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Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Cardiovascular System: Heart

Disease and Structural Disorders

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Heart Failure
Right Sided Heart Failure

Topics Discussed Here Are: 1. Heart Failure 2. Mitral Valve Prolapse 3. Mitral Regurgitation 4. Mitral Stenosis 5. Aortic Regurgitation 6. Aortic Stenosis

Manifestation: Distended neck veins ( pressure in superior vena cava) CVP Edema formation

Left Sided Heart Failure


Backflow

ENLARGED RA TV RV PV LA

Lungs

Pulmonary Congestion *MV* LV


Will have CO

Dyspnea (Orthopnea)

Pulmonary Edema (Acute Heart Failure) Crackles Frothy secretions

Manifestation: CO Easy fatigability Cyanosis (Peripheral) o Prolonged capillary refill o CO, O2 Restlessness (Syncope/fainting) o Sleepy, yawning, LOC Urine output ( Blood flow to kidneys)

AV

Combined Left and Right Sided Heart Failure


All signs and symptoms of LEFT and RIGHT

Diagnosing Heart Failure


Usually goes UNDIAGNOSED Can be diagnosed as MI / Valvular disorders Right Sided Heart Failure: Presence of PERIPHERAL EDEMA Left Sided Heart Failure: Presence of PULMONARY EDEMA

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Confirmation o TEE o Laboratory Tests BNP SUREST BUN For LSHF Serum electrolytes Edema o Na Hyponatremia!! o K - Hyperkalemia!!

Main Objective for HF


To relieve discomforts of patients To improve the functional status and quality of life

Management:
Drugs:

Diuretics o Removes excess ECF, the rate of urine produced o Example: Furosemide (Lasix) K+ WASTING (Hypokalemia) Spironolactone (Aldactone) K+ SPARING (Hyperkalemia) Digitalis o Force of myocardium contractility Nursing Care for DIGITALIS o Example: Digoxin (Lanoxin) o Get HR
o o

REMEMBER for DIURETICS Monitor I&O Eat K+ Foods o Banana, citrus fruits, cantaloupe, watermelon, green leafy vegetables K+ Supplements (KCl) o Incorporate to IV o UO should be > 30ml/hr

Get Pulse deficit If < 60 per min, HOLD LANOXIN

ACE Inhibitors o Example: Benzapril (Lotensin) Captopril (Capoten) Enalapril (Vasotec)


Kidney JG Cells Renin + Angiotensinogen

ACTION of ACE Inhibitors Promotes vasodilation and diuresis the secretions of aldosterone o Na Retention Hyponatremia o K Excretion
Vasoconstriction

Angiotensin I

Angiotensin II

Angiotensin II Receptor Blocker (ARB) o Example: Valsartan o Action BP ( Systemic peripheral resistance) CO Beta Blockers Diet With HF o Example: > Na Diet (2 gm Na) Carvedilol (Coreg) Metoprolol (Topol) o Action Reduces adverse effects from constant stimulation of sympathetic nervous system Vasoconstriction Vasodilation (HYPOTENSION) Bradycardia Anti***** possibility of hypovolemia

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Valvular Disorders

Valves Regulates the flow of blood

Mitral Valve Prolapse


Or mitral prolapse syndrome More on women Pathophysiology o Blood regurgitates from LV to LA Signs and Symptoms Most are asymptomatic May include o Fatigue Regardless of activity o SOB Due to backflow of LA to PV o Dizziness Lack of blood flow to brain o Palpitations Attempt to beat faster due to CO o Chestpain Assessment and Diagnostic Findings Extra Heart Sound Mitral Click Murmur Diagnostic Test Doppler Echocardiography Management Directed at controlling: 1. Dysrhythmias Eliminate caffeine and alcohol Anti-dysrhythmic Drugs: Lidocaine (Zidocaine) IV Drip Titrate to the number of arrhythmias of patient 2. Chest Pain Calcium Channel Blockers Beta Blockers Nursing Management Educate Patient On: 1. Condition is hereditary 2. Prophylactic antibiotic therapy Due to the close proximity of URTI to Heart 3. No CAFFEINE and ALCOHOL

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Mitral Regurgitation
Definition: Backflow of blood from LV to LA Causes: 1. 2. 3. 4.

Degenerative Changes Aging process Rheumatic Heart Disease Infective endocarditis Collagen Vascular disease SLE Butterfly Lesion (Skin Kidney Heart (Mitral Regurgitation)

Assessment and Diagnostic Findings Assessment 1. Systolic MURMUR 2. Pulse may be regular / irregular Normal: Volume, rhythm Diagnostic Findings 1. Doppler Echocardiography (TE) 2. TEE Management 1. ACE Inhibitors as Captopril (Capoten) 2. Restriction of activity 3. Antibiotic prophylactic therapy 4. Surgery a. Mitral valvuloplasty b. Valve replacement

Mitral Stenosis
Pulmonary Veins

RA TV RV PV Lungs

Pressure in LA
MV

Pressure in LV
AV Aorta

Assessment and Diagnostic Findings Assessment Findings 1. Weak and irregular pulse 2. Low pitched murmurs 3. Atrial dysrhytmias Diagnostic Findings 1. Doppler Echocardiography (TE) 2. Cardiac Catheterization Management: 1. No strenuous activity and competitive sports 2. Drugs: Anticoagulants Anti-anemic 3. Surgery 4. Valvuloplasty Mitral Commissurotomy To widen the narrowed MV

Definition: Obstruction of blood from LA to LV Cause: Rheumatic Endocarditis Clinical Signs and Symptoms: 1. DOE (Dyspnea On Exertion) 2. Progressive Fatigue 3. Hemoptysis, cough, wheezing 4. Paroxysmal nocturnal dyspnea

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Aortic Regurgitation
4.
Pulmonary Veins

Chest Trauma

RA TV RV PV Lungs

Pressure in LA MV LV HYPERTROPHY AV Aorta

Clinical Manifestation: 1. Awareness of forceful heartbeat 2. Marked arterial Pulsations 3. Exertional Dyspnea and fatigue 4. Signs and Symptoms of Left Ventricular Failure Management: 1. Antibiotic prophylaxis 2. No physical exertion 3. Drugs a. Ca+ Channel Blockers, Nifedipine (Adalat, Procardia) b. ACE Inhibitors as Captopril (Capoten) 4. Surgery

Definition: - An obstruction within aortic valve - Blood Flow to LV from aorta Causes: 1. Inflammatory lesions 2. Infective endocarditis 3. Congenital abnormalities

Aortic Stenosis
Definition: Narrowing between LV and Aorta Cause: 1. Inflammatory changes 2. Congenital 3. Clinical Manifestation 1. Exertional Dyspnea, PND 2. Dyspnea and syncope 3. Angina Pectoris 4. Decrease pulse pressure Assessment Findings 1. Presence of MURMUR 2. Vibrations Diagnostic Findings 1. Doppler Echocardiography 2. ECG 3. Stress Test Management: 1. Antibiotic Prophylactic Therapy 2. Surgery Replacement of Valves

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