👩‍⚕️Foundations of Nursing Practice Unit 17 – Circulatory and Cardiovascular Care

Key Concepts and Terminology

• Cardiovascular system consists of the heart, blood vessels, and blood that work together to deliver oxygen and nutrients to the body's tissues
• Atherosclerosis is the buildup of plaque in the arteries, leading to narrowing and reduced blood flow
• Myocardial infarction (heart attack) occurs when blood flow to the heart muscle is blocked, causing damage or death to the affected tissue
• Congestive heart failure develops when the heart cannot pump efficiently, leading to fluid buildup in the lungs and other tissues
• Hypertension, or high blood pressure, puts increased strain on the heart and blood vessels, increasing the risk of cardiovascular disease
• Arrhythmias are abnormal heart rhythms that can be caused by various factors, including electrolyte imbalances, medications, and heart disease
• Coronary artery disease is the narrowing of the arteries that supply blood to the heart, often due to atherosclerosis
• Valvular heart disease involves damage or defects in the heart valves, affecting the flow of blood through the heart

Anatomy and Physiology Basics

• The heart is a muscular organ divided into four chambers: right atrium, right ventricle, left atrium, and left ventricle
  • The right side of the heart pumps deoxygenated blood to the lungs, while the left side pumps oxygenated blood to the body
• The cardiac cycle consists of systole (contraction) and diastole (relaxation) of the heart muscles, regulated by the conduction system
  • The sinoatrial (SA) node initiates the heartbeat, followed by the atrioventricular (AV) node, bundle of His, and Purkinje fibers
• Arteries carry oxygenated blood away from the heart, while veins carry deoxygenated blood back to the heart
  • Capillaries are the smallest blood vessels that facilitate the exchange of oxygen, nutrients, and waste products between the blood and tissues
• The circulatory system is divided into the pulmonary circulation (heart to lungs) and the systemic circulation (heart to body)
• Blood is composed of plasma, red blood cells, white blood cells, and platelets, each serving specific functions in the body
• The cardiovascular system works closely with other body systems, such as the respiratory and endocrine systems, to maintain homeostasis

Common Cardiovascular Disorders

• Coronary artery disease (CAD) is caused by the buildup of plaque in the coronary arteries, leading to reduced blood flow to the heart muscle
  • Risk factors for CAD include high blood pressure, high cholesterol, smoking, obesity, and family history
• Heart failure occurs when the heart cannot pump enough blood to meet the body's needs, often due to weakened heart muscle or valve problems
  • Symptoms of heart failure include shortness of breath, fatigue, swelling in the legs and feet, and rapid or irregular heartbeat
• Arrhythmias are abnormal heart rhythms that can be caused by various factors, such as heart disease, electrolyte imbalances, and certain medications
  • Common types of arrhythmias include atrial fibrillation, ventricular tachycardia, and bradycardia
• Valvular heart disease involves damage or defects in one or more of the heart valves, leading to impaired blood flow through the heart
  • Causes of valvular heart disease include congenital defects, rheumatic fever, and degenerative changes
• Peripheral artery disease (PAD) is the narrowing of the arteries in the legs, arms, and other areas outside the heart, often due to atherosclerosis
  • Symptoms of PAD include leg pain or cramping during activity (claudication), numbness, and slow wound healing
• Venous thromboembolism (VTE) is the formation of blood clots in the veins, which can lead to deep vein thrombosis (DVT) or pulmonary embolism (PE)
  • Risk factors for VTE include prolonged immobility, surgery, certain medications, and inherited blood clotting disorders

Assessment Techniques

• Vital signs, including blood pressure, heart rate, respiratory rate, and temperature, provide important information about cardiovascular function
  • Orthostatic blood pressure measurements can help assess for dehydration or autonomic dysfunction
• Auscultation of the heart involves listening to heart sounds (S1 and S2) and any additional sounds (murmurs, rubs, or gallops)
  • The point of maximal impulse (PMI) should be assessed for location and quality
• Inspection of the jugular venous pressure (JVP) can provide information about right-sided heart function and fluid status
• Palpation of peripheral pulses (radial, brachial, femoral, popliteal, and pedal) helps assess circulation and detect any abnormalities
• Assessing for edema in the lower extremities can indicate fluid retention, which may be related to heart failure or other conditions
• A thorough cardiovascular assessment should also include a review of the patient's medical history, risk factors, and current medications
• Functional assessments, such as the New York Heart Association (NYHA) classification, can help determine the severity of heart failure symptoms

Diagnostic Tests and Procedures

• Electrocardiogram (ECG or EKG) records the electrical activity of the heart, helping to diagnose arrhythmias, ischemia, and other abnormalities
  • Holter monitoring and event recorders are used to capture ECG data over an extended period to detect intermittent arrhythmias
• Echocardiography uses ultrasound to visualize the heart's structure and function, assessing valve function, ejection fraction, and detecting abnormalities
  • Transesophageal echocardiography (TEE) provides more detailed images by placing the ultrasound probe in the esophagus
• Stress tests, such as exercise stress tests or pharmacological stress tests, assess the heart's response to increased demand
  • Nuclear stress tests use radioactive tracers to evaluate blood flow to the heart muscle during stress and rest
• Cardiac catheterization involves inserting a catheter into the heart to measure pressures, assess valve function, and visualize the coronary arteries
  • Coronary angiography is performed during cardiac catheterization to detect blockages in the coronary arteries
• Computed tomography (CT) and magnetic resonance imaging (MRI) can provide detailed images of the heart and blood vessels
• Blood tests, such as troponin and B-type natriuretic peptide (BNP), can help diagnose and monitor cardiovascular conditions

Nursing Interventions and Care Strategies

• Monitoring vital signs, including blood pressure, heart rate, and respiratory rate, is crucial for detecting changes in cardiovascular status
  • Notify the physician of any significant changes or abnormalities in vital signs
• Administer medications as prescribed, such as antihypertensives, anticoagulants, and diuretics, and monitor for side effects
  • Educate patients about their medications, including proper administration, potential side effects, and the importance of adherence
• Assist with procedures, such as ECG, echocardiography, and stress tests, ensuring patient comfort and safety
• Encourage lifestyle modifications, such as maintaining a healthy diet, regular exercise, stress management, and smoking cessation
  • Provide resources and support to help patients make and sustain these changes
• Monitor fluid balance by tracking intake and output, administering IV fluids as ordered, and assessing for signs of fluid overload or dehydration
• Promote physical activity and early ambulation, especially for patients recovering from cardiovascular events or procedures
• Assess and manage pain, using pharmacological and non-pharmacological interventions as appropriate
• Provide emotional support to patients and their families, addressing concerns and promoting coping strategies

Medications and Treatments

• Antihypertensive medications, such as ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers, are used to lower blood pressure
  • Monitor blood pressure regularly and report any adverse effects, such as dizziness or hypotension
• Anticoagulants, such as heparin and warfarin, and antiplatelet agents, like aspirin and clopidogrel, are used to prevent blood clots
  • Monitor for signs of bleeding and educate patients about the importance of regular blood tests (INR) when taking warfarin
• Diuretics, such as furosemide and bumetanide, are used to reduce fluid overload in heart failure patients
  • Monitor electrolytes and assess for signs of dehydration or electrolyte imbalances
• Statins and other lipid-lowering medications are used to manage high cholesterol and reduce the risk of atherosclerosis
• Nitrates, such as nitroglycerin, are used to treat angina by dilating blood vessels and improving blood flow to the heart
  • Educate patients on the proper use of sublingual nitroglycerin and when to seek emergency care
• Inotropic agents, such as dobutamine and milrinone, are used to improve heart contractility in patients with severe heart failure
• Antiarrhythmic medications, such as amiodarone and lidocaine, are used to treat and prevent abnormal heart rhythms
• Cardiac rehabilitation programs combine exercise, education, and counseling to help patients recover from cardiovascular events and improve overall health

Patient Education and Health Promotion

• Educate patients about the importance of maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress management
  • Provide resources and support to help patients make and sustain these lifestyle changes
• Teach patients how to monitor their blood pressure at home and keep a log of their readings to share with their healthcare provider
• Instruct patients on the proper use of medications, including administration, potential side effects, and the importance of adherence
  • Emphasize the significance of not stopping medications without consulting their healthcare provider
• Discuss the signs and symptoms of worsening cardiovascular conditions, such as chest pain, shortness of breath, and edema, and when to seek medical attention
• Encourage patients to attend regular check-ups and follow-up appointments with their healthcare providers
• Provide information on smoking cessation programs and resources to help patients quit smoking
• Educate patients about the importance of managing other chronic conditions, such as diabetes and obesity, which can impact cardiovascular health
• Promote stress reduction techniques, such as deep breathing, meditation, and yoga, to help patients manage stress and improve overall well-being

Critical Thinking and Case Studies

• Case 1: A 65-year-old male presents with chest pain and shortness of breath. His ECG shows ST-segment elevation in the anterior leads. What actions should the nurse take?
  • Recognize the signs and symptoms of an acute myocardial infarction (MI) and initiate the appropriate emergency response
  • Administer oxygen, obtain IV access, and prepare for potential administration of thrombolytics or transfer for percutaneous coronary intervention (PCI)
  • Monitor vital signs, perform a focused assessment, and provide emotional support to the patient and family
• Case 2: A 78-year-old female with a history of heart failure presents with increasing shortness of breath and peripheral edema. What should the nurse assess and prioritize in her care?
  • Assess vital signs, lung sounds, and jugular venous pressure (JVP) to determine the severity of fluid overload
  • Review medications and consider the need for adjustments in diuretic therapy
  • Monitor fluid balance, provide oxygen as needed, and position the patient to ease breathing
  • Collaborate with the healthcare team to develop a comprehensive care plan that addresses the patient's needs and goals
• Case 3: A 55-year-old male is admitted for elective cardiac catheterization and possible stent placement. What pre- and post-procedure care should the nurse provide?
  • Educate the patient about the procedure, including risks, benefits, and post-procedure expectations
  • Ensure informed consent is obtained and that the patient has followed pre-procedure instructions (e.g., fasting)
  • Monitor vital signs, assess the catheterization site for bleeding or hematoma formation, and provide pain management as needed
  • Encourage early ambulation and provide discharge instructions, including activity restrictions and follow-up care
• Case 4: A 50-year-old female with a history of hypertension and obesity presents with palpitations and lightheadedness. Her ECG reveals atrial fibrillation with a rapid ventricular response. What should the nurse consider in her care?
  • Assess the patient's hemodynamic stability and monitor for signs of hypotension or decreased cardiac output
  • Administer rate-controlling medications, such as beta-blockers or calcium channel blockers, as ordered
  • Prepare for potential cardioversion if the patient remains symptomatic or hemodynamically unstable
  • Educate the patient about atrial fibrillation, including the importance of anticoagulation and lifestyle modifications to reduce risk factors