vessels control the amount of blood enteringblood vessels control the amount of blood entering

the heart and tissues.the heart and tissues.

Obstruction and narrowing can greatly affectObstruction and narrowing can greatly affecttissue oxygenation.tissue oxygenation.

Capillary dysfunction (when subjected toCapillary dysfunction (when subjected toinflammatory mediators)inflammatory mediators)

Venous pooling ( collection of blood in the venousVenous pooling ( collection of blood in the venoussystem caused commonly be venous valvesystem caused commonly be venous valve

incompetence).incompetence). Signs of impaired peripheral circulation can be:Signs of impaired peripheral circulation can be:

decreased peripheral pulses, pale skin color, cooldecreased peripheral pulses, pale skin color, coolextremities and decreased hair distributionextremities and decreased hair distribution..


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Altered Cardiac FunctionsAltered Cardiac Functions

Altered blood composition (Blood alterations)Altered blood composition (Blood alterations)--alteration in RBC, plasma or circulating volumealteration in RBC, plasma or circulating volume

can affect the tissue oxygenation.can affect the tissue oxygenation.

Anemia can lead to inadequate oxygenation ofAnemia can lead to inadequate oxygenation ofbody tissues leading to hypoxia.body tissues leading to hypoxia.

Signs of anemia may include chronic fatigue,Signs of anemia may include chronic fatigue,

pallor, shortness of breath and hypotension.pallor, shortness of breath and hypotension.

Bleeding, burns, dehydration can all lead to deficitBleeding, burns, dehydration can all lead to deficitin blood volumein blood volume


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The Nursing Process Applied inThe Nursing Process Applied inOxygenation: Cardiac FunctionOxygenation: Cardiac Function

AA

DD

PP II

EE


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ASSESSMENTASSESSMENT

To formulate accurate nursing care plan, theTo formulate accurate nursing care plan, thenurse must conduct an assessment of the CVSnurse must conduct an assessment of the CVS

status.status.

This may include gathering of subjective data,This may include gathering of subjective data,

objective data (through physical examination)objective data (through physical examination)

and laboratory data.and laboratory data.


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Nursing HistoryNursing History

Information obtained by the nurse oftenInformation obtained by the nurse oftenprovides the basis for interventions.provides the basis for interventions.

The nurse must elicit from the history the riskThe nurse must elicit from the history the riskfactors present, the functional pattern of thefactors present, the functional pattern of the

patient before consultation, the events thatpatient before consultation, the events that

lead to th

e occurrence of th

e manifestationslead to th

e occurrence of th

e manifestationsand the abnormal pattern of cardiovascularand the abnormal pattern of cardiovascularfunctions.functions.


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Physical ExaminationPhysical Examination

During inspection, the nurse observes the generalDuring inspection, the nurse observes the generalbehavior, sensorium, and appearance.behavior, sensorium, and appearance.

The nurse must inspect the skin for color changes,The nurse must inspect the skin for color changes,edema, abnormal pulsations, varicosities and nailedema, abnormal pulsations, varicosities and nailclubbingclubbing

Palpation involves checking for skin temperature,Palpation involves checking for skin temperature,capillary refill time (normally is less than 3capillary refill time (normally is less than 3seconds), pulses (either apical or peripheral).seconds), pulses (either apical or peripheral).

Auscultation involves the use of a stethoscope toAuscultation involves the use of a stethoscope tohear for the different heart sounds. Blood pressurehear for the different heart sounds. Blood pressureis also taken with the aid of the apparatus andis also taken with the aid of the apparatus and

stethoscope.stethoscope.


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Diagnostic TestsDiagnostic Tests CBC can determine the information about the bloodCBC can determine the information about the blood

components.The hemoglobin reflects the oxygencomponents.The hemoglobin reflects the oxygencarrying capacity of the bloodcarrying capacity of the blood

Cardiac Enzymes are released by DAMAGED cardiacCardiac Enzymes are released by DAMAGED cardiaccells and may indicate tissue damage as in myocardialcells and may indicate tissue damage as in myocardialinfarction.infarction.

Serum electrolytes can directly affect the heart functions.Serum electrolytes can directly affect the heart functions.Imbalances may cause arrhythmias.Imbalances may cause arrhythmias.

ECG records the electrical impulse conduction of theECG records the electrical impulse conduction of theheart in the resting patient.The treadmill test involvesheart in the resting patient.The treadmill test involveschecking the ECG of a patient subjected to exercise.checking the ECG of a patient subjected to exercise.

Echocardiogram is simply the ultrasound of the heartEchocardiogram is simply the ultrasound of the heart


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The Nursing Process in CardiacThe Nursing Process in Cardiac

CareCareNURSING DIAGNOSISNURSING DIAGNOSIS

Altered tissue perfusion (renal, Cerebral,Altered tissue perfusion (renal, Cerebral,

Cardiopulmonary, GI and Peripheral)Cardiopulmonary, GI and Peripheral)

Decreased Cardiac OutputDecreased Cardiac Output

Activity IntoleranceActivity Intolerance

Fluid volume excess

Fluid volume excess

Fluid volume deficitFluid volume deficit


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CARDIACCARDIAC

IMPLEMENTATIONIMPLEMENTATION

1. Assess the cardio1. Assess the cardio--pulmonary statuspulmonary status

VS, BP, Cardiac assessmentVS, BP, Cardiac assessment

2. Enhance cardiac output2. Enhance cardiac output

Establish IV line to administerEstablish IV line to administer

fluidsfluids


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The Nursing Process in CardiacThe Nursing Process in Cardiac

CareCareIMPLEMENTATIONIMPLEMENTATION3. Promote CARDIOVASCULARhealth and function3. Promote CARDIOVASCULARhealth and function

The nurse can employ health teaching strategies byThe nurse can employ health teaching strategies bypresenting information concerning risk factors,presenting information concerning risk factors,

availability ofhealthy lifestyle programs like fitnessavailability ofhealthy lifestyle programs like fitnessclubs.clubs.

The nurse can employ various therapeuticThe nurse can employ various therapeuticinterventions that will address specific problemsinterventions that will address specific problems


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ActivityActivityintoleranceintolerance

Monitor TPR and BPMonitor TPR and BPSpace activities in the daySpace activities in the dayPermit rest periods before activityPermit rest periods before activityLimit activity 1 hour before mealsLimit activity 1 hour before meals

Teach energy conservationTeach energy conservationmeasures like bed restmeasures like bed rest

Examples of Nursing measuresExamples of Nursing measures


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EdemaEdema Instruct patient to avoid constrictingInstruct patient to avoid constrictinggarmentsgarmentsInstruct to elevate edematous areasInstruct to elevate edematous areas

Instruct patient to avoid dependentInstruct patient to avoid dependentpositionspositions

Teach patient to prepare low sodiumTeach patient to prepare low sodiummealsmealsApply antiApply anti--embolic stockingsembolic stockings



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PainPain Instruct patient to stop activityInstruct patient to stop activitywhen pain occurswhen pain occurs

Administer nitroglycerin forAdminister nitroglycerin foranginaanginaPace activities within patientsPace activities within patientslimitslimits

Instruct patient to avoid coldInstruct patient to avoid coldtemperatures and smokingtemperatures and smoking

Instruct to report unrelievedInstruct to report unrelievedpain immediatelypain immediately



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Nursing Process for CARDIACNursing Process for CARDIAC

CARECARE4. Energy Conservation4. Energy Conservation

The patient should be warned against ValsalvaThe patient should be warned against Valsalvamaneuver which can cause sudden increase in bloodmaneuver which can cause sudden increase in blood

pressure but simultaneously preventing venouspressure but simultaneously preventing venousreturn.return.

The most important energy conserving activity isThe most important energy conserving activity isRESTREST

Regular rest periods should be provided. ActivitiesRegular rest periods should be provided. Activitiesshould be spaced to avoid fatigue.should be spaced to avoid fatigue.

i f CA D ACi f CA D AC


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CARECARE5. Administer medications as ordered5. Administer medications as ordered

Administration of meds is an importantAdministration of meds is an importantnursing functionnursing function

The nurse is also responsible for assessing theThe nurse is also responsible for assessing the

effects of medications and for potentialeffects of medications and for potential

complicationscomplications

N i P f CARDIACN i P f CARDIAC


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CARECARE6. Perform CPR as needed.6. Perform CPR as needed. CPR is a combination of oral resuscitationCPR is a combination of oral resuscitation

which supplies oxygen to the lungs andwhich supplies oxygen to the lungs andexternal cardiac massage which is intended toexternal cardiac massage which is intended to

rere--establish cardiac functions.establish cardiac functions.

The three cardinal signs of cardiac arrest thatThe three cardinal signs of cardiac arrest thatthe nurse must assess are Apnea, Absence ofthe nurse must assess are Apnea, Absence of

carotid or femoral pulses and dilated pupils.carotid or femoral pulses and dilated pupils.

Respiratory Arrest is the cessation ofRespiratory Arrest is the cessation ofbreathing. It often occurs because of blockedbreathing. It often occurs because of blocked

airway.airway.

CARDIACCARDIAC


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CARDIACCARDIAC


7. Promote gas exchange7. Promote gas exchange

Administer O2Administer O2

Position client inPosition client in SEMISEMI--FowlersFowlers

Encourage coughing and deepEncourage coughing and deep

breath

ing exercisesbreath

ing exercises

CARDIACCARDIAC


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CARDIACCARDIAC


8. Promote client comfort8. Promote client comfort

Assess the clients description ofAssess the clients description of

pain and ch

est discomfortpain and ch

est discomfortAdminister medication asAdminister medication asprescribedprescribed

Morphine for MIMorphine for MINitroglycerine for AnginaNitroglycerine for Angina

Diuretics to relieve congestion (CHF)Diuretics to relieve congestion (CHF)

CARDIACCARDIAC


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CARDIACCARDIAC


9. Prevent infection9. Prevent infection

Monitor skin integrity of lowerMonitor skin integrity of lower

extremitiesextremitiesAssess skin site for edema, redness andAssess skin site for edema, redness and

warmthwarmth

Monitor for feverMonitor for feverChange position frequentlyChange position frequently

CARDIACCARDIAC


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CARDIACCARDIAC


10. Minimize patient anxiety10. Minimize patient anxiety

Encourage verbalization of

Encourage verbalization offeelings, fears and concernsfeelings, fears and concerns

Answer client questions. ProvideAnswer client questions. Provide

information about procedures andinformation about procedures andmedicationsmedications

VA UAT ONVA UAT ON


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EVALUATIONEVALUATION

Patients with cardiovascularPatients with cardiovascular

dysfunction show widely variable ratesdysfunction show widely variable rates

of progress.of progress. Specific goals for these patients mustSpecific goals for these patients must

be individualized.be individualized.


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In SummaryIn Summary

The cardiovascular system transports gases inThe cardiovascular system transports gases inthe blood to and from the tissues and facilitatesthe blood to and from the tissues and facilitatesthe diffusion of gases between the capillariesthe diffusion of gases between the capillaries

and body tissuesand body tissues

The heart and blood vessels make up theThe heart and blood vessels make up the

cardiovascular system that together with blood iscardiovascular system that together with blood isthe major system for transporting oxygen andthe major system for transporting oxygen andnutrients to the tissues and wastes productsnutrients to the tissues and wastes products

away from the tissues for eliminationaway from the tissues for elimination


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The right side of the heart receives theThe right side of the heart receives the

unoxygenated blood while the left side of theunoxygenated blood while the left side of theheart receives oxygenated bloodheart receives oxygenated blood

The coronary arteries supply the oxygen andThe coronary arteries supply the oxygen and

nutrients to the heart musclesnutrients to the heart muscles


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The systemic vessels carry blood to the tissuesThe systemic vessels carry blood to the tissues

through the system of arteries, and return it tothrough the system of arteries, and return it tothe heart via a system of veinsthe heart via a system of veins

The blood pressure is determined by the cardiacThe blood pressure is determined by the cardiac

output and the peripheral vascular resistance. Itoutput and the peripheral vascular resistance. It

rises gradually from birth to adult range in therises gradually from birth to adult range in theadolescent periodadolescent period


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There are many factors that affect cardiovascularThere are many factors that affect cardiovascularfunctions; atherosclerosis causes fatty deposition withinfunctions; atherosclerosis causes fatty deposition withinthe arterioles/arteriesthe arterioles/arteries

Decreased cardiac output, impaired tissue perfusion,Decreased cardiac output, impaired tissue perfusion,and disorders affecting the blood are the majorand disorders affecting the blood are the majorcardiovascular problems that may affect oxygenation.cardiovascular problems that may affect oxygenation.

The most common cause of impaired blood flow isThe most common cause of impaired blood flow is

atherosclerosis.atherosclerosis.


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Nursing interventions to promote circulationNursing interventions to promote circulation

include using antiinclude using anti--embolic stockings, sequentialembolic stockings, sequentialcompression devices and administration ofcompression devices and administration of

cardiac medicationscardiac medications

Cardiopulmonary resuscitation (CPR) is usedCardiopulmonary resuscitation (CPR) is used

during cardiopulmonary arrest.during cardiopulmonary arrest.


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. . . End. . . End

Thank you very much goodluckThank you very much goodluck

Have a nice day!Have a nice day!

The Heart : MicroscopicThe Heart : Microscopic


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The Heart : MicroscopicThe Heart : Microscopic

AnatomyAnatomy The heart has three layersThe heart has three layers

The epicardiumThe epicardium

The myocardiumThe myocardium

The endocardiumThe endocardium

The heart is covered by the pericardium with aThe heart is covered by the pericardium with aparietal and visceral layersparietal and visceral layers

The pericardial sac is a potential space in betweenThe pericardial sac is a potential space in betweenthe two pericardial layers with a minimal (15 cc)the two pericardial layers with a minimal (15 cc)fluidfluid


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Anatomy & PhysiologyAnatomy & PhysiologyThe Layers of the Heart WallThe Layers of the Heart WallEpicardium (visceral

Epicardium (visceralpericardium)pericardium)

MyocardiumMyocardium

EndocardiumEndocardium

Essential layer of t

he

heart

Essential layer of t

he

heartCoronary arteries are found inCoronary arteries are found in

this layerthis layer

Middle and thickest layer of the heartMiddle and thickest layer of the heartResponsible for contraction ofResponsible for contraction of

the heartthe heart

Innermost layer of the heartInnermost layer of the heart

Lines the inside of theLines the inside of themyocardiummyocardium

Covers the heart valvesCovers the heart valves


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Myocardial Cells are ofTwo typesMyocardial Cells are ofTwo types

Myocardial Cell TypesMyocardial Cell TypesKinds ofKinds of

Cardiac CellsCardiac Cells

Myocardial cellsMyocardial cells

Specialized cellsSpecialized cells

of the electricalof the electrical

conductionconduction

systemsystem

WhereWhereFoundFound

MyocardiumMyocardium

ElectricalElectrical

conductionconduction

systemsystem

PrimaryPrimaryFunctionFunction

Contraction andContraction andRelaxationRelaxation

Generation andGeneration and

conduction ofconduction of

electricalelectrical

impulsesimpulses

PrimaryPrimaryPropertyProperty

ContractilityContractility

AutomaticityAutomaticity

ConductivityConductivity


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Anatomy & PhysiologyAnatomy & PhysiologyCharacteristics of cardiac cells: PhysiologyCharacteristics of cardiac cells: PhysiologyAutomaticityAutomaticity

ExcitabilityExcitability

ConductivityConductivity

ContractilityContractility

Ability to INITIATE an electrical impulseAbility to INITIATE an electrical impulse

Ability to RESPOND to the electric impulseAbility to RESPOND to the electric impulse

Ability of the cardiac cells to TRANSMIT theAbility of the cardiac cells to TRANSMIT theimpulse to other cellsimpulse to other cells

Ability of the cardiac cells to CONTRACT orAbility of the cardiac cells to CONTRACT or

shorten in response to electric stimulusshorten in response to electric stimulus


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The Heart : PhysiologyThe Heart : Physiology

This consists ofThis consists of

The conducting systemThe conducting system

The cardiac cycleThe cardiac cycle The cardiac output and Blood pressureThe cardiac output and Blood pressure

The preload and afterloadThe preload and afterload

The Starlings law of the heartThe Starlings law of the heart


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The conducting system of theThe conducting system of theheart is a group of specializedheart is a group of specialized

heart cells that functions toheart cells that functions toconduct electrical impulsesconduct electrical impulsesindependent of any nerveindependent of any nerve

supplysupply


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The parts of the conducting systemThe parts of the conducting systemof the heart are:of the heart are:

The SA (sinoThe SA (sino--atrial) nodeatrial) nodeThe AV (atrioThe AV (atrio--ventricular) nodeventricular) node

The Bundle of His with its rightThe Bundle of His with its rightand left bundleand left bundle

The Purkinje fibersThe Purkinje fibers


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Cardiac CycleCardiac Cycle-- Refers to the repetitive pumping process thatRefers to the repetitive pumping process that

begins with the onset of cardiac musclebegins with the onset of cardiac musclecontractions and ends with the beginning ofcontractions and ends with the beginning ofthe next contractions.the next contractions.

The cardiac cycle consists of the contractionThe cardiac cycle consists of the contractionphase and the relaxation phase in eachphase and the relaxation phase in each

heartbeatheartbeat The SYSTOLE is the contraction phaseThe SYSTOLE is the contraction phase

The DIASTOLE is the relaxation phaseThe DIASTOLE is the relaxation phase


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Heart sounds can be auscultatedHeart sounds can be auscultated

S1, S2, S3, and S4S1, S2, S3, and S4

S1 is due to the closure of the AV valvesS1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valvesS2 is due to the closure of the semilunar valves

S3 is due to the rushing of blood through theS3 is due to the rushing of blood through the

AV openingAV opening S4 is due to contraction of the atriumS4 is due to contraction of the atrium

The Heart: REGULATION OFThe Heart: REGULATION OF


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The Heart: REGULATION OFThe Heart: REGULATION OF

HEARTFUNCTIONHEARTFUNCTION The amount of blood the heart pumps out inThe amount of blood the heart pumps out in

each beat is called theeach beat is called the STROKE VOLUMESTROKE VOLUME

CARDIAC OUTPUT(CO)CARDIAC OUTPUT(CO) Vol. of bloodVol. of blood

pumped by either ventricle of the heart eachpumped by either ventricle of the heart eachminuteminute

CO = SV x HR (the number of timesCO = SV x HR (the number of timescontracts each minutecontracts each minute

CO at rest = 70ml/beat x 72bpmCO at rest = 70ml/beat x 72bpm

= 5040 ml/min or 5L/min= 5040 ml/min or 5L/min


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The Heart: Intrinsic RegulationThe Heart: Intrinsic Regulation

**the force of contraction producedby cardiac muscle isthe force of contraction producedby cardiac muscle isrelated to the degree of stretch of cardiac muscle fibersrelated to the degree of stretch of cardiac muscle fibers

VENOUS RETURNVENOUS RETURN IS THE AMOUNTIS THE AMOUNT

OF BLOOD THAT RETURNS TO THEOF BLOOD THAT RETURNS TO THE

HEARTHEART


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The PRELOAD is the degree of stretchingThe PRELOAD is the degree of stretchingof the ventricular walls when it is filledof the ventricular walls when it is filled--upupwith bloodwith blood

The AFTERLOAD is the resistance toThe AFTERLOAD is the resistance towhich the heart must pump to eject thewhich the heart must pump to eject the

bloodblood


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INCREASED VENOUSE RETURNINCREASED VENOUSE RE

TURN

-- heart fills to a greater volume and stretch = incheart fills to a greater volume and stretch = incpreloadpreload

-- Cardiac muscle fibers contract with greater forceCardiac muscle fibers contract with greater force= inc vol of blood to be ejected from the heart= inc vol of blood to be ejected from the heart

-- = inc stroke volume= inc stroke volume

Inc venous returnInc venous return inc preloadinc preload inc COinc CO

Starlings Law of the HeartStarlings Law of the Heart -- relationshiprelationshipbetween preload and stroke volumebetween preload and stroke volume


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EXTRINSIC REGULATIONEXTRINSIC REGULATION

Nervous ControlNervous Control

Reflex ControlReflex Control

Hormonal ControlHormonal Control


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BP regulationBP regulation

CentralCentral

Pons and medullaPons and medulla

Sympathetic nervous systemSympathetic nervous system Increases heartIncreases heartraterate

Parasympathetic nervous system (vagus)Parasympathetic nervous system (vagus)

decreases heart ratedecreases heart rate

l il i


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BaroreceptorsBaroreceptors

Receptors sensitive to stretch located in theReceptors sensitive to stretch located in the

carotid sinuses and aortic archcarotid sinuses and aortic arch stretch stretch reflex increase in heart ratereflex increase in heart rate

BPBP

stretch stretch reflex decrease in heart ratereflex decrease in heart rateBPBP

BP l iBP l i


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HormonalHormonal

EpinephrineEpinephrine vasoconstriction(skinvasoconstriction(skinand viscera)and viscera) increased resistanceincreased resistance

increased BPincreased BP--epinephrine causes vasodilation ofepinephrine causes vasodilation of

blood vessels in skeletal muscles &blood vessels in skeletal muscles &cardiac musclescardiac muscles

ADHADH water reabsorptionwater reabsorption BloodBloodvolumevolume increased BPincreased BP

H l R l iH l R l i


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Hormonal RegulationHormonal Regulation

Angiotensinogen A1Angiotensinogen A1Angiotensin 2Angiotensin 2

ANFANF increase sodium excretionincrease sodium excretion

increased urineincreased urine decreased blooddecreased bloodvolumevolume decreased BPdecreased BP

bloodLung


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Th Bl d l ATh Bl d l A


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The Blood vessel: AnatomyThe Blood vessel: Anatomy

This consists of the artery, vein and capillaryThis consists of the artery, vein and capillary

together with the lymphatic vesselstogether with the lymphatic vessels

The ARTERY has thicker wall, deeplyThe ARTERY has thicker wall, deeply

located, pulsating, reddish, with abundantlocated, pulsating, reddish, with abundantsmooth muscles and elastic tissues that carriessmooth muscles and elastic tissues that carries

oxygenated blood away from the heartoxygenated blood away from the heart

towards the body tissuestowards the body tissues


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Th Bl d l Ph i lTh Bl d l Ph i l


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The Blood vessel: PhysiologyThe Blood vessel: Physiology

The diameter of the arterioles is the mainThe diameter of the arterioles is the maincontributor of the peripheral resistancecontributor of the peripheral resistance

In the presence of epinephrine, coldIn the presence of epinephrine, cold

temperature and irritation, the smooth musclestemperature and irritation, the smooth musclesof the blood vessels will contract making theof the blood vessels will contract making thelumen smallerlumen smaller resistanceresistance

In the presence of histamineIn the presence of histamine,,warmwarmtemperature, the vessels will dilatetemperature, the vessels will dilate

resistanceresistance

A t & Ph i lA t & Ph i l

TerminologyTerminology


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Anatomy & PhysiologyAnatomy & PhysiologyTerminologyTerminologyChronotropicChronotropic

effecteffect

DromotropicDromotropic

effecteffect

Inotropic effectInotropic effect

Refers to a change in heart rateRefers to a change in heart rate

A positive chronotropic effect refers to an increaseA positive chronotropic effect refers to an increasein heart ratein heart rate

A negative chronotropic effect refers to a decreaseA negative chronotropic effect refers to a decrease

in heart ratein heart rate

Refers to a change in the speed of conductionRefers to a change in the speed of conduction

through the AV junctionthrough the AV junctionA positive dromotropic effect results in an increaseA positive dromotropic effect results in an increase

in AV conduction velocityin AV conduction velocity

A negative dromotropic effect results in a decreaseA negative dromotropic effect results in a decrease

in AV conduction velocityin AV conduction velocity

Refers to a change in myocardial contractilityRefers to a change in myocardial contractility

A postive inotropic effect results in an increase inA postive inotropic effect results in an increase in

myocardial contractilitymyocardial contractility

A negative inotropic effect results in a decrease inA negative inotropic effect results in a decrease in

myocardial contractilitymyocardial contractility

S t i i l tiS t i i l ti


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Systemic circulationSystemic circulation

The aortaThe aorta-- leaves the left ventricle to formleaves the left ventricle to formthe ascending aorta, aortic arch, descendingthe ascending aorta, aortic arch, descendingaorta, thoracic aorta and abdominal aortaaorta, thoracic aorta and abdominal aorta

The Vena cava ( superior and inferior)The Vena cava ( superior and inferior)drains the whole body and returns the blooddrains the whole body and returns the bloodto the right atriumto the right atrium

Ph i l f i l tiPh i l f i l ti


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Physiology of circulationPhysiology of circulation

Blood pressure is the measure of force exertedBlood pressure is the measure of force exertedby blood against the blood vessel wallby blood against the blood vessel wall

Measured by sphygmomanometerMeasured by sphygmomanometer

NormallyBP is measured as systolic pressureNormallyBP is measured as systolic pressureand diastolic pressureand diastolic pressure

PULSE PRESSURE = SPPULSE PRESSURE = SP--DPDP

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