1. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chapter 21 Cardiovascular System Function, Assessment, and Therapeutic Measures

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition The Heart  In Mediastinum  Pericardial Sac: Three Layers  Fibrous Pericardium  Parietal Pericardium  Visceral Pericardium (Epicardium)  Serous Fluid Between Inner Layers

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anterior Heart View

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Frontal Heart View

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Structure and Vessels  Four Chambers  Right/Left Atrium, Right/Left Ventricle  Cardiac Layers  Epicardium, Myocardium, Endocardium

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Structure and Vessels (cont’d)  Coronary Arteries  Valves  Tricuspid, Pulmonic, Mitral, Aortic

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Blood Flow Vena Cava » Right Atrium» Tricuspid » Right Ventricle» Pulmonic » Pulmonary Artery » Lungs » Pulmonary Veins» Left Atrium » Mitral » Left Ventricle» Aortic Valve » Aorta

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Conduction  SA Node  AV Node  Bundle of His  Right and Left Bundle Branches  Purkinje Fibers

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Output  Amount of Blood Ejected from the Left Ventricle in 1 Minute  Stroke Volume x Heart Rate = CO

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nervous System Regulation of the Heart

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hormones and the Heart  Epinephrine  Increases Heart Rate  Force of Contraction  Cardiac Output  Systolic BP

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hormones and the Heart (cont’d)  Aldosterone  Regulates Sodium/Potassium  Atrial Natriuretic Peptide  Excretes Sodium

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Blood Vessels  Arteries  Veins  Capillaries

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Structure of Blood Vessels

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Blood Pressure  Blood Force Against Blood Vessel Walls  Normal  Systolic <120 mm Hg  Diastolic <80 mm Hg

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renin-Angiotensin-Aldosterone Mechanism

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pathways of Circulation  Pulmonary  Systemic

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the Cardiovascular System

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the Cardiovascular System (cont’d)  Atherosclerosis  Arteriosclerosis  Blood Pressure Increases  Vein Valves More Incompetent  Heart Muscle Less Efficient  Dysrhythmias Common

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiovascular Disease  Number 1 Killer  Healthy Lifestyle  Smoking Cessation  Dietary Fat Reduction  Two Servings of Fish Weekly  Exercise

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiovascular Disease (cont’d)  Go Red for Women  American Heart Association’s Nationwide Movement to Celebrate the Power Women Have to Band Together to Wipe Out Heart Disease  Color Red and Red Dress Linked with This Ability

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiovascular Assessment  Health History  Physical Assessment  Diagnostic Studies

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Health History  Symptoms – WHAT’S UP?  Allergies  Past Medical History  Medications  Family History  Health Promotion Methods

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment  Vital Signs  Blood Pressure  Pulse  Respirations  Temperature

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment (cont’d)  Inspection  Oxygenation, Skin Color  Extremities: Hair, Skin, Nails, Edema, Color  JVD  Capillary Refill  Clubbing

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Clubbing

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment (cont’d)  Palpation  Point of Maximum Impulse  Extremity Temperature  Poikilothermy  Edema  Homans’ Sign

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Edema

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Homans’ Sign

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment (cont’d)  Auscultation  Heart Sounds  S1  S2  S3  S4

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Heart Sounds

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment (cont’d)  Auscultation (cont’d)  Murmurs  Pericardial Friction Rub

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Studies Joint Commission National Patient Safety Goal  Improve Accuracy of Patient Identification  Use at Least Two Patient Identifiers (Neither Patient's Location) Whenever Collecting Laboratory Samples or Administering Medications or Blood Products

34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Studies Joint Commission National Patient Safety Goal (cont’d)  Use Two Identifiers to Label Sample Collection Containers in Presence of Patient

35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Studies Joint Commission National Patient Safety Goal (cont’d)  Immediately Prior to Any Invasive Procedure, Conduct Final Verification Process to Confirm Correct Patient, Procedure, Site, and Availability of Appropriate Documents

36. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Noninvasive Diagnostic Studies  Chest X-Ray  CT Scan  Magnetic Resonance Imaging

37. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Electrocardiogram  Records Cardiac Electrical Activity  Signal-averaged ECG  Risk for Ventricular Dysrhythmias  Ambulatory Electrocardiogram Monitoring  Holter Monitoring

38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Echocardiogram  Ultrasound  Records Motion  Heart Structures  Valves  Heart Size, Shape, Position

39. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Transesophageal Echocardiogram  Probe in Esophagus  Clearer Picture  NPO Until Gag Reflex Returns

40. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Exercise StressTest  Cardiac Stress Test  Cardiac Response to Exercise and Increased Oxygen Needs  Peripheral Vascular Stress Test  Vascular Response to Walking

41. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Stress Test

42. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Noninvasive Diagnostic Studies  Plethysmography  Diagnoses Deep Vein Thrombosis/Pulmonary Emboli/Peripheral Vascular Disease  Pressure Measurement  BP Readings Along Extremity

43. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Noninvasive Diagnostic Studies (cont’d)  Arterial Stiffness Index  Atherosclerosis/Cardiovascular Disease  Tilt Table Test  Lying to Standing BP and HR  Doppler Ultrasound  Impaired Blood Flow Reduces Sound Waves

44. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radioisotope Imaging  Radioisotopes IV, Gamma Camera Scan  Detects Cardiac Ischemia/ Damage/ Perfusion  Thallium Imaging  Technetium Pyrophosphate Scan  Technetium 99m Sestamibi  MUGA Scan  Positron Emission Tomography

45. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Blood Studies  Blood Lipids  Triglycerides, Cholesterol, Phospholipids  hs-CRP  Homocysteine  Cardiac Biomarkers  Creatine Kinase, Troponin, Myoglobin  Magnesium

46. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Studies Joint Commission National Patient Safety Goal  Improve Effectiveness of Communication Among Caregivers  For Orders/Telephonic Reporting of Critical Test Results, Verify Complete Order/Test Result by Reading Back Complete Order/ Test Result to Person Giving it

47. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Invasive Studies  Angiography  Cardiac Catheterization  Hemodynamic Monitoring  Electrophysiology Study

48. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Catheterization

49. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pulmonary Artery Catheter

50. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Exercise: Walking Program  Cardiac Rehab  Smoking Cessation  Balanced Diet, Weight Loss  Oxygen

51. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Antiembolism Devices  Elastic Stockings  Intermittent Pneumatic Compression

52. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Medications  Cardiac Glycosides  Vasodilators  Antihypertensives  Antidysrhythmics  Antianginals

53. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Medications (cont’d)  Anticoagulants  Thrombolytics

54. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Lifestyle and Cardiac Care  Risk Factors  Support Groups  Sexual Activity

55. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Surgery  Preparation for Surgery  Cardiopulmonary Bypass  Video-assisted Thoracoscope  General Procedure for Cardiac Surgery  Minimally Invasive Cardiac Surgery

56. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiopulmonary Bypass Pump

57. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiopulmonary Bypass Pump in Use