Nursing care of patients with Cardiovascular Disorders

Cont Currently, the trend is towards early discharge and management of patient at home so careful planning is an essential aspect of cardiac care. Thorough assessment of the patients home environment and of the support systems is critical to ensure optimal restoration of function. Early planning ensures that essential services are available for the patient and detailed teaching of the patient and family is more crucial than ever in this area of early hospital discharge.

OBJECTIVES:
At the end of the session the student will be able to: Define key terminologies applicable to managing cardiovascular disorders. Prepare and assist patient undergoing diagnostic, therapeutic, corrective surgery and rehabilitative procedures Effectively manage patients with: Myocardial infarction Congestive heart failure Cardiac arrest Rheumatic heart disease

NUTRITIONAL METABOLIC PATTERN

DIAGNOSTIC PROCEDURES ANGIOGRAPHY: Therapeutic radiography of the heart and blood vessels with the use of radiopaque contrast medium. *A catheter is introduced directly into the vessels

Pre procedure Care Clear explanation of the procedure to the patient. Consent to be signed by the patient if over 21 years. Nil by mouth 2 hours before the procedure. Benefit, risk and possible complications

POST PROCEDURE CARE

Position ensure the patient is comfortable in bed. Monitor vital signs. Check for bleeding at puncture site. Observe for pulsation/discoloration on extremities Headache Discomfort of the groin of the punctured site.

VENOGRAPHY
Radiographic procedure to visualize veins-filled with
a contrast medium: detect thrombophlembitis. PRE-OP PROCEDURE Clear explanation of the procedure Consent to be signed

POSTOP-PROCEDURE Observe for Any signs of allergy Tachycardia Numbness of the extremities Hives Any signs of redness, swelling, bleeding or thrombosis on the injection site.

Electrocardiography/Echocardiography (Lab)

OVERVEIW OF COMMON CARDIAC DISORDERS

Myocardial Infarction(MI) Congestive Heart Failure(CHF) Rheumatic Heart Disease(RHD) Cardiac Arrest

MANAGEMENT OF MYOCARDIAL INFARCTION (NURSING) COMFORT: Semi fowlers position to ease breathlessness Administer warm humidified O2 via Hudsons mask Complete bed rest Administer prescribed drugs Connect the patient to cardiac monitor and also pulse oxy meter Keep an accurate fluid balance chart Close monitoring of vital signs hourly, hourly until patients condition is stabilized

NURSING PROCESS Nursing assessment Level of consciousness History risk of life threatening complications Pain Aggravating and relieving factors Cyanosis,pallor,and clammy skin Numbness, tingling or paresthesia, cardiac monitor Vital signs Nursing diagnosis Nursing intervention Evaluation

PATIENT EDUCATION/ DISCHARGE PLAN

Signs and symptoms of myocardial infarction Diet most appropriate for cardiac patients, which is low salt, low fat diet. Medication compliance Avoid sedentary life style Avoid strenuous exercises cause more harm to the aching heart.

Avoid smoking and alcohol consumption Report to the hospital early when develop signs and symptoms of Myocardial Infarction

CONGESTIVE HEART FAILURE

The treatment focuses at the elimination of excessive accumulation of body fluids increasing the force and efficiency of myocardial contraction and reducing the workload of the heart. Promoting rest and administrating pharmacologic agents can achieve these.

NURSING MANAGEMENT
Complete bed rest Semi fowlers position to ease breathing Elevate feet to reduce edema Administer warm humidified oxygen via Hudsons mask medications as prescribed Provide commode or bed pan to avoid patient getting up to the toilet. Continue with close monitoring of the patient through vital signs (Temperature, Pulse, Resp, B/P) every 4 hours

CONT
Provide low salt and low fat diet for the client to

reduce excess fluids from the body Administer prescribed medication

Encourage the patient to do deep breathing and

coughing exercise to avoid atelectasis Any abnormality in your observation must be reported to the doctor

Document all the changes occur and the treatment carried out

NURSING CARE PLAN

ASSESSMENT
NURSING DIAGNOSIS NURSING INTERVENTION

EVALUATION

PATIENT TEACHING/ DISCHARGE

Educate patient on the signs and symptoms of the condition Encourage deep breathing and coughing exercise Advise on sedentary life style Dietary advice - salt and fat free Compliance to medication Seek medical attention early

To attend follow up clinic

CARDIAC ARREST
Cessation of effective cardiac output due to absence of cardiac activity.Pt. is minutes away from biologic death it is important to recognize early and CPR immediately. Clinical manifestations. Assystole on cardiac monitor Unresponsiveness Absence of pulse in the major artery Cool and cyanotic skin Hypoxemia

Management
1.Basic life support: Recognize the arrest Get medical support CPR 2.Advance medical life support In a hospital set up procedures available Resuscitation should begin ASAP. Emergency trolley -drugs Endotracheal intubation Iv drugs to correct acidosis, maintain b/p and stimulate normal cardiac rhythm Defibrillation to terminate ventricular fibrillation by far the most successful way.

RHEUMATIC HEART DISEASE(RHD):

Systemic inflammatory disorder following pharyngeal infection with group A streptococcus in 1/10 people. - effect of rheumatic fever on the heart.
Clinical Manifestations. Acute streptococcal pharyngeal infection fever, sore throat, chills and rigor. Carditis Acute migratory polyarthritis-severe pains and swelling of larger joint of the lower limbs Chorea-involuntary motor movements Rash

MANAGEMENT
No cure but to prevent or control it to avoid recurrence. Prompt treatment of streptococcal pharyngitis with benzathine penicillin Reduce joint swelling Relieve pain Blood tests Follow up

SURGICAL INTERVENTION - HEART SURGERY

Open-heart surgery is most commonly performed for coronary heart disease, vascular dysfunction and congenital defects. The procedure requires temporary cardiopulmonary by pass (blood is diverted from the heart and the lungs and mechanically oxygenated and circulated to provide a dry blood less field during the operation)

OBJECTIVES: At the end of the session the student should be able to:
Demonstrate the skills in preparing the patient for cardiac surgery Manage post operative cardiac patients Teach and provide appropriate skills to continue with home care.

TYPES OF SURGERY
Coronary artery bypass surgery graft is anatomized to the aorta and the other end of the graft is secured to the distal end of the coronary vessel Valvular surgery - prosthetic or biologic valves are placed in the heart
Congenital heart surgery- defects of the heart can be

surgically repaired

PREOPERATIVE MANAGEMENT (SPECIFIC)

Explain the procedure clearly to the patient

Review the patients condition to determine status of

pulmonary, renal, hepatic, hematologic and metabolic systems NBM Consent Medications ECG result/ECHO result Anesthetists review Physiotherapist pre assessment
Cardiac history

Pulmonary status patient with chronic obstructive disease may require prolonged postoperative respiratory support

PRE OPERATIVE CARE

Check and document laboratory results in the patients folder.
Check the blood bank if any unit of blood is ready for

the patient evaluate medication regime i.e. some drugs may have been stopped several days before surgery (Digoxin)

Encourage patient to stop smoking

Routine Preoperative care to be included

POST OPERATIVE CARE

Nurse patient in semi fowlers position
Patient will be on mechanical ventilator continue ventilator care (continuous O2) ICU Accurate recording of vital signs (Temp, Resp, Pulse, B/P) Close monitoring of intake and output and keep an

accurate fluid balance chart

POST OPERATIVE CARE

Close monitoring of the Under water seal drainage Ensure that the chest drain is patent and draining well Personal hygiene Administer prescribed medication Continue with chest physio Close monitoring of Arterial Blood Gas (ABG) Close monitoring of SpaO2 (Pulse Oxymetery) Documentation of all the activities carried out

PATIENT EDUCATION
Educate the patient to avoid strenuous exercises Encourage the patient to take rest Explain to the patient to avoid lifting heavy things Must participate in activities that do not cause pain and

discomfort Encourage the client to increase walking time daily Climb up the stairs one or two times during the first week and increase slowly as tolerated. Avoid large crowd Avoid driving until first postoperative check up

PATIENT EDUCATION
May resume sexual activity two weeks after surgery Teach signs and symptoms of the disease

Advice the patient to report to the nearest health center if develop chest pain
Diet low salt and fat diet - avoid added salt

Encourage the patient to quit smoking and alcohol

Compliance to medication Follow up clinic

MANAGEMENT OF PATIENT WITH VASCULAR DISORDER

OVERVIEW OF THE VASCULAR DISORDERS

Deep venous thrombosis
Thrombophlebilitis

OVERVIEW
Varicose veins
Arteriosclerosis Occlusive Arterial Disease

Arterial Embolism
Aneurysm Hypertension

MANAGEMENT OF DEEP VENOUS THROMBOSIS

To prevent propagation of the thrombosis and reduce the risk of pulmonary embolus; to prevent recurrent thromboemboli

MEDICAL MANAGEMENT
Anticoagulant therapy
IV Heparin is given initially, followed by 3- 6 months of oral

Thrombolitic therapy this is only given on selected cases e.g. life or limb threatening situations due to risk of bleeding

Cont.
Non pharmacological therapies superficial

thrombophlebitis as an adjuvant to anticoagulant with DVT Dry heat Warm water bottles Heat cradle (thermostatically controlled or regulated with electric bulbs Bed rest to prevent muscle contraction (may dislodge
clot)

MEDICAL MANAGEMENT

Moist heat Hydrotherapy Warm compression Pressure gradient therapy to promote vasodilatation Electrically or pneumatically controlled boots or sleeves Elastic garments

Surgery

To place filter into the inferior vena cava to prevent pulmonary embolism in a patient who cannot tolerate prolonged anticoagulant therapy Thrombectomy may be necessary for severely compromised venous drainage of the extremity

NURSING MANAGEMENT
ASSESMENT
NURSING DIAGNOISIS NURSING INTERVENTION

EVALUATION

NURSING MANAGEMENT OF PATIENT WITH VASCULR SURGERY

INTRODUCTION

Vascular surgery involve operations of the arteries, veins or lymphatic systems.

May be performed on an urgent basis as in embolectomy for acute embolism, or electively for vein ligation and stripping of varicose veins after a

conservative treatment failed

PREOPERATIVE CARE (SPECIFIC)

Assess the nutritional status of the patient and improve preoperatively to aid in wound healing postoperatively Conduct ECG to be able to detect any abnormality

Assess skin for any skin impairment which can be treated before sending the patient to theatre

PREOPERATIVE
Check capillary blood glucose (CBG) to rule out diabetes
Avoid smoking Explain the procedure clearly to the client to avoid

anxiety and stress

Routine preparation to be included

POST OPERATIVE CARE

Semi fowlers position Administer humidified oxygen Check the patients positionespecially the lower extremities Position the legs straight and support with pillows to avoid complications

POPSTOPERATIVE CARE
Close monitoring of vital signs
Keep an accurate fluid balance chart

And close monitoring of intake and output

Close observation of they operation site Documentation of all the activities in the patients folder

NURSING CARE PLAN

ASESSMENT
NURSING DIAGNOSIS NURSING INTERVENTION

EVALUATION

PATIENT EDUCATION AND DISCHARGE PLAN

Teach the patient on how to look after the wound at home
Compliance to medication Immediately report to the hospital if experience pain

on the site

DISCHARGE PLAN
Continue his exercise at home

Bed rest Avoid heavy lifting

Avoid smoking and drinking alcohol

Follow up clinic

MANAGEMENT OF LYMPHATIC DISORDERS

Lymphadema: swelling of the tissues (particularly) in the dependent position), produced by an obstruction to the lymph flow in an extremity.
Lymphangitis: acute inflammation of lymphatic channels which most commonly arises from a focus of infection in an extremity.

MANAGEMENT (NURSING)
Complete Bed Rest
Nurse patient in a semi fowler's position Administer humified oxygen.

Keep an accurate fluid balance chart through close monitoring of intake and output.
Elevate lower limbs and educate the patient to

continue with passive exercises whilst lying down in bed. Administer prescribed medication.

LYMPHANGITIS
Bed Rest Elevate the affected extremity Administer antibiotics as prescribed Surgical intervention incision and drainage when abscess formed Wound care change dressing prn Encourage patient to take a lot of fluids Diet as prescribed

PATIENT EDUCATION/DISCHARGE PLAN

Educate the client to use elastic bandage or stocking.
Avoiding trauma to extremities Compliance to medication Personal hygiene Follow up clinic.

Any Questions?