CARDIOVASCULAR

ANATOMY & PHYSIOLOGY

O Delivers oxygenated blood to tissues
O Removes wastes products

HEART
O Hollow vascular organ
O Size oI a closed Iist; located between the
lungs in the mediastinum
O Weighs about 250-300 gms
O Leading into and out oI the heart are the
great vessels:
I inIerior vena cava
S superior vena cava
A aorta
P pulmonary artery & (4)
pulmonary veins
O 4 chambers: (2) atria & (2) ventricles
separated by a interventricular septum
O 2 sets oI valves:
Atrioventricular valves (tricuspid &
mitral)
Semilunar valves (pulmonic &
aortic)
O Deoxygenated venous blood returns to the
right atrium through three vessels:
S superior vena cava (returning
blood Irom the upper body)
I inIerior vena cava (returning
blood Irom the lower body)
C coronary sinus (returning blood
Irom the heart muscle

O Contractions oI the heart occur in a rhythm

SA node

AV node

Bundle oI His
RBB LBB


SA NODE
O Pacemaker; initiates heartbeat
O At the junction oI the vena cava and R
atrium
O enerates electrical impulses at 60-100 x
per min
O Controlled by the sympathetic and
parasympathetic nervous system

AV NODE
O Located in the lower aspect oI the atrial
septum
O Receives electrical impulses Irom the SA
node

BUNDLE OF HIS (Atrioventricular bundle)
O Fuses with AV node to make another
pacemaker site
O Branches into RBB which extends down
the right side oI the interventricular
septum and LBB which extends into the
leIt ventricle
O %erminates into purkinje Iibers
O Can initiate and sustain a heart rate at
40-60 beats/min

HEART SOUNDS
O S1 closure oI the AV valves
O S2 closure oI the Semilunar valves
O S3 ventricular gallop due to rapid
Iilling oI the ventricle. Increased leIt
atrial pressure (which propels the
blood Iorward with increased Iorce)
and noncompliance oI the leIt
ventricle, i.e. CHF, valvular
regurgitation; normally heard in 30
years old, young healthy athletes
O S4 atrial gallop; produced as leIt
atrial systole propels volume into the
leIt ventricle just prior to ventricular
systole; reverberation oI blood
ejected Irom the leIt atrium into the
leIt ventricle, i.e. CHF

HEART RATE
O Normal heart rate 60-100 beats/min
O Sinus tachycardia ~ 100
O Sinus bradycardia 60
O CO SV x HR
O AP CO x %PR







AUTONOMIC NERVOUS SYSTEM
O Sympathetic Nervous System
Decrease BP detected

Stimulation oI SNS Iibers

Norepinephrine

Increased HR
Increased conduction speed
Increased contractions
Peripheral vasoconstriction



O Parasympathetic Nervous System
increase BP detected

Stimulation oI PNS Iibers

Acetylcholine

decreased HR
decreased conduction speed
decreased contractions


VASCULAR SYSTEM
O Network oI arteries, arterioles, capillaries,
venules and veins
O Constantly Iilled with about 5 L oI blood
O Arteries carry oxygenated blood away
Irom the heart; tough elastic layer to propel
blood to the arterial system
O Capillaries exchange oI Iluids,, nutrients
and metabolic wastes products; thin walled;
highly permeable; connected to arteries and
veins
O Veins carry unoxygenated blood to the
heart; thinner, more pliable that the artery
wall; has valves that helps return blood
against the Ilow oI gravity

COMMON DIAGNOSTIC EXAMS

CARDIAC ENZYMES
1. CK-B (creatinine kinase, myocardial
muscle)
O Elevation indicates myocardial
damage
O Elevates within 4-6 hrs
O Peaks in 18-24 hrs II the attack
O Remains elevated up to 72 hrs
O Normal value: 12-70 U/ml ()
10-55 U/ml (F)

2. LDH (lactate dehydrogenase)
O Elevates w/in 24 hrs II attack
O Peaks in 48-72 hrs
O Normal value: 45-90 U/L

3. %roponins
O Has 3 proteins: cardiac troponin,
troponin I & troponin %
O %roponin % may be Iound in
skeletal muscle; Sn 94, Sp 60
O %roponin I cardiac speciIic; has
high aIIinity Ior myocardial injury;
Sn 95, Sp 90
O Elevates in 3 hrs; peaks in 14-20 hrs;
lasts up to 7 days;
O N value: ~0.6 ng/ml

4. OLOBIN oxygen binding protein in
cardiac and skeletal muscles; not speciIic Ior
myocardial injury
O Elevates w/in 1 hr aIter cell death
O Peaks in 4-6 hrs
O Returns to normal in 24-36 hrs

Nursing Interventions:
O uscle trauma caused by I
injections can raise the CK levels
O Handle the collection tube gently to
prevent hemolysis and send
immediately to the laboratory

SERUM LIPIDS
O Lipid proIile measures serum cholesterol,
triglycerides and lipoprotein level
O Assesses the risk Ior CAD
O Normal values:
Serum cholesterol 200mg/dl
LDL 130 mg/dl
HDL 30-70 mg/dl






GRAPHIC RECORDING STUDIES
1. EC (electrocardiogram)
O Non-invasive; evaluates Iunction oI
the heart by recording electrical
activity

2. Holter onitoring ambulatory EC;
allows recording oI heart activity as the
patient Iollows his normal activity
O Patient wears a small tape recorder
connected to bipolar electrodes
placed on his chest; lasts Ior 24 hrs
O Patient keeps a diary oI his activities
and associated symptoms
O Record intermittent arrhythmias

Nursing Interventions:
O Advise not to tamper monitor or
disconnect the wires/electrodes
O Not allowed to shower or bath while
wearing the monitor
O Emphasize the need to keep track oI his
activities regardless oI symptoms

3. Exercise EC/ Stress %est
O Non-invasive, assess cardiovascular
response to an increase workload;
threadmill is most commonly used
O Detects and evaluates CAD
O ay be used with myocardial nuclide
testing (perIusion imaging) an invasive
procedure
O %he procedure is stopped once the
patient Ieels chest discomIort, Iatigue,
exercise intolerance, dyspnea,
claudication, weakness, dizziness,
hypotension, pallor, disorientation or
EC changes
O II patient can`t tolerate exercise, the
stress test can be perIormed by IV
injections oI coronary vasodilator
(Dypiridamole or Adenosine) to dilate
coronary arteries and stimulate eIIect oI
exercise

Nursing Intervention:
Pre:
O Obtain inIormed consent
O Advise adequate rest
O Advise light meal 1-2 hrs beIore the
procedure
O Avoid smoking, alcohol and caIIeine
O Check doctor`s orders to determine
which cardiac meds should be
withheld or given
O Advise to wear comIortable clothing
and shoes
Post:
O onitor patient`s BP and EC Ior
10-15 minutes
O NotiIy physician Ior any chest pain,
SOB, dizziness or hypotension
O Wait at least 2 hours beIore
showering; advise to use warm water


4. Echocardiogram
O Noninvasive imaging technique based on
the principles oI ultrasound
O Detects structural and Iunctional changes

Nursing Intervention:
O Advise to lie still during the procedure
O ay resume activities as ordered

RADIONUCLIDE IMAGING TESTS
1. CARDIAC CA%HE%ERIZA%OIN &
CORONAR ANIORAPH
O %wo common invasive tests
O A catheter is threaded through an artery
(LeIt sided catheterization) or vein (right
sided catheterization) into the heart
O Detects structure, perIormance oI the
heart valves and circulatory system;
measures oxygen saturation

Nursing Intervention:
Pre:
O Obtain inIormed consent
O Assess allergy to seaIoods, iodine or
radiopaque dyes
O Withhold solid Ioods Ior 6-8 hrs and liquids
Ior 4 hrs to prevent aspiration and vomiting
O Document height, weight, vital signs and
note quality and presence oI peripheral
pulses
O InIorm that patient may Ieel Ilattery Ieeling
as the catheter is passed through the heart; a
Ilushed, warm Ieeling when the dye is
injected
O
Post:
O onitor vital signs, cardiac rhythm at least
every 30 mins Ior 2 hours initially
O Assess Ior chest pain, or dysrhythmias
O onitor peripheral pulses (color, warmth,
sensation) oI extremity (notiIy iI with
tingling, numbness, cool, pale, cyanosis or
loss oI pulses)
O Assess pressure dressing Ior any bleeding or
hematoma
O Keep aIIected extremity extended and
immobilized Ior 4-6 hrs and keep leg
straight to prevent arterial occlusion
O Strict bed rest Ior 6-12 hrs; do not elevate
the head oI the bed ~ 15 degrees, however
patient may turn to sides
O Encourage Iluid intake to promote excretion
oI dye
O Assess Ior hypersensitivity reaction

2. CEN%RAL VENOUS PRESSURE (CVP)
O easure oI the mean pressure within the
superior vena cava
O Indicates pressure caused by the blood
returned to the superior vena cava and
right atrium or preload
O Normal CVP pressure is 3-8 mmHg
O onitors the volume status

easuring CVP:
O Place the patient in supine position with
head oI the bed elevated at 45 degrees
O %he right atrium is located at the
midaxillary line at the 4
th
ICS. %he zero
point oI the transducer need to be at the
level oI the right atrium
O Advise patient to relax and avoid
coughing or straining



CARDIOVASCULAR DISORDERS

1. CORONARY ARTERY DISEASE
O Narrowing or obstruction oI arterial
lumina that interIeres with cardiac
perIusion
O As a result oI accumulation oI lipid
containing plaque in the arteries
(atherosclerosis)
O Coronary artery narrowing is signiIicant
iI the lumen diameter oI the leIt main
artery is reduced at least 50 or iI any
major branch is reduced at least 75
O ay lead to hypertension, angina,
dysrhythmias, I, heart Iailure and
death

Risk Factors:
O Family history oI heart disease
O Hypertension, D, hyperlipidemia
O Obesity
O Smoking
O High Iat, high carbohydrate diet
O Sedentary liIestyle

Pathophysiology:
Deposition oI Iatty Iibrous plaques

Progressive occlusion oI coronary arteries

Decreased myocardial perIusion

Decreased oxygen supply

Ischemia

Assessment:
O Normal Iindings during asymptomatic
periods
O Angina, is the classic symptom oI CAD
O Nausea, vomiting, weakness,
diaphoresis, cool extremities

Diagnostic Exams:
O EC S% segment depression or %
wave inversion (ischemia); S% segment
elevation, Iollowed by % wave inversion
(inIarction)
O Cardiac catheterization most deIinite
source Ior diagnosis; shows presence oI
atherosclerotic plaque
O Blood lipid levels may be elevated

Interventions:
%he goal oI treatment is to provide relieI oI
an acute attack, correct the imbalance
between the myocardial oxygen supply &
demand and prevent the progression oI the
disease and Iurther attacks to reduce the risk
oI I.

ANGINA
O Chest pain resulting Irom myocardial
ischemia due to inadequate blood and
oxygen supply to the myocardium
O Has 4 major Iorms:
1. Stable also called exertional
angina; pain that`s predictable in
Irequency, severity and duration;
relieved with nitrates and rest
2. Unstable also called preinIarction
angina; unpredictable degree oI
exertion, duration and severity over
time; may not be relieved with
nitroglycerin
3. Prinzemetal also called variant
angina; due to coronary artery
spasm; may occur at rest

Assessment:
O Pain develops slowly or quickly;
described as substernal, crushing,
squeezing pain; may radiate to
shoulders, arms, jaw, neck & back;
usually lasts 5 minutes but can last
up to 15-20 minutes; relieved by
nitroglycerin or rest
O Dyspnea
O Pallor & cold, clammy skin
O Sweating
O Palpitations, tachycardia
O Dizziness, Iaintness

Diagnostic Exams:
O EC S% depression or elevation
and/or % wave inversion during an
episode oI angina attack
O Stress %est changes in EC may
indicate ischemia
O Cardiac enzymes normal
O Cardiac catheterization provides
inIormation about patency oI
coronary arteries; deIinitive
diagnosis

Nursing Interventions:
Immediate management:
O Assess pain
O aintain bed rest
O Administer oxygen at 3 L/min
O Administer nitroglycerin as
prescribed to dilate the coronary
arteries, reduce oxygen requirements
oI the myocardium and relieve the
chest pain
O Obtain 12 lead EC

Following acute episode:
O Assist the client to identiIy angina-
precipitating events: 4E`s ( Eating
heavy meals, Exercise, Extreme
temperatures & Emotions)
O Instruct to stop activity and rest iI
chest pain occurs and to take
nitroglycerin as prescribed
O Instruct to seek medical attention iI
the pain persists
O Assist client to identiIy risk Iactors
that can be modiIied

. MYOCARDIAL INFARCTION
O Occlusion oI a coronary artery that leads
to oxygen deprivation, myocardial
ischemia and eventually necrosis
O Extent oI myocardial impairment and the
patient`s prognosis depend on the size
and location oI the inIarct, the condition
oI the uninvolved myocardium, the
potential Ior collateral circulation and
the eIIectiveness oI compensatory
mechanisms.

Pathophysiology:
- hypercoagulability conditions
- atherosclerotic plaque ruptures
- thrombus Iormation at the site
oI vascular injury

thrombotic occlusion oI
coronary artery

myocardial ischemia

anaerobic metabolism
(lactic acid Iormation, blood pH,
K loss)

myocardial necrosis

deterioration oI
ventricular perIormance

cardiac output & oxygen supply

activation oI the autonomic
nervous system

Risk Factors:
O Atherosclerosis
O CAD
O Hypercholesterolemia
O Smoking
O Hypertension, Obesity
O Physical inactivity

Diagnostic Exams:
O Cardiac enzymes CK-B, LDH, &
troponin are elevated
O EC - S% segment elevation, % wave
inversion, & abnormal Q wave
O CBC elevated WBC count on the 2
nd

day II I
O Other exams done aIter the acute stage:
O Exercise %olerance %est
O %hallium scans
O ultigated cardiac blood pool imaging
scans
O Cardiac catheterization

Assessment:
O Pain (crushing sternal pain with
radiation to the jaw, back and leIt arm,
occur without cause, unrelieved by rest
or nitrates & lasts ~ 30 mins
O Cold, clammy skin
O Dyspnea
O Sense oI impending doom
O Pallor, cyanosis
O %achy or bradycardia
O Hypo or hypertension

Nursing Interventions: (Acute stage)
O Assess cardiovascular status and
maintain cardiac monitoring
O Place patient in semi-Iowler position to
enhance comIort and breathing
O Administer oxygen 2 4 L/min by nasal
cannula as prescribed
O Obtain 12 lead EC
O Administer medications as prescribed:
- Nitroglycerin
- orphine
- %hrombolytics, aspirin,
anticoagulant
- Beta blockers
- Stool soIteners

Following acute episode:
O onitor Ior complications related to I
O aintain bed rest Ior the Iirst 24 36 hrs
O Allow to stand or use bedside commode
iI prescribed
O Progress Irom dangling oI legs at the
side oI the bed Ior 30 mins 3x a day to
ambulation in the client`s room then in
the hallway 3x a day as prescribed


3. HEART FAILURE
O Inability oI the heart to maintain
adequate circulation to meet the
metabolic needs oI the body because oI
an impaired pumping capability
O Diminished cardiac output; inadequate
peripheral perIusion
O Congestion oI the lungs and periphery
occur

ClassiIied as:
O Acute or chronic
O LeIt sided or right sided
O Systolic or diastolic

Risk Factors:
O CAD
O I
O Hypertension
O Rheumatic heart disease
O Congenital heart disease
O Ischemic heart disease
O Arrhythmias



Noncardiovascular causes:
O Pregnancy
O Increase environmental temp or
humidity
O Severe physical or mental states
O %hyrotoxicosis
O Anemia, acute blood loss
O COPD

Assessment:
Right sided heart Iailure:
O Signs oI RHF evident in the systemic
circulation
O Dependent edema
O Distended neck veins
O Hepatojugular reIlex
O Ascites
O Hepatomegaly
O Fatigue
O Weight gain

LeIt sided heart Iailure:
O S/Sx are evident in the pulmonary
system
O Productive cough, Irothy sputum
O Dyspnea on exertion
O Orthopnea, paroxysmal nocturnal
dyspnea
O Crackles or rales
O Fatigue
O Pallor, cyanosis
O ConIusion and disorientation


Compensatory echanism:
%he body`s response to decreased
cardiac output:
O ReIlex increase in sympathetic
activity
O Release oI rennin Irom the
juxtaglomerular cells oI the kidney
O Anaerobic metabolism by aIIected
cells
O Increase extraction oI oxygen by the
peripheral cells

Nursing Interventions:
O Place in high Iowler`s position to
reduce pulmonary congestion
O Administer oxygen in high
concentration as prescribed
O Prepare Ior intubation and ventilator
support iI required
O onitor V/S, I&O, CVP, and weight
O Diet: low sodium, low Iat, low
cholesterol, high potassium, Iluid
restriction
O Provide adequate rest periods
O Administer the II medication as
prescribed:
1. orphine sulIate provide sedation &
vasodilation
2. Diuretics decrease preload, excretion oI
Na & water, decrease circulating blood
volume, decrease pulmonary congestion
3. Digitalis increase ventricular contractility,
improve cardiac output
4. Inotropics e.g. dopamine, dobutamine


NYHA CLASSIFICATION

Class I: ordinary physical activity doesn`t cause
dyspnea or angina; %herapy: ACE inhibitors & Beta
blockers (unless contraindicated)

Class II: slight limitation oI physical activity but
asymptomatic at rest; ordinary physical activity
causes dyspnea or angina; %herapy: sodium
restricted diet, diuretics, digoxin, aldosterone
antagonists, angiotensin receptor blockers,
hydralazine & nitrates

Class III: marked limitation oI physical activity but
typically asymptomatic at rest; less than ordinary
activity causes dyspnea or angina; %herapy: same
with class III

Class IV: unable to perIorm any physical activity
without discomIort, symptoms may be present at
rest; discomIort increases with physical activity;
%herapy: same with class I-III, mechanical assist
device, continuous inotropic therapy, hospice care

4. HYPERTENSION
O ClassiIication oI prehypertension
describes an individual with a systolic
BP between 120-139 mmHg or a
diastolic pressure between 80-89 mmHg
O ajor risk Ior coronary, cerebral, renal
& peripheral vascular disease
O Hypertensive Urgency: no end organ
damage; lower BP within 2-3 days
O Hypertensive Emergency: presence oI
changes in sensorium, papilledema or
heart Iailure; use IV drugs stat; lower BP
in 24hrs

Forms oI hypertension:
1. Primary or Essential hypertension
O No known cause
O Risk Iactors: aging, male, race
(blacks), Iamily hx, obesity,
smoking, sedentary liIestyle
2. Secondary hypertension
O Result oI other disorders or
conditions
O Risk Iactors: cardiovascular, renal,
endocrine disorders, pregnancy,
medications

Pathophysiology:
O Development oI hypertension
arise Irom several theories:
O BP CO (SV x HR) x %PR
O Increase sympathetic activity
O Increase absorption oI sodium
and water in the kidneys
O Increase activity oI the RAAS
O Increase peripheral vascular
resistance

Assessment:
O Occipital headache
O Visual disturbances
O Dizziness, tinnitus, epitaxis
O Chest pain
O Nausea & vomiting

Diagnostic Exams:
O UA protein, RBC, WBC
glomerulonephritis
O FBS increase glucose D
O CBC anemia, polycythemia
O Lipid proIile increase chole &
LDL atherosclerosis
O Excretory urography renal
diseases
O Serum potassium - 3.5 mEq/L
primary aldosteronism
O BUN & Crea BUN ~ 20 mg/dl,
crea ~ 1.2 mg/dl renal disease
O EC LVH or ischemic heart
disease
O CXR cardiomegaly

Interventions:
oal: decrease BP, prevent or lessen extent
oI organ damage & correct underlying cause
O Advise regular exercise program;
reduce weight
O Stop smoking
O Advise to take meds as prescribed
and to monitor BP regularly
O Stress the importance oI Iollow-up
care
O Diet: low Iat, low Na 2 gms/day,
limit alcohol and caIIeine intake
O edications:
1. Diuretics
2. Beta blockers
3. Calcium channel blocker
4. ACE inhibitors
5. A2 receptors blockers
6. Vasodilators

. CARDIAC TAMPONADE
O Space between the parietal &
visceral layers oI the pericardium Iill
with Iluid (20-50 ml)
O Restricts ventricular Iilling and
reduce CO

Assessment:
O Pulsus paradoxus
O Increase central venous pressure
O ugular venous distention with clear
lungs
O Distant muIIled heart sounds
O Decrease CO and BO

Interventions:
O Place in critical care unit Ior
hemodialysis monitoring
O IV Iluid as prescribed to manage
decreased CO
O Prepare Ior pericardiocentesis
(withdrawal oI pericardial Iluid)
O onitor recurrence

. ARTERIAL OCCLUSIVE DISEASE
O Chronic disorder in which partial or
total arterial occlusion deprives the
lower extremities oI oxygen and
nutrients
O Atherosclerosis is the most common
cause

Risk Factors:
O smoking, aging, hypertension,
hyperlipidemia, D, Iamily history
oI vascular disorders, emboli
Iormation, thrombosis, trauma or
Iracture

Assessment:
O 5 P`s (paralysis, paresthesia, pallor,
pain & pulselessness)
O Pain (intermittent claudication, rest
pain, burning, aching, relieved by
placing extremities in a dependent
position)
O Loss oI hair and dry scaly skin
O %hickened toenails

Diagnostic Exams:
O Arteriography shows type
(thrombus or embolus) and degree oI
obstruction
O Doppler ultrasonography shows
reduce blood Ilow distal to occlusion

Interventions:
O onitor the extremities Ior 5 P`s
O Elevate the Ieet at rest but reIrain
Irom elevating them above the level
oI the heart because extreme
elevation slows arterial blood Ilow to
the Ieet
O Severe cases, may sleep with
aIIected leg hanging Irom the bed or
sit upright in a chair
O Avoid crossing oI legs, exposure to
cold, applying direct heat, tobacco
and caIIeine
O Advise smoking cessation,
hypertension control and walking
exercise

edications:
O Dextran and antiplatelets
O Aspirin, ticlopidine, pentoxiIylline
and cilostazol
O %hrombolytics
O Antilipemics

Surgical procedures:
O Embolectomy
O %hromboendarterectomy
O Patch graIting
O Bypass graIting
O Lumbar sympathectomy
. RAYNAUD`S DISEASE
O Vasospasm oI the arterioles in the
upper and lower extremities;
constriction oI the cutaneous vessels
O Attacks are intermittent and occur
with exposure to cold or stress
O Primarily aIIecting the Iingers, toes,
ears, cheeks

Causes:
Unknown but associated with several
connective tissue disorders

Pathophysiology:
O Intrinsic vascular wall hyperactivity
to cold
O Increase vasomotor tone due to
sympathetic stimulation
O Antigen-antibody immune complex

Assessment:
O Blanching Iollowed by cyanosis
during vasoconstriction
O Numbness, tingling, swelling and
cold temperature at the aIIected body
part

Interventions:
O Instruct to avoid precipitating Iactors
such as cold and stress
O Instruct to avoid smoking
O Instruct to wear warm clothing,
socks and gloves in cold weather

edications:
O Ca channel blockers vasodilation;
prevent vasospasm
O Adrenergic blockers improves
blood Ilow , e.g. phenoxybenzamine
(Reserpine)

. BUERGER`S DISEASE
(THROMBOANGITIS OBLITERANS)
O Occlusive disease oI the median and
small arteries and veins
O Distal upper and lower limbs are
aIIected
O AIIects men 20-35 yrs old
O Risk Iactor: smoking

Assessment:
O Intermittent claudication
O Aching pain, severe at night
O Intense redness, progressing to
cyanosis
O Cool, numb, tingling sensation
O Diminished pulses in distal
extremities
O Development oI ulcer

Diagnostic Exam:
O Duplex ultrasonography
O Contrast angiography



Interventions:
O Instruct to stop smoking
O onitor pulses
O Advise to avoid injury to upper and
lower extremities
O Administer vasodilators as
prescribed

. PHLEBITIS

Assessment:
O Red, warm area
O Pain and soreness
O Swelling

Interventions:
O Apply warm moist soaks to dilate the
vein and promote circulation
O Assess signs oI complications: tissue
necrosis, inIection, or pulmonary
embolus

10.DEEP VEIN THROMBOSIS
O Acute condition characterized by
inIlammation and thrombus Iormation
O AIIects small veins or large veins e.g.
vena cava, Iemoral, iliac and subclavian
veins
O Progressive, may lead to pulmonary
embolism

Causes:
O Idiopathic
O Results Irom endothelial damage,
accelerated blood clotting or reduced
blood Ilow

Risk Factors:
O Prolonged bed rest, trauma,
childbirth, use oI hormonal
contraceptives


Pathophysiology:
Alteration in epithelial lining

Platelet aggregation
Fibrosis entrapment oI RBC, WBC

%hrombus Iormation

Chemical inIlammatory process in the
vessel epithelium

Fibrosis

Occlusion oI vessel lumen
Embolize

Assessment:
O CalI or groin tenderness or pain with
or without swelling
O () homan`s sign
O %ender, warm skin
O Fever, chills, malaise

Diagnostic Exams:
O Doppler ultrasonography identiIies
decrease blood Ilow and any
obstruction to venous Ilow
O Venography conIirms diagnosis;
shows Iilling deIects and diverted
blood Ilow

Interventions:
O oal: control thrombus Iormation,
prevent complications, relieve pain
& prevent recurrence
O Provide bed rest
O Elevate aIIected extremity above the
level oI the heart
O Using knee gatch or pillow under the
knees
O Do not massage extremity
O Advise to wear anti-embolic
stockings (decrease venous stasis and
to assist venous return)
O onitor Ior shortness oI breath and
chest pain Ior pulmonary embolism
O Administer the II medications as
prescribed:
O %hrombolytic therapy (tissue
plasminogen activator) initiated 5
days aIter onset oI symptoms
O Heparin prevent enlargement oI
existing clot and Iormation oI new
clots
O WarIarin (Coumadin) Iollowing
heparin therapy
O Analgesics decrease pain
O Diuretics decrease edema
O onitor side eIIects and hazards oI
anticoagulant therapy
O onitor Prothrombin time
O Surgical management: vein stripping
& graIting

11.VARICOSE VEINS
O Distended, protruding veins that appear
darkened and tortuous
O Vein walls weaken and dilate, valves
become incompetent

Risk Iactors: pregnancy, prolonged
standing or sitting

Assessment:
O Dull, aching pain in the legs aIter
standing
O Ankle edema
O () trendelenburg`s test

Interventions:
O Emphasize the use oI antiembolic
stockings
O Instruct to elevate legs as much as
possible
O Instruct to avoid constrictive clothing
O Prepare client Ior sclerotherapy or vein
stripping as prescribed



COMMON CARDIAC DRUGS
1. Nitrates dilate coronary arteries; to
decrease preload and aIter load
2. Calcium channel blocker dilate coronary
arteries & reduce spasm
3. Beta blockers reduce BP & heart rate
4. Aspirin prevent thrombus Iormation
5. Cholesterol Lowering medications reduce
development oI atherosclerotic plaque




PA%HOPHSIOLO

RIH% SIDED HEAR% FAILURE

IneIIective right ventricular contractility

Failure oI RV pumping ability

Decreased CO to lungs

Blood backup into RA &
Peripheral circulation

Weight gain, peripheral edema,
Organomegaly


LEF% SIDED HEAR% FAILURE

IneIIective LV contractility

Failure oI LV pumping ability

Decreased CO to body

Blood backup into LA
& lungs

Pulmonary congestion, dyspnea
Activity intolerance

Pulmonary edema
& RHF