CIRCULATORY SYSTEM: midterm Primary Function Supply body cells and tissues with O2 and eliminate CO2 as cellular

waste Heart main organ 5 Special function of the heart pumping abilities 1. Automaticity 2. Excitability 3. Conductivity 4. Contractility 5. Rhytmicity Automaticity ability to initiate electrical stimulus independently. Excitability ability to respond to electrical stimulation Conductivity ability to transmit the electrical stimulus from cell to cell in the heart. Contractility ability to stretch as a single unit and recoil Rhytmicity ability to repeat the cycle with regularity Cardiac Tissue Layer 3 distinct layer of tissue 1. Epicardium 2. Myocardium 3. Endocardium

Epicardium fibrous and connective tissue Myocardium muscle tissue Endocardium thin, smooth layer of endothelial cells Pericardium saclike structures that surrounds and support the heart 2 Membranous Layers 1. Parietal Pericardium 2. Visceral Pericardium (Epicardium) Parietal Pericardium outer tougher layer Visceral Pericardium (Epicardium) inner serous layer Heart Chambers 1. Right Atrium 2. Right Ventricle 3. Left Atrium 4. Left ventricle Heart Valves 1. Tricuspid Valve 2. Bicuspid Valve 3. Semilunar Valve 4. Pulmonic Valve 5. Aortic valve Tricuspid valve contains 3 cusps; valve between the right atrium and the right ventricle Bicuspid valve 2 cusps/mitral; mitral valve is located

between the Left atrium and Left ventricle Semilunar valve resembles the portion of the moon, prevents blood from flowing back. Pulmonic valve the valve between the Right Ventricle and pulmonary artery. Aortic valve valve between the LV and aorta into the ventricles after the heart contracts. Chordae Tendineae cordlike structure attached to mitral and tricuspid valve. Arteries and Veins Arteries carry O2 blood away from the heart, smallest artery is called ARTERIOLES Veins return deoxygenated blood to the heart. 3 layers of veins and arteries 1. Tunica Adventitia 2. Tunica Media 3. Tunica Intima Systemic Circulation Capillaries O2 to the blood (diffusion)(Fx) surrounds the alveoli.

Cardiopulmonary circulation 1. Inferior Venacava 2. Superior Venacava 3. Right Atrium 4. TV 5. RV 6. Pulmonary Artery (delivers venous blood to the R and L lungs) 7. Lungs (exchange O2 in inspired air for the CO2 in the venous blood) 8. CO2 is transferred into the alveoli and exhaled 9. Pulmonary Vein brings the O2 blood into the Left Atrium 10.MV 11.LV 12.Aorta 13.Body cells and Tissues Assessment: Cardio Pulmonary Disease Hx taking o Biographic data o Past Hx and present During Admission o Medication o Clients experience of the s/sx o Family hx o Past hx o ADL o Lifestyle o Smoking and drinking

o o

Diet Allergy o

Physical Examination o General Survey/Appearance o Signs of Pain o V/S Monitor (TPRBP) T = increase RR- characteristics, labored breath BP increased change baseline data accurate assessment, strict BP monitoring Assess for baseline BP Cardiac Rate and rhythm - ECG o Heart Sound upon auscultation Lub S1 Dub S2 S3 ventriculargallop follows S1 and S2 sounds like LubDub-Dee or Ken-Tu-ky o Skin Cyanosis Pallor Cold and clammy Poor skin turgur o Signs of Edema when blood is not pump effectively

Pitting Edema marks of finger remains Height = 2 lbs wt. gain if there is a presence of massive edema; wt lost tissue CHF increase volume fluid and pressure in the right side of the heart; distended of jugular vein, neck congestion Nsg Intervention = place in 45o semi-fowlers position Jugular Vein if the right heart fails blood Mental Status alert and oriented but others may be confused and distorted Lung Sounds Brain Ischemia decrease O2 supply in the brain

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o o

Diagnostic Test Studies 1. Cardiac Enzymes a. Troponin 1 and T b. Myocardial injury i. CKMB (Creatine Kinase) 2. Lactate Dehydrogenase 3. LDH Flip: myocardial necrosis 4. Myoglobin 5. Potassium a. Hypokalemia b. Hyperkalemia 6. Calcium and Phosphorus

7. Inverse Relationship 8. ECG location of injury 9. Echocardiugram a. Non-invasive b. Structures and functional changes 10.Stress test treadmill testing 11.Cardiac Catheterization a. Insertion with a catheter into the heart (left or right) b. Client prep. i. Consent/npo ii. Hx o allergies iii. Tell the pt about the various sensations c. Post procedure (ISAME) i. Important points ii. Strict bed rest 4 6o iii. Affected extremity straight iv. Maintain pressured dressing v. Encourage fluids as ordered. 12.Hemodynamic Monitoring (central venous pressure monitoring/CVP) a. Indicated Right ventricular filling pressure b. Normal valves i. Avg. 4.6 mmhg ii. Measuring cvp iii. Level of right atrium iv. Supine 45o elevated

c. Pulmonary artery pressure d. Swan ganz catheter i. Wedged in the pulmonary artery ii. Good indicator of left ventricular and diastolic pressure. 13.Percutaneous Transluminal Coronary Angioplasty a. To open the vessel lumen b. Closure complications i. Closure ii. Spasm iii. Ami c. Important Points: i. Maintain strict bed rest ii. Anticoagulants and ASA iii. IV Nitroglycerine

16.Magnesium Sulfate pt w/ preeclampsia a. Knee jerk reflex (+) i. Percussion hammer b. Fetal Heart Tone REVIEW OF TERMS Afterload force against w/c the heart has to pump to eject blood from the ventricle Angina Pectoris Pain in the chest form coronary insufficiency in the absence of MI Myocardial Infarction (MI) death of a portion of myocardium due to loss of the blood supply Cardiac output amount of blood pumped out at the Left ventricle per minute Stroke Volume x HR 4 8 L/Min avg 5L/min Blood Pressure Cardiac Output x TPR Preload volume of blood stretching the left ventricle at the end of diastole. Stroke volume amount of blood ejected from the left ventricle of each contraction 65 70ml = average Pulse Pressure 30 40 mmHg

14.CABG Coronary Artery bypass Grafting a. Occluded arteries are bypassed b. Blood vessel used i. Sapherous veins ii. Mammary arteries c. Important points i. Inform the patient what to expect. 15.Angina Pectoris a. Stable b. Unstable c. Prinzametals d. Classic e. Crescendo f. Variant

Cardiac Output body needs: exercise = increase CO (Increase: HR, BP, RR, SV) COR Pulmonale a right heart problem resulting from increased pulmonary vascular resistance or from narrowing of the pulmonary vascular tree. Frank Starling Law the more the heart fill the more the force of contraction Cardiac Tamponade compression of heart due to excessive fluid or blood in the pericardial sac Paroxysmal Nocturnal Dyspnea aka cardiac dyspnea on lying down for a while, fluid redistributes itself in the body, resulting in pulmonary edema Pericarditis inflammation of the pericardium patients typically get relief by leaning forward. Myocardial Infarction death of heart muscle Coronary Occlusion total closure of the coronary artery Coronary Thrombosis formation of a blood clot w/c closes the artery

Formation of localized necrotic areas within the myocardium, allows sudden coronary occlusion and the abrupt cessation of blood and O2 flow to the heart muscle Prolonged Ischemia lasting more than 35 45 minutes produces irreversible cellular damages and necrosis of the myocardium Transneural Infarction if extended myocardial wall Atrial Spasm complications of MI Dysrhytmia develop during the time because affected area are electrical disable Myocardial cells 1st zone
Inured cells which may live if blood supply to the area of restored surrounding the 1st zone and 2nd zone

ruptures. S/SX: dyspnea, rapid Right sided heart failure and shock Ventricular Aneurysm the bulging of the portion of the heart affected by MI, this area is poorly contractile tissue w/c predispose to heart failure. Arterial Embolism clots can form in the cavity of the ventricular aneurysm/tissue debris can break free. if clot nether the systemic arterial circulation they may occlude in the peripheral artery Venous Thrombosis it arises mostly in the veins of the lower extremities and pelvis. Pulmonary Embolism it arises from venous thrombi in the lower extremities and pelvis arises from right ventricle after MI onset: chest pain, cyanosis, dyspnea Pericarditis inflammation of the pericardium maybe mild or severe if pericardial effusion develops the client is observed closely for cardiac tamponing. Pericardiocentesis removal of excess fluid in the pericardial (fluid cavity)

Ischemic Area 3rd zone

50% death is caused by MI It can last 72 hrs-chest pains Cardiogenic Shock occurs when 40% of the ventricle has lost the ability to pump effectively. the sooner the shock is detected monitoring of pulmonary artery catheter Ventricular Rupture it occurs when a soft necrotic area from a transneural or interventricular septal MI

Mitral Insufficiency if the capillary are involved in MI the mitral valve are compromise thus mitral regurgitation occurs The risk factors for coronary artery disease and Heart Attack: 1. Smoking 2. High BP 3. Too much fat in diet 4. Diabetes 5. Male gender 6. Age 7. Heredity Cardiovascular S/Sx 1. Chest pain 2. Increased jugular vein venous distention 3. BP elevated 4. Pulse deficit may indicate arterial fibrillation 5. ECG may show tachycardia, bradycardia and dysrhtmias Respiratory S/Sx 1. SOB 2. Dyspnea 3. Tachypnea 4. Crackles Gastrointestinal nausea/vomiting
Genitourinary decrease urine output Skin S/Sx: 1. 2. 3. 4.

S/Sx: 1. 2. 3. 4. 5. 6. 7. 8.

Anxiety Restlessness Light headaches Headache Visual Disturbance Altered Speech Altered Motor function Further change in LOC

Treatment Diet: low cholesterol, low salt Activity: bed rest 24 48o to lower O2 demand Cardiac monitoring Percutaneous transluminal coronary angioplasty may be done to re open artery. Nursing Management Promoting O2 and tissue perfusion Instruct the patient to avoid over fatigue O2 therapy for the 1st 24 48o Semi-fowlers to allow greater diaphragm expansion Promote adequate C.O. Monitor the ff parameters: o Dysrhytmias on ECG tracings o VS o Effects with daily activity on cardiac status o Rate and rhythm of pulse administer pharmacotherapy as prescribed Promoting comfort Relive pain; administer morphine sulfate as ordered. Providing Rest The client is usually place on bed rest with commode privileges for 24 48o

Psychological Fear with feeling of impending doom or patient may deny that anything is wrong. Medications For relief of pain, this is a priority. Pain may cause shock Morphine sulfate, lidocaine or nitrioglycerine administered intravenously

Thrombolytic Therapy To disintegrate blood clot by activating the fibrinolytic processes

Streptokinase, urokinase and tissue plasminogen activator (TPA are currently used. Administration is most critical between 3 6o after the initial infarction has occurred Detect for occult bleeding during and after thrombolytic therapy Assess neurologic status changes w/c may indicate by bleeding or cardiac tamponade Anticoagulant antiplatelet meds are administered after thrombolytic therapy to maintain arterial potency Other medications: Beta-adrenergic blocking agents; diazepam (valium)

Cool Clammy Diaphoretic Pale in appearance

Explain the purpose of CCU is for continuous monitoring and safety during the early recovery period Provide psychosocial support to the client and his family

Neurologic

Promoting Activity

Gradual increase in activity is encouraged after the first 24 48o may be allowed to sit on a chair for increase periods of time and begins ambulation on the 4th or 5th day. Monitor for sings of dysrhytmias, chest pain, and changes in v/s during activity.

Promoting Nutrition and Elimination Provide small, frequent feedings Provide low calorie and low cholesterol, low sodium diet Avoid stimulants Avoid taking very hot or very cold beverages and gas forming foods Use of bedpan and straining at stool should be avoided Use bedside commode Administer stool softener as ordered, e.g. Sodium decussate Facilitating learning Teaching is started once client is free of pain and excessive anxiety Promoting a positive attitude and active participation of the client and family

Blood transports dissolved gasses Phlebotomy Extraction of RBC not for donation.

AHEM Reviewer: circulation system

Pulmonic valve the valve between the Right Ventricle and pulmonary artery. Epicardium the outer cardiac tissue layer of the heart. Contractility the ability of the heart to stretch as a single unit and recoil. Cardiac output amount of blood pumped out at the Left ventricle per minute Myocardial Infarction death of heart muscle or heart attack Coronary Occlusion the narrowing of coronary arteries caused by clot that blocks the blood flow. Blood it transports dissolved gases, nutrients, waste products enzymes and hormones in the body system. Folic Acid other term for vitamin B9 Anemia disorder caused by decrease in production of RBC 5L average cardiac output of a healthy adult

ECG a cardiac diagnostic test used to locate the site of injury Pericarditis the inflammation of the pericardium Right Atrium it receives deoxygenated blood from the venous system. RBC blood component which contains molecules of hemoglobin IDA Iron Deficiency Anemia the most common type of anemia 5 Special function of the heart pumping abilities 1. Automaticity 2. Excitability 3. Conductivity 4. Contractility 5. Rhytmicity 3 layers of veins and arteries 1. Tunica Adventitia 2. Tunica Media 3. Tunica Intima
The risk factors for coronary artery disease and Heart Attack: 1. Smoking 2. High BP 3. Too much fat in diet 4. Diabetes 5. Male gender 6. Age 7. Heredity

S/Sx 1. 2. 3. 4.

SOB Dyspnea Tachypnea Crackles

Priority Nsg Dx for MI 1. Pain 2. Altered tissue perfusion: cardiac Types of Anemia 1. Megaloblastic anemia 2. Iron Deficiency Anemia 3. Sickle cell Anemia Post Operative care after cardiac Catheterization 1. Strict bed rest 4 6o 2. Affected extremity straight 3. Maintain pressured dressing 4. Encourage fluids as ordered Complications of MI 1. Pericarditis 2. Congested heart Failure Cardiopulmonary Circulation
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Superior and Inferior Venacava Right Atrium Tricuspid Valve Right Ventricle Pulmonary Semilunar valve Pulmonary trunk Pulmonary arteries Lung tissue (pulmonary circulation) Pulmonary veins Left Atrium Bicuspid valve Left ventricle Aortic semilunar valves Aorta 15. Body Tissues (systemic circulation) back to 1

Respiratory