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# Cardiovascular Alterations

NRS 322 - Acute II
by

## Katrina Dielman

on 7 November 2018

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#### Transcript of Cardiovascular Alterations

Cardiovascular Alterations
Perfusion
-

Central

&

Peripheral

Most common
symptoms
reported with impaired perfusion:
Fatigue
Shortness of breath
Pain
Congenital Heart Disease - CHD
8 in every 1000 live births
Cardiomyopathy
Pericarditis
Pericardial Effusion
Valvular Disorders
Dysrhythmias
Cardiac Action Potentials
NRS 322 - Acute II
Central Perfusion:
Generated by cardiac output, affected by myocardial function and blood volume
Sx:
Reduced cognition, anxiety, diaphoresis, increased respiratory rate
Tissue or Local Perfusion:

Affected by central perfusion and patency of vessels
Sx:
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 -
Automaticity
Conduction
Slow
potential
Fast
potential
Hematologic Disorders
Note the antidysrhythmic drug classes that affect the
automaticity
and
conductivity
of the different cardiac cells
Case Study:
A 5-Year-Old Girl With Headache and Vomiting

Case Study:
Pulmonary Hypertension

Case Study:
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
Cyanosis
Treating HF:

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.,
digoxin
)
Diuretics
(loop or thiazide diuretics combined with spironolactone to spare K+); consider K+ supplements
Vasodilators
(e.g., hydralazine, captopril, enalapril)
Optimize
nutritional
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
Cyanosis:
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
Therapeutic Management
http://reference.medscape.com/viewarticle/844659_1
Nursing Diagnoses & Priorities
Ineffective tissue/cardiac tissue perfusion
Administer oxygen to maintain saturations >95%

Acute pain
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
Preventive immunizations
Avoid exposure to high risk settings/situations
Therapeutic Management
Therapeutic Management -
Pericarditis, Pericaridal Effusion
Therapeutic Management -
Cardiomyopathy
http://reference.medscape.com/viewarticle/844654
Non-surgical management
Drug therapy:
Diuretics, vasodilating agents, cardiac glycosides, beta blockers
Implantable
cardiac defibrillators
Toxin exposure avoidance

Surgical management
- depends upon the type of cardiomyopathy
Ventriculomyomectomy of hypertrophied tissue of HCM to increase outflow
Percutaneous alcohol septal ablation for HCM
Heart transplantation
is treatment of choice for DCM

Psychosocial

End-of-life
planning
Pericarditis
Pain management:
NSAIDs
, antibiotics for bacterial form, corticosteroids for non-bacterial form,
sitting forward
Avoid aspirin & anticoagulants due to risk for tamponade
Pericardial drainage for acute, pericardiectomy for chronic

Pericaridal effusion
puts patients at risk for

Physiological findings:
(SBP 10 mm Hg or more higher on expiration than inspiration)
, decreased CO, muffled heart sounds, circulatory collapse
Interventions:
Increase fluid volume to
maintain CO
, hemodynamic monitoring, pericardiocentesis, pericardial window, pericardiectomy
Nonsurgical management
Rest
Drugs:
Diuretics, beta blockers, digoxin, oxygen, nitrates, vasodilators, anticoagulants

Surgical management
Valve replacement
Mechanical valve
- requires
anticoagulation
Tissue valve
-
doesn't last as long
, but does not require anticoagulation; higher calcium in younger patients may cause damage to the tissue valve

References
McKinney, E.S., James, S.R., Murray, S.S., Nelson, K.A., & Ashwill, J.A. (2013).
Maternal-Child nursing
(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
(6): 00062.
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