Activity – Exercise Pattern Cardiac By Elola Maberry MSN, RN

Assessment Nursing history Diagnostic studies EKG Blood tests Bedside 12-lead Blood tests Hgb Electrolytes – potassium There are several diagnostic tests R/T cardiovascular assessment and we’re not going to talk about all of these at this point. The ones we will mention are EKG monitoring. The 12 lead shows different views of the heart. Bedside monitoring uses one lead. Usually the client is attached to a portable transmitter and they are monitored in a separate monitoring room. If the hospital doesn’t have a designated telemetry unit, the client is usually monitored in the intensive care unit. Hgb is an important consideration in cardiovascular., since it is responsible for carrying oxygen. If a client already has cardiovascular disease and they have a reduced hgb, this increases the chance for cardiovascular tissue deprivation. K is extremely important in cardiovascular function. Either hyperkalemia or hypokalemia can have serious effects on cardiac muscle function. Other electrolytes are also important and we will go into those later. Hemodynamic monitoring is used primarily in critical care areas in caring for the heart patient. This type monitoring includes cardiac monitoring, pulmonary artery monitoring and arterial pressure monitoring. Physical assessment includes those things you learned at the beginning of the semester – ausculatation of the carotid arteries (detection of bruits), apical pulse, lungs ( why is listening to breath sounds important in cardiac assessment?)

Assessment Nursing history Diagnostic studies EKG Blood tests Bedside 12-lead Blood tests Hgb Electrolytes – potassium Hemodynamic studies Evaluation of pressures involved in blood circulation Physical assessment Auscultation of apical pulse, carotid arteries, lung sounds, assessment of skin color, temperature, edema Hemodynamic monitoring is used primarily in critical care areas in caring for the heart patient. This type monitoring includes cardiac monitoring, pulmonary artery monitoring and arterial pressure monitoring. Physical assessment includes those things you learned at the beginning of the semester – ausculatation of the carotid arteries (detection of bruits), apical pulse, lungs ( why is listening to breath sounds important in cardiac assessment?)

Risk factors for coronary artery disease Nonmodifiable Heredity Age Gender Coronary artery disease is the #1 cause of cardiovascular disease, with athereosclerosis being the primary cause. There are risk factors that are nonmodifiable and those that are modifiable. Nonmodifiable include: Heredity – if a close relative had heart disease, the person is more likely to develop it. Age – is another factor – risk increases as the person ages. Gender – is another factor – Through middle age, the man is more prone to heart disease. Hormones serve to protect women until then. After menopause, the woman is as susceptible to heart problems as the man. Modifiable risks are those that can reduce the likelihood of developing heart disease. One of the greatest factors is elevated cholesterol levels. Lipoproteins include triglycerides, phospholipids and cholesterol. There are 2 types of cholesterol – HDL –high density lipoproteins which are the good ones and LDL – low density which are the Bad ones. Eaxcess intake of saturated fats is the leading reason for a high cholesterol level, so the client needs to be taught the importance of reducing his or her intake of these. Hypertension is another major reason coronary associated with heart disease. It increases the workload of the heart, increases oxygen denmand, and causes ventricular hypertrophy.

Risk factors for coronary artery disease Nonmodifiable Heredity Age Gender Modifiable Hypertension Cigarette smoking Obesity Sedentary lifestyle Elevated lipid levels Modifiable risks are those that can reduce the likelihood of developing heart disease. One of the greatest factors is elevated cholesterol levels. Lipoproteins include triglycerides, phospholipids and cholesterol. There are 2 types of cholesterol – HDL –high density lipoproteins which are the good ones and LDL – low density which are the Bad ones. Eaxcess intake of saturated fats is the leading reason for a high cholesterol level, so the client needs to be taught the importance of reducing his or her intake of these. Hypertension is another major reason coronary associated with heart disease. It increases the workload of the heart, increases oxygen denmand, and causes ventricular hypertrophy.

Cardiac Output CO = Stroke Volume X Heart Rate Factors affecting cardiac output Heart rate Contractility Preload Afterload What is CO? Amount of blood pumped by the ventricles in 1 minute What is Stroke volume? The amount of blood (usually 70 liters) pumped from the ventricles into the circulation. Cardiac output + the Stroke volume X the number of times the heart beats. Why is CO so important? It determines how well tissues are being perfused Which brings you to another term – What is perfusion? It simply means the degree of effectiveness oxygen and nutrients are reaching the cells. Tissues that aren’t being perfused cause all kinds of problems – death to what ever area is not getting blood supply. This may result in a heart attack, stroke or any other tissue.

Assessment of Respiratory Function Nursing History Physical assessment – assess respiratory rate, depth, rhythm, position client assumes, thoracic lung expansion, auscultation of breath sounds Diagnostic studies Sputum Pulmonary function tests Arterial blood gases You need to review the nursing history R/T the respiratory system in you book regarding – current respiratory problems – cough, SOB, chest pain with breathing; lifestyle – smoking hx, environmental factors, risk factors, medication history. Remember all the physical assessment data we talked about earlier in the semester. we’re not going back through this but you need to review all those things we talked about Sputum=-collected for obtaining cultures & sensitives, cytology and acid-fast bacillus PFT- are non-invasive, measures lung volume and capacity ABG- evaluates the acid-base and oxygenation status of the client

Factors Affecting Respiration Age Environment Lifestyle Health status Medications Stress Factors affecting the respiratory system related to age occurs more frequently with the older adult. Among these are less elastic airways, a decrease in the amount of exchanged air, dry mucous membranes, decrease in muscle strength and endurance. The higher the altitude the lower the pO2. The person has higher heart and respiratory rates. Other enviromental factors include pollution and smog Exercise increased alveolar expansion and deep breathing patterns A number of medications depress respirations among these are narcotics and barbiturates. Morphine is really bad to depress respirations. When these drugs are first begun, it’s important to monitor the patient closely. Stress is also a factor. A person will frequently hyperventilate with stress. What happens to the blood gases? (the Po2 rises and the Pco2 drops) why does this occur? The person is breathing fast and not exhaling CO2

Alterations in Respiration Hypoxia Hypoxemia Hypoxia is simply insufficient oxygen in the blood. It may occur as a result of problems with ventilation – such as COPD, diffusion of gases – such as pulmonary edema, or transport of gases to the tissue with conditions such as anemia or heat failure When a person is hypoxic, they may have a rapid pulse (heart trying to compensate), rapid shallow respirations, dizziness, flaring of nostrils, use of accessory muscles to breathe and cyanosis. THE difference between hypoxia and hypoxemia is hypoxemia refers to reduced oxygen in the blood

Alterations in Respirations Altered breathing patterns rate, volume, rhythm, ease of respiratory effort Cheyne – Stokes Kussmaul’s Orthopnea Cheyne – Stokes – respirations vary from deep to shallow to periods of apnea. This type respiration occurs frequently with brain injury, heart failure and drug overdose Biot’s shallow, occurs with central nervous system disorders kussmaul’s – With this type breathing, the patient is hyperventilating, trying to blow off excess acid (CO2) This is seen frequently in patients with ketoacidosis Orthopnea is the inability to breathe without being in an upright position. This is the characteristic position for patients with COPD