Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 18
NURSING CARE OF
THE CLIENT:
CARDIOVASCULAR
SYSTEM
Heart Disease
Since 1900, the leading cause of death in
the United States every year except in
1918.
 Approximately 1.1. Million Americans
experience myocardial infarction each
year, with 367,000 ending in death.
 Congestive heart failure a factor in
approximately 250,000 deaths each year.

Structure of the Heart

Consists of three layers:
 Endocardium (inner lining of heart
chambers and valves).
 Myocardium (thickest part of the heart;
consists of cardiac muscle).
 Epicardium (inner layer of a double
walled sac called the pericardium that
surrounds the heart).
Structure of the Heart:
Chambers

The heart is a hollow muscular organ
containing four chambers:
 Atria (upper chambers).
 Ventricles (lower chambers).
Structure of the Heart: Valves

There are four valves in the heart:
 Tricuspid.
 Bicuspid (mitral).
 Pulmonic.
 Aortic.
Circulation of Blood
Blood enters the heart through veins and
leaves the heart through arteries.
 Blood is distributed throughout the body
and returns to the right atrium of the heart
through the inferior and superior vena
cava.

Coronary Arteries
Supply nutrients and oxygen to the
muscle tissue of the heart.
 The two coronary arteries are the right
coronary artery and the left coronary
artery, which branch off the aorta.

Conduction System
For the heart to beat regularly in a
rhythmic sequence, electrical impulses
follow a set pattern through the
conduction system of the heart.
 The conduction system consists of the
sinoatrial node, atrioventricular node,
bundle of His, bundle branches and
Purkinje fibers.

Arterioles and Arteries
Arteries are thick-walled tubes that
vasoconstrict (decrease in diameter) or
vasodilate (increase in diameter).
 The arteries divide and branch into
smaller vessels called arterioles, or
smaller arteries.

Capillaries

Very thin vessels that connect the
smallest arterioles with the smallest
venules.
Venules and Veins
Venules are small vessels that emerge
from the capillaries and gradually
increase in size.
 As venules increase in size, they
eventually form veins.

Health History

Nurse has three goals when obtaining
health history:
 Identify present and potential health
problems.
 Identify possible familial and lifestyle
risk factors.
 Involve the client in planning long-term
health care.
Health History

Nurse has three goals when obtaining
health history:
 Identify present and potential health
problems.
 Identify possible familial and lifestyle
risk factors.
 Involve the client in planning long-term
health care.
Assessment: Subjective Data

Typical concerns expressed by client with
cardiac disorder are chest pain, dyspnea
(difficulty in breathing), edema, fainting,
palpitations, diaphoresis, and fatigue.
Types of Dyspnea
Exertional (when client participates in
activity and becomes short of breath).
 Orthopnea (difficulty breathing when lying
down).
 Paroxysmal nocturnal dyspnea (person
suddenly awakes, is sweating, and is
having difficulty breathing).

Assessment: Objective Data
A head-to-toe assessment of a cardiac client
should include assessments of:
 Skin.
 Neck veins.
 Respirations.
 Heart sounds.
 Abdomen.
 Extremities.
Homan’s sign
Indicator of deep vein thrombosis (DVT).
 To test, nurse dorsiflexes the client’s foot.
If there is pain in the calf or the leg or
behind the knee, the Homan’s sign is
positive and may indicate the presence of
a venous clot.

Common Diagnostic Tests
Laboratory Tests
Arterial Blood Gases, Complete Blood Count, Platelet Count, Hemoglobin, Hematocrit, Electrolytes,
Cardiac enzymes, Erythrocyte sedimentation rate, Glucose, Prothrombin time,
Partial Thromboplastin time, International Normalized Ratio, Serum Lipids
Radiologic Tests
Chest X-rays, Cardiac positron emission tomography scan, Radionuclide angiography,
Technetium pyrophosphate scanning, Thalium scan
Other Diagnostic Tests
Cardiac biopsy, Cardiac catheterization, Echocardiogram, Holter monitor, MRI,
Pericardiocentesis, Pulse oximetry, Stress test, Arterial plethysmography, Venous plethysmography
Dysrhythmia: Defined as:
An irregularity in the rate, rhythm, or
conduction of the electrical system of the
heart.
 Symptoms include fainting, seizures,
fatigue, decreased energy level,
exertional dyspnea, chest pain, and
palpitations.

Bradycardia: Defined as:
Sinus bradycardia is a heart rate of 60
beats/minute or less.
 Causes include myocardial infarction,
electrolyte imbalances, vagal stimulation,
heart block, drug toxicity, intracranial
tumors, sleep, and vomiting.

Tachycardia
A sinus rhythm with a heart beat ranging
from 100 to 150 beats/minute.
 Causes are exercise, emotional stress,
fever, medications, pain, anemia,
thyrotoxicosis, pericarditis, heart failure,
excessive caffeine intake, and tobacco
use.

Atrial Dysrythmias
Premature Atrial Contractions.
 Atrial Tachycardia.
 Paroxysmal Supraventricular Tachycardia.
 Atrial Flutter.
 Atrial Fibrillation.

Ventricular Dysrythmias
Premature Ventrical Contractions.
 Ventricular Tachycardia.
 Ventricular Fibrillation.
 Ventricular Asytole.

Atrioventricular Blocks
In atrioventricular blocks, the electrical
conduction is interrupted to some degree
between the atria and ventricles at the AV
node.
 The extent of interruption is classified as
First degree, Second Degree or Third
Degree AV Blocks.

Inflammatory Disorders

Inflammatory or infectious conditions of
the heart include:
 Rheumatic Heart Disease.
 Endocarditis.
 Myocarditis.
 Pericarditis.
Rheumatic Heart Disease
A complication of rheumatic fever that is
linked to group A streptococcus following
an upper respiratory infection.
 Rheumatic fever and rheumatic heart
disease affect about 1.8 million persons in
the United States.

Endocarditis

May cause valvular heart disease with the
possibility of the valve needing to be
surgically replaced (valvuloplasty) or
replaced with a mechanical (caged-ball
valve or tilting-disk valve) or biological
valve from a calf, pig, or human.
Pericarditis
An inflammation of the membranous sac
surrounding the heart.
 Causative organisms are viral, bacterial,
fungal, or parasitic.

Valvular Heart Disease
Occurs when the valves do not open and
close properly.
 A thickening of the valve tissue, causing
the valve opening to be narrow, is called
valvular stenosis.

Mitral Valve Prolapse

Mitral insufficiency can cause mitral valve
prolapse, in which the valve leaflets,
chordae tendineae, and papillary muscles
become damaged.
Occlusive Disorders
Arteriosclerosis.
 Angina Pectoris.
 Myocardial Infarction.

Arteriosclerois
Narrowing and hardening of the arteries.
 Three types:
 Atherosclerosis (fatty deposits called
plaque on inner lining of vessel walls).
 Calcific sclerosis (calcium deposits on
the middle layer of the wall of the
arteries).
 Arteriolar sclerosis (a thickening of the
arterioles caused by hypertension).

Angina Pectoris
Chest pain caused by temporary
inadequate blood and oxygen supply to
the myocardial tissues.
 Surgical treatment for angina includes a
PTCA, intracoronary stent, transcatheter
ablation, or a coronary artery bypass
graft.

Myocardial Infarction (MI)
Caused by an obstruction in a coronary
artery resulting in necrosis (death of the
tissues supplied by the artery.
 Obstruction is usually due to
atherosclerotic plaque, a thrombus, or an
ambolism.

Congestive Heart Failure (CHF)
Often the final stage of many other heart
conditions.
 Develops when the heart is no longer
capable of meeting the oxygen needs of
the body. The heart is literally failing.

Peripheral Vascular Disorders
Venous
thrombosis.
 Venous
thrombophlebitis.
 Varicose veins.

Raynaud’s
disease.
 Aneurysm.
 Hypertension.

Venous Thrombosis/
Thrombophlebitis


Phlebitis
(inflammation in the
wall of a vein without
clot formation)
Thrombosis
(formation of a clot in
a vessel).


Phlebothrombosis
(formation of a clot
because of blood
pooling in the vessel)
Thrombophlebitis
(formation of a clot
due to an
inflammation in the
wall of the vessel)
Virchow’s Triad

Three factors leading to the formation of a
clot—pooling of blood, vessel trauma, and
a coagulation problem—are called
Virchow’s Triad.
Varicose Veins

Also known as varicosities, they are
visibly prominent, dilated, and twisted
veins.
Buerger’s Disease
(Thromboangiitis Obliterans)

An inflammatory disease of the small and
medium arteries and veins that leads to
vascular obstruction.
Raynaud’s
Disease/Phenomenon

An intermittent spasm of the digital
arteries and arterioles resulting in
decreased circulation to the fingers and
toes.
Aneurysm
A localized dilation occurring in a
weakened section of an artery’s medial
layer.
 Symptoms of an aneurysm depend upon
the location of the aneurysm in the body
and are often asymptomatic until they
start leaking or pressing on other
structures.

Hypertension (HTN)
Also known as high blood pressure, it is
defined as an elevated arterial blood
pressure.
 Often the hypertensive client may not be
experiencing any symptoms and does not
see the importance of caring effectively
for this condition.
