UNIT 9
CIRCULATION
UNIT 9: STUDENT LEARNING
OUTCOMES
• Demonstrate safe patient-centered, culturally component nursing care using
evidence-based practice for patients with impaired circulation. (CSLO 4, 1)
• Identify risk factors, prevention, and/or early detection of health problems for
patients with impaired circulation. (CLSO 4)
• Discuss communication and collaborative skills needed to provide care for
patients with impaired circulation. (CLSO 6, 3)
EXTERIOR ANATOMY OF THE HEART
INTERIOR ANATOMY OF THE HEART
4
CARDIAC CONDUCTION SYSTEM
PATHWAY OF BLOOD IN
THE HEART
CARDIAC OUTPUT
• Cardiac Output  amount of blood pumped by the ventricles in 1 minute
• Normal Range 4 – 8 L/min
HR
SV
• Number of
ventricular
contractions
per minute
• The amount of
blood ejected
with each
contraction
CO
PRELOAD VS. AFTERLOAD
9
ALTERED STRUCTURE AND FUNCTION OF
OXYGENATION
• Cardiovascular alterations
• Interrupted electrical
impulses
• Decreased blood flow
• Electrolyte disturbances
• Cardiac failure
From Ignatavicius DD, Workman ML, Rebar CR, et al: Medical-surgical nursing:
Concepts for interprofessional collaborative care, ed 9, St. Louis, 2018, Elsevier.
Copyright © 2020 by Elsevier Inc. All rights reserved
ASSESSMENT
• Health history
• Alterations of the cardiopulmonary system
• Vital signs
• Blood pressure (lying, sitting, and standing)
• Respiratory rate
• Apical and peripheral pulses
• Inspection, palpation, and auscultation of the heart and lungs
• Peripheral vascular assessment
• Pulses, skin color and texture, and capillary refill
Copyright © 2020 by Elsevier Inc. All rights reserved
10
ASSESSMENT
• Laboratory and Diagnostic Tests
• Lipids
• Total cholesterol
• Low-density lipoprotein (LDL)
cholesterol
• High-density lipoprotein (HDL)
cholesterol
• Triglycerides
• Cardiac enzymes
• Chest X-ray
In Urden LD, Stacy KM, Lough ME: Critical care nursing, ed. 7, St.
Louis, 2014, Mosby. From Dettenmeier PA: Radiographic assessment
for nurses, St. Louis, 1995, Mosby.
Copyright © 2020 by Elsevier Inc. All rights reserved
11
ASSESSMENT
• Laboratory and Diagnostic Tests
• Electrocardiogram
• 12-leads
From Ignatavicius DD, Workman ML: Medical-surgical nursing:
Patient-centered collaborative care, ed. 9, St. Louis, 2018, Saunders
Copyright © 2020 by Elsevier Inc. All rights reserved
12
ASSESSMENT
• Laboratory and Diagnostic Tests
• Echocardiogram
• Cardiac Catheterization
From Lewis SL, Dirksen SR, Heitkemper MM, et al:
Medical-surgical nursing: Assessment and
management of clinical problems, ed. 8, St. Louis,
2011, Mosby.
Copyright © 2020 by Elsevier Inc. All rights reserved
13
LIFESPAN CONSIDERATIONS
• Heart rate decreases with age
• Blood pressure increases with age
• Irregularity in heart rate is common in infants and children, often changes based on
respiratory cycle
• Atherosclerosis: buildup of fatty plaques and is the primary contributor to
cardiovascular disease. Atherosclerosis tends to increase with age and lifestyle.
• Hypertension: affects the older population. If children or adolescents have
increased blood pressure, it is usually associated with lifestyle issues, such as obesity,
sedentary lifestyle, or stress
NON-MODIFIABLE RISK FACTORS
• Heredity:
• Parent with heart disease leads to higher risk
• Ethnicity:
• African Americans have higher risk
• Age:
• Primarily affects people > 60 y/o
• Gender:
• Until menopause, estrogen has a protective effect in women, slowing the
progression of atherosclerosis and reducing the risk of CVD.
• Postmenopausal women have the same risk for CVD as men.
MODIFIABLE RISK FACTORS
• Lab values:
• Elevated serum lipid levels
• Hypertension
• Increases workload of the heart, increasing oxygen demands and coronary
blood flow. Increased workload causes hypertrophy of ventricles.
• Causes endothelial damage to blood vessels resulting in atherosclerosis
• Lifestyle
• Smoking: causes peripheral vascular resistance, vasoconstriction, and increases
heart’s workload
• Obesity: places increased workload on heart, which increases oxygen demand.
• Sedentary Lifestyle
• Diseases
• Diabetes: accelerated development of atherosclerosis and high lipids and
triglycerides.
NON-TRADITIONAL RISK FACTORS
• Metabolic Syndrome
• Must have at least 3 of 5 risk factors
listed below to have metabolic
syndrome:
o Central obesity
o Increased triglycerides
o Hypercholesterolemia
o Hypertension
o Elevated fasting glucose level
ALTERATIONS IN CARDIOVASCULAR
FUNCTION
Decreased Cardiac Output:
Myocardial Infarction
Heart Failure
Cardiomyopathy
Very irregular or excessively
rapid or slow heart rates
• Congenital heart defects
•
•
•
•
HEART FAILURE
ATHEROSCLEROSIS
• Most common cause of
impaired blood flow to
organs and tissues.
• As vessels narrow and
become obstructed, distal
tissues receive less blood,
oxygen, and nutrients.
TISSUE ISCHEMIA
• Obstruction in blood flow can
lead to tissue ischemia (MI,
stroke, or gangrene)
• Peripheral vascular disease
leads to ischemia of distal
tissues (legs and feet).
• Gangrene and amputation
may result.
• S/S: decreased peripheral
pulses, pain or paresthesia,
pale skin, cool extremities,
decreased hair distribution
ANEMIA
Causes:
• RBC’s lost b/c of acute or
chronic bleeding
• Diet is deficient in iron or folic
acid
• Hemoglobin and RBCs are not
formed adequately
• RBC’s break down
Main S/S:
• Chronic fatigue
• Pallor
• Shortness of breath
• Hypotension
NURSING PROCESS: ASSESSMENT
• Diagnostic Studies
• Blood Tests: serum lipid level,
electrolytes, hemoglobin,
creatinine kinase (CK), &
troponin
• Hemodynamic Studies:
evaluates fluid status and
cardiovascular function and
completed in a cath lab
• Cardiac Monitoring
• EKG - recording of electrical
activity of the heart
NURSING PROCESS: DIAGNOSING &
PLANNING
• Diagnoses:
• Decreased cardiac output
• Activity intolerance
• Planning:
• Maintain or improve tissue perfusion
• Maintain or restore adequate cardiac output
NURSING PROCESS: IMPLEMENTATION
• Medications:
• Nitrates, calcium channel blockers, and ACE inhibitors reduce workload of heart
and prevent vasoconstriction
• Positive inotropic drugs (Digoxin) increase contractile strength of the heart
• Beta Blockers (propranolol) block sympathetic nervous system action and
decrease oxygen consumption
• Vasodilators
• Diuretics
CLIENT TEACHING
• Maintain regular physical activity at least 30 minutes 5 days/week
• Avoid exposure to cold
• Be familiar with CPR
• Reduce sodium, saturated fats, weight, & increase fiber in diet
• Do not smoke
• Drink alcohol in moderation
• Reduce stress and manage anger
• Manage diabetes and HTN; maintain glucose and BP
• Hormone replacement therapy for females after menopause
• Consider daily low dose aspirin therapy
IMPLEMENTATION AND EVALUATION
• Medications for cardiovascular diseases
• Hypertension: diuretics, angiotensin-converting enzyme (ACE) inhibitors,
angiotensin II receptor antagonists, beta-blockers, calcium channel blockers,
alpha 1 antagonists, alpha 2-agonists, and vasodilators
• Heart failure or edema: Diuretics
• Arrhythmias or heart failure: Antiarrhythmics
Copyright © 2020 by Elsevier Inc. All rights reserved
30
31
IMPLEMENTATION AND
EVALUATION
• Anticoagulant therapy
• Warfarin interferes with the synthesis of
clotting factors
• All other anticoagulants inhibit the activity
of clotting factors
• Antiembolism hose
• Promote venous blood return and to
prevent edema
• Sequential compression devices
• Reduce risk for lower extremity venous
stasis
Copyright © 2020 by Elsevier Inc. All rights reserved
IMPLEMENTATION AND EVALUATION
• Patient education
• Heart failure patient education
• Smoking cessation
• Immunizations
Copyright © 2020 by Elsevier Inc. All rights reserved
32