OUR LADY OF GUADALUPE COLLEGES

COLLEGE OF NURSING
NCM 118: Medical-Surgical Nursing
Lecture – Prelim
CARDIOVASCULAR SYSTEM

● ↑Pericardial fluids → Pericardial effusion – a fluid

CARDIOVASCULAR SYSTEM >20mL → Can lead to cardiac tamponade
● Delivers oxygen
● Eliminate waste products
CARDIAC TAMPONADE
● Helps in metabolism
● Parts: Heart, Blood Vessels, Blood
A medical emergency that takes place when abnormal
amounts of fluid accumulate in the pericardial sac
HEART
compressing the heart and leading to a decrease in
● Pumping station of the body cardiac output and shock.
● Size of a fist
● Location: 2nd rib, 5th ICS, Midclavicular Line, Inferior
Mediastinum
● Layers: Epicardium, Myocardium, Endocardium
● Covering: Pericardium

Layers of the Heart

Epicardium
● Outermost layer
● Epicarditis

Myocardium
● Middle layer
● Contracting part Signs and Symptoms (BECK’S TRIAD)
● Myocarditis – most dangerous, because this layer is ● Narrowed pulse pressure (hypotension)
responsible for contraction. !EMERGENCY ○ Pulsus Paradoxus – decrease of >10 mm Hg
○ S/sx: Fatigue systolic blood pressure during inspiration.
● Distended jugular vein
Endocardium ● Muffled heart sound
● Inner most part
● Endocarditis Cause
● Trauma
PANCARDITIS
Inflammation of all layers of the heart Management
● Pericardiocentesis – puncture of the pericardial sac
to aspirate pericardial fluid
Pericardium
● Covering of the heart
● Contains pericardial fluid (5-20mL) – to decrease VALVES OF THE HEART
friction for the beating heart and to prevent friction rub ● Promotes unilateral flow and prevent backflow of
blood.
PERICARDITIS ● Atrioventricular Valve – Tricuspid (right) and Mitral
● Inflammation of the pericardium (left) valve
● Semilunar Valve – Pulmonary and Aortic valve
Causes:
● Viral/Bacterial Infecion CHAMBERS OF THE HEART
● Surgery (e.g., coronary artery bypass graft (CABG), ● 4 Chambers
percutaneous transluminal coronary angioplasty ● RA, RV, LA, LV
(PTCA)
● Lung Metastasis
Cardiac Output – amount of blood pumped by the heart in
Signs and Symptoms one full minute
● Chest pain that radiates at the back – the reason why HR x SV = CO
it radiates at the back is because the pericardium
covers the heart from front to back 4-6L of blood is pumped per minute
● Friction Rub – grating or scratching in the left sternal SV — amount of blood pumped per beat (average resting
border SV=60-130mL)

Christian Jay Calisagan

BSN 4-1 1
 BLOOD FLOW IN THE HEART BLOOD SUPPLY OF THE HEART
Deoxygenated blood from the upper part of the body enters
Aorta
the SVC and then to the right atrium; Deoxygenated blood
↓
from the lower part of the body enters the IVC and then to
Coronary Artery (Left and Right)
the right atrium
↓
↓
Right Coronary Artery → Right side and Back part of the heart
Tricuspid Valve
↓
↓
Left Coronary Artery → Left Anterior Descending Artery and
Right Ventricle
Circumflex Artery
↓
Pulmonary Valve
↓ LEFT ANTERIOR DESCENDING ARTERY
Pulmonary Artery Common site of Coronary Artery Disease (CAD)
↓
Lungs (Gas Exchange)
↓ CORONARY ARTERY DISEASE
Pulmonary Vein (now oxygenated) ● Build up of plaque (atheroma/fat deposit) in the
↓ arteries that supplies blood to the heart (coronary
Left Atrium artery)
↓ ● Atherosclerosis – build up of plaque in the artery –
Mitral Valve this fat can be diluted through exercise
↓
Left Ventricle
↓
Aortic Valve
↓
Aorta
↓
Oxygenated blood will be delivers all over the body

Ventricular Filling – filling of blood in the ventricles (occurs

during diastole) Complications
1. Angina Pectoris
2. Myocardial Infarction
HEART SOUNDS
● Closure of the AV valves Risk Factors
S1 Sound “Lub” ● Ventricular SYSTOLE (contract) ● Familial History (Genetics)
● Alcohol
● Closure of the SL valves ● Cigarette Smoking – cigarettes contrains nicotine that
S2 Sound “Dub” ● Ventricular DIASTOLE (relax) has a vasopressin effect (narrowing of blood vessels)
● Type B Personality – Hyperactive people, people that
● Ventricular Gallop easily gets panic
S3 Sound “Dee” ● Indicator of CHF ● Obesity
● Race – common in african americans
● Atrial Gallop ● Sedentary Lifestyle – can lead to hyperlipidemia
S4 Sound ● Indicator of Hypertension
TYPE B PERSONALITY
PROPERTIES OF THE HEART These are people that are hyperactive. When a person is
● Ability to maintain rhythm hyperactive, their adrenal medulla releases catecholamines
(epinephrine and norepinephrine) – these emergency
hormones has a vasocontriction effect.

RHYTHMICITY HYPERLIPIDEMIA

Normal LDL = <130 mg/dl

Normal HDL
● Male = 35-65 mg/dl
EXCITABILITY ● Ability to respond to impulse ● Female 35-85 mg/dl
CONDUCTABILITY ● Ability to transmit electrical impulses
CONTRACTABILITY ● Ability to contract Female, naturally, has higher levels of fats
AUTOMATICITY ● Ability to initiate/generate impulse

Christian Jay Calisagan

BSN 4-1 2
 Total Cholesterol should be <200 mg/dl, if it is higher ● If the pain is not relieved after the 3rd dose, do not
than 200, a client is at high risk of CAD give another dose – the patient already has met the
maximum effect
● Administer the drug in reclining or sitting position to
ANGINA PECTORIS ensure safety – the patient is at risk for fall
● Chest pain that is brought about by myocardial (headache and hypotension)
ischemia ● Avoid alcohol while taking this drug
● When oxygen supply is insufficient, cells switch to ● If given topically (NTG patch), the nurse should
anaerobic metabolism, resulting in the production of wear gloves
lactic acid as a byproduct. This buildup of lactic acid
contributes to the discomfort and pain characteristic of
angina episodes. 2. Unstable Angina (Preimfarction or Crescendo Angina)
● Chest pain more than 15 minutes
Types of Angina ● Not relieved by RON (Rest, Oxygen, Nitroglycerin)
1. Stable Angina (Predictable or Exerction Angina) ● DOC: Morphine Sulfate
● predictable and consistent pain that occurs on ● Risk for: Acute Coronary Syndrome (95% occlusion of
exertion and is relieved by rest and/or nitroglycerin the artery that can lead to MI)

Risk Factors Pattern

1. Exercise (Sex) CAD
2. Eating Heavy Meal ↓
3. Extreme Emotion Ischemia (Angina Pectoris)
↓
Signs and Symptoms ACS
● Chest pain that stay for 5-10 minutes ↓
MI
Management
● Rest 3. Silent Angina (Prinzmetal Angina)
● Oxygen (1-2 lpm) ● (-) Chest pain
● Nitroglycerine – a potent vasodilator (in a large dose it
can dilate artery) Management
● 24-hour Holter Monitoring (24-hour Ambulatory ECG)
○ NI: Take a bath before application of the
SEXUAL ACTIVITY machine.
A patient asked, “I have a heart disease, can I still have sex
with my wife?” Other Management for Angina Pectoris
1. Beta Blockers - ↓ Heart rate → ↓ Cardiac Workload
Answer: → ↓ O2 Demand
For a patient who have recently sufferd from MI, they should
wait at least 6-8 weeks. Sexual activity is best in the 2. Calcium-Channel Blockers
morning because the BP is low (came from sleep). A client ● Nicardipine, Amplodipine, Nifedipine, Felodipine
also should not have sex after a heavy meal because the ● Dilates blood vessels → ↓heart rate → ↓ Cardiac
stomach is distended – this will lead to the heart pumping demand
more forcefully
MYOCARDIAL INFARCTION
● (+) Irreversible necrosis in the heart
NITROGLYCERINE ADMINISTRATION
● Given sublingual – there is increased absorption because Signs and Symptoms
there is presence of blood vessels in the soft the frenulum ● Chest pain (squeezing, crushing)
● Feeling of impending doom
Effectiveness ● Pain radiating in the left arm, neck, and jaw
● If pain is relieved or decreased pain
Diagnostic Tests
Freshness Indicator ● ECG
● There is burning sensation under the tongue ○ Zone of Ischemia – Inverted T Wave
○ Zone of Injury – ST Segment Elevation
Side Effects ○ Zone of Necrosis – Pathologic Q Wave
● Cephalgia (Headache) ● LDH (Lipid) – <130 mg/dL
● Hypotension ● Troponin Level – elevated 3hrs to 7-10 days after MI
● Myglobin – elevated 2-7hrs after MI
Nursing Intervention ● CBC – ↑WBC, ↑CK-MB (6hrs from the onset of pain -
● Administer the drug with 5 minutes interval for 3 2 days)
doses

Christian Jay Calisagan

BSN 4-1 3
 ● Thrombolytic – dissolves clot (clot buster)
○ Streptokinase, Eurokinase, Tissue
Plasminogen Activator (TPA)

Other Management for Myocardial Infarction

● Beta-blockers
● Calcium-channel blockers

CONGESTIVE HEART FAILURE

● Decreased pumping ability of the heart

TYPES OF CHF
Signs and Symptoms (Systemic)
● Bipedal Edema
RIGHT-SIDED
● Weight Gain
HF
● Jugular Vein Distention (JVD)
● Ascites
● First to be impaired
● Most common

Signs and Symptoms (Pulmonary)

● Non-productive cough
● Pink frothy sputum – there presence of
Management fluids in the alveoli, when the client
● Morphine Sulfate (Narcotic Analgesic cough, there may be small amount of
○ Given to promotes peripheral vasodilation to LEFT-SIDED blood
decrease the workload of the heart – BEST HF ● Pulmonary edema
○ Relieve of Pain ● Orthopnea
○ Relieve Anxiety ● Bilateral lung fine crackles
● Antidote: Naloxone (Narcan) ● Cyanosis (late sign- – respiratory
● NI: Check RR before administration (if less than 12, distress
hold the medication, assess the pt, and report to the
physician) Management
● Oxygen Therapy ● Intubation (ET)
● Antiplatelet – to prevent platelet aggregation to ● Ready suction
prevent further thrombus formation
○ Aspirin, Clopidogrel, Ticlopidine
● Anticoagulant – to prevent coagulation process
○ Heparin, Warfarin

HEPARIN
● Given subcutaneously
● Yes to pregnant women

Nursing Interventions
● Monitor PTT (Normal Partial Thromboplastin Time:
22-35 seconds)

Antidote – Protamine Sulfate

WARFARIN
● Given per orem
● No to pregnant women – can lead to craniofacial
malformation of the baby

Nursing Interventions Management for CHF

● Monitor PT (Normal Prothrombin Time: 11-12 ● Diet – LSLF
seconds) ● Limit OFI – 1L a day (divided into 200mL)
● Digoxin (Lanoxin)
Antidote – Vitamin K ● Diuretics – Furosemide (Lasix)

Christian Jay Calisagan

BSN 4-1 4
 DIGOXIN (LANOXIN)

Positive Inotropic – ↑ force of contraction

Negative Chronotropic – ↓HR

Nursing Intervention
● Check HR before administration

Digitalis Toxicity
● Normal Serum Value: 0.5-2 nanogram/dL
○ Digoxin has narrow therapeutic index

Signs and Symptoms (Digitalis Toxicity)

● Visual Disturbances (xanthopsia)
● GI Distrubances (constipation)
● Hypokalemia

Antidote – Digitalis Immune Fab (Digibind)

FUROSEMIDE (LASIX)
● Given per orem

Signs of Toxicity
● Ototoxicity (Tinnitus)
○ Rationale: The ear has fluids in the endolymph
and perilypmh. Administration of furosemide
can reduce this and can lead to dryness.
● Potassium-Wasting – Hypokalemia

NOTE!
Digoxin and Furosemide can be given simultaneously. Both
drugs can cause hypokalemia but this decrease in serum
potassium is associated with Digitalis Toxicity. Administer
DG bind

Christian Jay Calisagan

BSN 4-1 5