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

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

4. 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.

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

6. 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.

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

10. 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.

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

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

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

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

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

16. 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.

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

18. 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.

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

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

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

22. Cardiomyopathy Etiology Signs and symptoms Diagnosis Medical treatment
Heart transplant

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

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

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

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

27. Mechanical and Biologic Tissue Valves for Valve Replacement
See Figure 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.

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

29. 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.

30. 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