2. This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance
Community CollegeandCareerTraining Grants, as implementedby the U.S. Department of Labor’s Employment and
Training Administration. Rogue Community Collegeis an equal opportunity employer/program. Auxiliary aids and
services, alternate form and language services are available to individuals with disabilities andlimitedEnglish proficiency
free of cost upon request.
This work is licensed under a Creative Commons Attribution 4.0 International License.
4. Hollow Organ
Four Chambers
◦ R & L atriums
◦ R&L ventricles
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9. One Way System
Asst w/ Fluid Balance
Fights Infection
Lymph Nodes
Empty into Lg. veins
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10. Coronary Artery Disease (CAD)
◦ Acute Coronary syndrome (ACS)
Angina
Myocardial Infarction (MI)
Cardiovascular System Conclusion:Takes food
and oxygen in, takes away waste. It seems so simple,
but as we've seen, it's really a complex task that
takes four body parts - the heart, blood vessels,
blood, and lymph vessels - all working together to do
this "simple" job, that keeps us alive.
11. Hearts blood supply
Arteries may narrow
Could eventually occlude
Risk Factors
Treatment:
◦ Stent
◦ CABG
22. SOB w/activity
Fatigue w/exertion
Cyanosis
Sudden Wt. gain
Edema
Vertigo
Diaphoresis
Confusion and memory lapses
23. Report to nurse
Accurate I&O
Daily weights as ordered
Low sodium diet restrictions
Fluid restrictions as ordered
Prevent fatigue
24. Abnormal Heart beat
Electrical Condition
May be life-threatening
Treatment depends on type
EKG/ECG:
◦ Electrical activity
of the heart
25. Sinus Rhythm: 60-100 per min. “normal”
Bradycardia: <60
◦ slow
Tachycardia: >100
◦ fast
26. Atrial Fibrillation
◦ Atria quivers
◦ At risk for block clots
Heart Block:
◦ Stimulus can’t get through
◦ Sx’s depend on level of block
27. Ventricular Tachycardia
◦ vents too fast
◦ Can’t fill all the way
Ventricular Fibrillation:
◦ vents quiver
Asystole:
◦ NO HEART BEAT
◦ Start CPR
41. Check BP x2 in both arms: Manual
Report to nurse STAT
Lie down/elevate feet
42. Discontinue saline lock (Does not have
fluids
running)https://www.youtube.com/watc
h?v=73tYvGurGE4
43. This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance
Community CollegeandCareerTraining Grants, as implementedby the U.S. Department of Labor’s Employment and
Training Administration. Rogue Community Collegeis an equal opportunity employer/program. Auxiliary aids and
services, alternate form and language services are available to individuals with disabilities andlimitedEnglish proficiency
free of cost upon request.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Editor's Notes
The cardiovascular system is composed of the heart and the network of arteries, veins, and capillaries that transport blood throughout the body. The average adult male has between 5 to 6 liters of blood or blood volume, while the average adult female has between 4 to 5 liters. The blood carries oxygen and essential nutrients to all of the living cells in the body, and also carries waste products from the tissues to the systems of the body through which they are eliminated.
Most of the blood is made up of a watery, protein-laden fluid called plasma. A little less than half of this blood volume is composed of red and white blood cells, and other solid elements called platelets
• Hollow, muscular organ about the size of a fist
• Lies to left of center chest, behind the sternum
• Four chambers:
R & L atriums (plural is atria)- upper
R & L ventricles- lower
• Four valves- help blood to flow in one direction
• Pumps blood to lungs and body
• Has internal pacemaker, in right atrium- causes contraction of heart muscle- Normal heart
beats 60-100 times per minute
• Carry blood to and from all the tissues in the body
Arteries- away from the heart with oxygenated blood
Veins- to the heart with deoxygenated blood
Arterioles- the smallest arteries
Capillaries- branch off the arterioles- where oxygen exchange happens
• Plasma is the liquid part
• Solid parts
Erythrocytes- red blood cells to carry oxygen
Leukocytes- white blood cells to fight infection
Thrombocytes- platelets to help blood clot
• A one-way, open-ended circulatory system of lymph fluid
• Helps keep bodily fluid levels in balance and defends the body against infections
• Clear lymph fluid moves through the tissues, to the lymph nodes, and then to the bloodstream
• Lymph nodes (masses of lymph tissue) clean the lymph fluid, removing bacteria
• All lymphatics empty into the large veins in the shoulder area, then return to the general
circulation
CAD is the most common type of CV disease and accounts for the majority of these deaths. Patient s w/CAD can be asymptomatic of develop chronic stable angina.
Unstable angina and MI are more serious manifestations of CAD and are termed ACS
Coronary Artery Disease (CAD)
• Coronary arteries supply blood to the heart
• Coronary arteries narrow as a result of atherosclerosis- (plaque build up in arteries)
• When coronary arteries become narrow, no blood can get through causing areas of heart
muscle to die (infarct: death of heart tissue due to lack of oxygen)
• Risk Factors for CAD: Smoking, obesity, hypertension, elevated cholesterol, lack of exercise,
stress, family history., sex/age of patient, race
• Cardiac Catheterization may be performed to diagnose or treat blockages (refer Care of the
Surgical Patient (Cardiac) regarding femoral dressing, etc)
• Coronary Bypass surgery is done- Sternal precautions post-op (refer Care of the Surgical
Patient (Cardiac) regarding Sternal Precautions)
Angina (Pectoris)
• Results from heart muscle being deprived of oxygen (O2)
• Blood flow to heart increases when need for O2 increases
• Exertion, stress and excitement increase heart’s need for oxygen. Narrow arteries (from fatty
deposits/plaque) prevent increased blood flow- may cause chest discomfort/pain or “angina”
Responsive Observations:
Often described as a tightness, pressure or discomfort in the chest complaints of
heartburn/indigestion
Some complaints of pain in chest, jaw, neck, back, between shoulder blades, or down
one or both arms-often with numbness
Dyspnea (difficulty breathing) is common
Nausea, diaphoresis (sweating), change in skin color- pale, grayish or bluish
Weakness
CNA Actions:
Report to nurse STAT
Obtain vital signs STAT, or as directed by nurse
Encourage person to stop activity and rest
Responsive Observations:
Often described as a tightness, pressure or discomfort in the chest complaints of
heartburn/indigestion
Some complaints of pain in chest, jaw, neck, back, between shoulder blades, or down
one or both arms-often with numbness
Dyspnea (difficulty breathing) is common
Nausea, diaphoresis (sweating), change in skin color- pale, grayish or bluish
Weakness
CNA Actions:
Report to nurse STAT
Obtain vital signs STAT, or as directed by nurse
Encourage person to stop activity and rest
Myocardial Infarction (MI)
• Heart Attack
• Can lead to cardiac arrest- no heart beat (asystole)
• Occurs when one or more of the coronary arteries become completely blocked preventing
blood from reaching areas of heart
• Lack of blood and oxygen causes the tissue to die
• Infarct refers to area of dead heart tissue
• Risk factors for MI: Excessive stress, smoking, high-fat diet, high LDL and low HDL, family
history of early MI, diabetes, hypertension, obesity, history of substance abuse, age, female
(menopause), sedentary lifestyle
Responsive Observations:
Uncomfortable pressure; fullness in chest; pain; squeezing feeling in the chest, under
the sternum/mid back, or arms
Pain is more extreme/intense/lasts longer than in angina
Shortness of breath (SOB), heartburn, nausea, vomiting
Anxiety or feeling of “doom”
Irregular heartbeat; high (or low) blood pressure
CNA Actions:
Report complaints of chest pain/jaw pain or chest discomfort to nurse STAT
Obtain vital signs STAT, or as directed by nurse
Stay with patient and call for help
Try to calm patient and relieve anxiety if possible
Limit patient’s physical activity as directed by nurse
Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.
The heart is not able to pump enough blood to meet all needs of the body
• Fluid backs up into the lungs and throughout the body
• Causes (can include):
hypertension, myocardial infarction (MI), coronary artery disease (CAD), abnormal
heart/valves/heart rhythm
recent or previous heart surgery
rheumatic fever, severe lung disease, infection of heart valves- endocarditis or
myocarditis
• Right-sided failure
Blood backs up in the venous system- feet/ankles and legs are swollen (peripheral
edema)
Edema can be “pitting”, leaving a temporary indentation in skin when pressed with finger
Urinary frequency, particularly at night
• Left-sided failure
From CHF- blood backs up in the lungs
Fluid leaks into the lungs causing congestion and coughing, shortness of breath, fatigue
Responsive Observations:
Shortness of breath with regular activities
Increased fatigue with exertion
Cyanosis, (Bluish color of the Skin) especially on ears and nose
Increased weight; sudden weight gain
Edema in legs, feet and ankles
Sitting in chair to sleep or with more pillows
Rapid and irregular heart rate
Vertigo (dizziness)
Diaphoresis (sweating)
Confusion and memory lapses
CNA Actions:
Report to nurse
Accurate I & O
Maintain diet restrictions (low salt)
Maintain fluid restrictions as ordered
Organize ADL activities to prevent fatigue
Daily weights per orders
Dysrhythmia
• An abnormal heart beat (or rhythm)- also called “arrhythmia”
• May be life-threatening and require immediate action
• Treatment depends on cause and type of dysrhythmia
• Definition of EKG: to obtain the pattern of electrical activity in the heart (electrocardiogram)
Tachycardia- rapid heart rate= tachyarrhythmia of more than 100
• Bradycardia- slow heart rate= brady arrhythmias of less than 60
• Atrial flutter- patient’s pulse can be regular
• Atrial fibrillation- the atria quiver- causes inadequate blood pumped to rest of body
• Heart Block- heart rate is very slow; life-threatening
• Ventricular tachycardia- ventricles beat too fast; life threatening
• Ventricular fibrillation- the ventricles quiver; lethal (there is NO blood being pumped at all)
• Asystole- no heart rate- person is in cardiac arrest
• Definition of EKG: to obtain the pattern of electrical activity in the heart (electrocardiogram)
Responsive Observations:
Palpitations (feels like skipped heart beats)
Complaints of pounding in chest
Dizziness or light-headed
Fainting, weakness or fatigue
Short of breath; chest discomfort
CNA Actions:
Report S/S to nurse promptly
If S/S severe (ie. . .pt. loses consciousness) call for help immediately and stay with
patient
Deep Vein Thrombosis (DVT)
• Development of a thrombus (blood clot) in the deep veins of the legs, pelvis or arms
• Blood pools in the legs
• Blood clots form in the veins
• Blocks circulation in the vein
-OR-
• Becomes an embolus (traveling blood clot)
Can break away and travel to lung
Pulmonary artery blocked
Can be fatal
Responsive Observations:
Swelling in leg
The leg may be larger in size than the other leg
Leg may feel warm or be red
Pain or tenderness on calf or thigh
Chest pain, shortness of breath and/or dyspnea (difficulty breathing)- Report
immediately!
CNA Actions:
Prevention: TEDs, SCDs (sequential compression devices- foot or calf pumps), rangeof-
motion after surgery and early ambulation as ordered
If deep vein thrombosis present- all activity under direction of nurse
Elevation of extremity if directed. Use bed controls vs pillow
Do not massage the leg
HTN Defined:
Persistent:
SBP > 140mmHg
DBP > 90mmHg
Current use of antihypertensive Rx’s
Primary or "essential” or idiopathic is elevated BP w/o an identified cause and accounts for 90-95%
Secondary (5%) – adrenal, renal Causes see Table 33-3 pg 742
BP relies on a balance btwn CO and PVR
Most essential HTN pts have increased PVR and normal CO
There is a direct relationship btwn htn and CVD, and a proportional increase in the risk of MI HF, stroke, and renal disease with higher BP.
1/3 adults have high BP
Additional 28% are at risk for developing hypertension+
An elevated SBP is a more important risk factor for developing htn than an elevated DBP in individuals older than 50
Confirm: take two resting BP readings, sitting in chair for 5 minutes
• Confirm elevated reading in contralateral arm
• Patients are treated for hypertension by their physician if BP is over 140/90
• Evaluation of “white coat hypertension:” this is a phenomenon in which patients exhibit
elevated blood pressure in a clinical setting but not in other settings. It is believed that this is
due to the anxiety some people experience during a clinic visit. Repeat BP in 15-20 minutes in
calm, quiet environment.
• Hypertension is the “Silent Killer”; often does not have symptoms, and if not treated, can
cause damage to organs.
• Can lead to stroke, heart attack, kidney failure and blindness
Common Causes of Hypertension:
Sleep apnea
Drug induced-related
Chronic kidney disease, Reno vascular disease
Primary aldosteronism
Cushing’s syndrome or steroid therapy (steroids prescribed for breathing)
Coarctation of aorta
Thyroid/parathyroid disease
Narrowed blood vessels (atherosclerosis)
Obesity; high salt/fat diet
Alcohol abuse
Smoking
Inactive lifestyle
Can occur in pregnancy
CNA Actions:
Report high blood pressure readings
Re-check BP in both arms, obtain resting BPs
Encourage pt. to follow special diet as ordered (NAS: no added salt)
Hypotension
• Low Blood Pressure
• Consistently lower than 90 mm Hg systolic and/or 60 mm Hg diastolic
• May be caused by weak or irregular heart rate, or anemia
• Lack of blood volume: dehydration or hemorrhage
• Medication may lower BP:
Pain medications, angina meds, anesthesia
Orthostatic Hypotension
• Sudden decrease in BP occurring when a pt. stands from sitting or lying position
Standing the body compensates for change in position by heart beating harder
Patient may feel lightheaded and faint from lack of oxygen to brain
May be caused by medication or aging
Allow time for adjustment of BP- stand patient up slowly
Responsive Observations:
Low BP readings, complaints of dizziness (vertigo) or syncope (fainting),
lightheadedness, blurred vision, nausea, diaphoresis
Rapid, shallow breathing
CNA Actions: (see Skills Checklist: how to take orthostatic BPs)
Check BP in opposite arm; recheck as ordered
Report abnormal findings to nurse
Elevate feet as ordered
Assist patient to lie down if dizzy