MAINTAINING CARDIAC AND
VASCULAR FUNCTION
DR. IRENE ROCO
ASST. PROFESSOR
MAINTAINING CARDIAC AND VASCULAR FUNCTION
OUTLINE
• MAINTAINING CARDIAC FUNCTION
• MAINTAINING VASCULAR FUNCTION
1. POSITIONING AND LEG EXERCISES
2. ANTI EMBOLI STOCKINGS –
3. SEQUENTIAL COMPRESSION DEVICES (SCD)
• MEDICATIONS
• ROLE OF THE NURSE
I - MAINTAINING CARDIAC FUNCTION
NURSING INTERVENTIONS
1.
POSITION THE CLIENT IN HIGH FOWLER’S POSITION TO DECREASE PRELOAD AND REDUCE
PULMONARY CONGESTION
2.
MONITOR INTAKE AND OUTPUT
a.
MILD TO MODERATE CARDIAC FUNCTION – FLUID RESTRICTION IS NOT REQUIRED
b.
SEVERE HEART FAILURE - FLUID RESTRICTION MAY BE ORDERED
II - MAINTAINING VASCULAR FUNCTION
NURSING INTERVENTIONS
1.
POSITIONING AND LEG EXERCISES
A. AVOID PILLOWS UNDER THE KNEES OR MORE THAN 15 DEGREES OF KNEE FLEXION TO
IMPROVE BLOOD FLOW TO THE LOWER EXTREMITIES AND REDUCE VENOUS STAGNATION
B. LEGS ELEVATED ( 20 – 30 DEGREES) TO PROMOTE VENOUS RETURN TO THE HEART
•
AVOID THIS POSITION FOR PATIENTS WITH CARDIAC DYSFUNCTION BECAUSE IT WILL
INCREASE PRELOAD AND MAY STRESS THE DYSFUNCTIONAL HEART
CONT..
POSITIONING
AND LEG EXERCISES
C. ALTERNATE CONTRACTION AND
RELAXATION OF THE MUSCLES
ONCE EVERY ONE TO TWO HOURS
WHILE AWAKE
1.
CALF PUMPING EXERCISES –
ALTERNATE DORSIFLEXION AND
EXTENSION OF THE FEET
2.
KNEE FLEXION AND EXTENSION
3.
RAISING AND LOWERING LEG
II - MAINTAINING VASCULAR FUNCTION
2. ANTI EMBOLI STOCKINGS –
•
MADE OF STRONG ELASTIC MATERIAL WHICH PROMOTES VENOUS
RETURN USING CONTINUOUS PRESSURE
•
ANTI EMBOLISM STOCKINGS MUST FIT PROPERLY. TOO LARGE
STOCKINGS CANNOT PROVIDE SUFFICIENT VEIN COMPRESSION; TOO
TIGHT CAN OBSTRUCT BLOOD FLOW
•
INSPECT THE CLIENT’S LEGS AND FEET REGULARLY TO ENSURE
CIRCULATION IS NOT IMPEDED BY THE STOCKINGS
•
SHOULD BE APPLIED IN THE MORNING BEFORE CLIENT GOES OUT OF
BED
•
USUALLY REMOVED FOR 30 MINUTES ONCE EVERY EIGHT HOURS
II - MAINTAINING VASCULAR FUNCTION
3.
SEQUENTIAL COMPRESSION DEVICES (SCD)
• PLASTIC SLEEVES ATTACHED BY A TUBING TO AN AIR PUMP
THAT ALTERNATELY INFLATE AND DEFLATE PORTIONS OF THE
SLEEVES TO A SPECIFIED PRESSURE, WRAPPED AROUND THE
LEGS THE ANKLE AREA INFLATES FIRST FOLLOWED BY THE
CALF REGION AND THEN THE THIGH AREA
• SCD IS REMOVED FOR AMBULATION AND DISCONTINUED IF
CLIENT RESUMES ACTIVITIES
Purpose / Indication of SCD
• to promote venous return from the
legs
CONTRAINDICATION
• Arterial Insufficiency
• To decrease risk of DVT and /or
pulmonary embolism
• Cellulitis
• Prevention of thrombi and edema from • Infection of extremity
venous stasis
• Preexisting venous thrombosis
III - MEDICATIONS
1.
TO REDUCE THE WORKLOAD OF THE HEART AND PREVENT VASOCONSTRICTION - NITRATES,
CALCIUM CHANNEL BLOCKERS, ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS
2.
TO TREAT CARDIAC DYSRHYTHMIAS
3.
TO INCREASE THE CONTRACTILE STRENGTH OF THE HEART- POSITIVE INOTROPIC DRUGS
(DIGITALIS)
4.
TO BLOCK THE SYMPATHETIC NERVOUS SYSTEM ACTION ON THE HEART AND DECREASE
OXYGEN CONSUMPTION - BETA ADRENERGIC BLOCKERS (PROPRANOLOL, METOPROLOL)
5.
FOR PERIPHERAL VASCULAR DISEASE AND HYPERTENSION - DIRECT VASODILATORS
ROLE OF THE NURSE
1.
HELP CLIENT UNDERSTAND THE PURPOSE, EFFECTS, AND SIDE EFFECTS OF DIFFERENT
NUMEROUS MEDICATIONS
2.
ASSESS FOR THE EFFECTS AND POTENTIAL COMPLICATIONS
Medication
Effects and potential
complications
Nurse’s Role
Diuretics
can lower potassium level
Assess I & O, potassium Level
Positive Inotropics
Strengthen contraction
Assess BP, HR, Peripheral pulses , lung sounds as
indicators of cardiac output
Antihypertensives
May cause postural hypotension
Monitor blood pressure
ROLE OF THE NURSE
3. PROMOTE CLIENT COMPLIANCE WITH THE MEDICATION REGIMEN . INCLUDE THE CLIENT’S
SPOUSE OR SIGNIFICANT OTHERS IN DISCUSSION CONCERNING MEDICATIONS
•
MISSING DOSES
•
STOPPING MEDICATION
4. CAUTION CLIENT TO GET OUT OF THE BED SLOWLY AND AVOID HOT BATHS WHICH COULD
INCREASE VASODILATION OR SYNCOPE
5. INSTRUCT LOW FAT, LOW SODIUM DIET
6. NEVER IGNORE ANY CLIENT’S COMPLAINTS OF CHEST PAIN OR DISCOMFORT . CHEST PAIN IN
CARDIAC CLIENT MUST BE ASSUMED TO BE A SERIOUS SIGN OF CARDIAC HYPOXIA
REFERENCES
• KOZIER & ERBS FUNDAMENTALS OF NURSING. EIGHTH ED.
• CRAVEN & HIRNLE. FUNDAMENTALS OF NURSING. HUMAN HEALTH AND FUNCTION.
LIPPINCOTT & WILLIAMS. FOURTH ED.