Send the link below via email or IMCopy
Present to your audienceStart remote presentation
- Invited audience members will follow you as you navigate and present
- People invited to a presentation do not need a Prezi account
- This link expires 10 minutes after you close the presentation
- A maximum of 30 users can follow your presentation
- Learn more about this feature in our knowledge base article
Do you really want to delete this prezi?
Neither you, nor the coeditors you shared it with will be able to recover it again.
Make your likes visible on Facebook?
Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.
Transcript of Cardiovascular Alterations
Parts 1 & 2
reported with impaired perfusion:
Shortness of breath
Congenital Heart Disease - CHD
8 in every 1000 live births
Cardiac Action Potentials
NRS 322 - Acute II
Generated by cardiac output, affected by myocardial function and blood volume
Reduced cognition, anxiety, diaphoresis, increased respiratory rate
Tissue or Local Perfusion:
Affected by central perfusion and patency of vessels
Reduced/absent pulses, cool/cold extremities, discoloration
Calculating Time on the ECG
Method # 1 : The Cardiac Ruler Method
Place the beginning point of a cardiac ruler over an R wave. Look at the number on which the next R wave falls and that becomes the heart rate for that patient. Use the following numbers to indicate what the heart rate is between two successive R waves : 300, 150, 100, 75, 60, 50, 43, 37, 33, 30
Method # 2 - The Six Second Tracing Method
Obtain a six second tracing (30 five mm boxes) and count the number of R waves that appear within that 6 second period and multiply by 10 to obtain the HR/min.Example : If there are 12 five mm boxes in a 6 second tracing then the heart rate would be : 12 x 10 = 120 bpm.
Method # 3 - The 300 Method
Count the number of large boxes between 2 R waves and divide this number into 300 to obtain the HR/min.Example : If there were 2.5 large 5 mm boxes between two successive R waves, then the heart rate would be : 300/2.5 large boxes = 120 bpm
Method # 4 - The 1500 Method
Count the number of small boxes between two R waves and divide this number into 1500 to obtain the HR/min.Example : If there were 12.5 small boxes between two successive R waves, then the heart rate would be : 1500/12.5 small boxes = 120 bpm.
Alterations of -
Note the antidysrhythmic drug classes that affect the
of the different cardiac cells
A 5-Year-Old Girl With Headache and Vomiting
Palpitations in a 19-Year-Old With a Rash
Tetralogy of Fallot Treatment
Fetal Circulation Before Birth
Physiologic consequences of CHD
Heart failure - HF
Pulmonary hypertension - PAH
Decreasing cardiac workload & increasing CO
Correct the underlying problem ASAP
Positive inotrope to strengthen contractions and improve blood flow to the kidneys to promote diuresis, negative chronotrope slowing conduction through the AV node (e.g.,
(loop or thiazide diuretics combined with spironolactone to spare K+); consider K+ supplements
(e.g., hydralazine, captopril, enalapril)
intake and decrease work of eating
Pulmonary Hypertension - PAH:
Diagnosed when PA pressure >20 mmHg at rest (normal is 15 mmHg at rest)
Early surgical intervention
may allow children with reversible PAH to return to normal pulmonary pressures after surgery
Inhaled nitric oxide
is an effective pulmonary vasodilator for children with large L to R shunting
Risk is from compensatory polycythemia, hypercyanotic episodes
Careful monitoring of fluid status to prevent hemoconcentration from dehydration
Teach knee-chest position; consider administering O2 and morphine, systemic vascocontrictors
Nursing Diagnoses & Priorities
Ineffective tissue/cardiac tissue perfusion
Administer oxygen to maintain saturations >95%
Ensure adequate hydration
related to vaso-occlusion
Administer analgesics & perform non-pharmacologic pain relief measures, passive ROM exercises
Risk for infection
related to compromised spleen and chronic immunocompromised state
Avoid exposure to high risk settings/situations
Therapeutic Management -
Pericarditis, Pericaridal Effusion
& Cardiac Tamponade
Therapeutic Management -
Diuretics, vasodilating agents, cardiac glycosides, beta blockers
Toxin exposure avoidance
- depends upon the type of cardiomyopathy
Ventriculomyomectomy of hypertrophied tissue of HCM to increase outflow
Percutaneous alcohol septal ablation for HCM
is treatment of choice for DCM
, antibiotics for bacterial form, corticosteroids for non-bacterial form,
Avoid aspirin & anticoagulants due to risk for tamponade
Pericardial drainage for acute, pericardiectomy for chronic
puts patients at risk for
JVD, paradoxical pulse
(SBP 10 mm Hg or more higher on expiration than inspiration)
, decreased CO, muffled heart sounds, circulatory collapse
Increase fluid volume to
, hemodynamic monitoring, pericardiocentesis, pericardial window, pericardiectomy
Diuretics, beta blockers, digoxin, oxygen, nitrates, vasodilators, anticoagulants
doesn't last as long
, but does not require anticoagulation; higher calcium in younger patients may cause damage to the tissue valve
McKinney, E.S., James, S.R., Murray, S.S., Nelson, K.A., & Ashwill, J.A. (2013).
(4th ed.). St. Louis, MO: Elsevier.
Ignatavicius, D.D., & Workman, M.L. (2016).
Medical-Surgical nursing: Patient-Centered collaborative care
(8th ed.). St. Louis, MO: Elsevier Saunders.
Buckle, S. (2015). Pulmonary hypertension: A clinical case study.
Journal of Lung, Pulmonary and Respiratory Research, 2