Medical-Surgical Nursing: Concepts & Practice 3rd edition Chapter 19 Care of Patients with Cardiac Disorders Copyright © 2017, Elsevier Inc. All rights reserved.

Heart Failure Etiology Older Adult care Pathophysiology Right- or left-sided heart failure Systolic failure or diastolic failure Signs, symptoms, and diagnosis Treatment

Goals of Treatment Reduce the demand for oxygen and the workload of the heart. Strengthen the heart’s pumping action. Relieve venous congestion in the lungs. Minimize sodium and water retention in the tissues.

Pathophysiology of Congestive Heart Failure After a Myocardial Infarction Congestion Increased pressure See Concept Map 19-1 on p. 425.

Factors that Precipitate Heart Failure Anemia Systemic infection (sepsis) Fluid overload Pulmonary embolism Thyroid disorders Dysrhythmias Pericarditis, myocarditis, or endocarditis Thiamine deficiency Chronic pulmonary disease Physical, emotional, or environmental stress See Box 19-1 on p. 425.

Comparison of Left-Sided and Right-Sided Heart Failure Selected etiology Pathophysiology Signs and symptoms See Table 19-2 on p. 426.

Systolic and Diastolic Failure Problems occur in either the filling or ejection phase of the cycle. Determination of ejection fraction can be done with echocardiography or left heart catheterization and is a key feature in determining the correct treatment.

Treatment Medical intervention Heart-healthy diet Cardiac resynchronization therapy (CRT) Left ventricular assist devices (LVADs) Ventricular restoration surgery Complementary and alternative therapies

Heartmate Left Ventricular Assist Device See Figure 19-2 on p. 429. Courtesy of Thoratec, Pleasanton, CA.

Nursing Management Assessment (data collection) Left-sided failure versus right-sided failure Older adult care Nursing diagnosis and planning Implementation Evaluation

Cardiac Conduction Disorders (Dysrhythmias) Etiology Pathophysiology Signs and symptoms Life-threatening cardiac dysrhythmias Diagnosis and treatment

Cardiac Conduction System See Figure 19-4 on p. 433. From Aehlert B: EKGs made easy, ed. 2, St. Louis, 2002, Mosby.

Evaluating an Electrocardiographic Rhythm Strip Obtain a strip with at least 10 large graph squares. Calculate the rate. Measure the distance between the P waves. Measure the PR interval. Measure the QRS duration. See Box 19-3 on p. 429.

Treatment Drug therapy Cardioversion Cardiac pacemakers Patient teaching Radiofrequency catheter ablation Automatic implantable cardiac defibrillators (ICDs)

Thoracic Placement of Permanent Pacemaker and Transvenous Pacing Wires See Figure 19-7 on p. 440. A, Reproduced with permission of Medtronic, Inc. B, From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 8, St. Louis, 2011, Mosby.

Infective Endocarditis Etiology Pathophysiology Signs and symptoms Diagnosis Treatment Older adult consideration

Pericarditis Effusion Cardiac tamponade Friction rub Dressler’s syndrome Pulsus paradoxus Diagnosis Pericardiocentesis Pericardiotomy

Effects of Pericardial Effusion See Figure 19-9 on p. 442. From Gould BE: Pathophysiology for health professions, ed. 2, Philadelphia, 2002, Saunders.

Cardiomyopathy Etiology Signs and symptoms Diagnosis Medical treatment Heart transplant

Three Main Types of Cardiomyopathy Dilated Hypertrophic Restrictive See Box 19-3 on p. 443.

Nursing Management for Infectious and Inflammatory Heart Disease Thorough history and physical examination Medications Teaching plan

Cardiac Valve Disorders Mitral valve prolapse (MVP) Mitral stenosis Mitral regurgitation (insufficiency) Aortic stenosis Aortic regurgitation (insufficiency)

Treatment of Valve Disorders Medical treatment Surgical treatment Reparative procedures Valve replacement Nursing management

Mechanical and Biologic Tissue Valves for Valve Replacement See Figure 19-10 on p. 445. From Bonow RO, Mann DL, Zipes DP, Libby P: Braunwald’s heart disease: a textbook of cardiovascular medicine, ed. 9, Philadelphia, 2012, Saunders.

Common Therapies and Their Nursing Implications Oxygen therapy Pharmacologic agents Digitalis toxicity Dietary controls Heart-healthy lifestyle recommendations

Classic Symptoms of Digitalis Toxicity Yellow-green halos around lights, nausea, diarrhea, and confusion Physiologic changes resulting from age, electrolyte imbalances (particularly hypokalemia or hypercalcemia), renal impairment, metabolic disturbances, and certain heart conditions can predispose a patient to digitalis toxicity. Digitalis can be very effective in treating certain kinds of cardiac disorders, but its therapeutic range is quite narrow. A therapeutic dose is only about one-third less than the dose that will induce toxicity.

Community Care Thorough heart and lung assessment Patient teaching Identify beginning signs of heart failure. Monitor heart rates and rhythms closely. Replace fluids and electrolytes early in the course of the illness. Patient teaching