Chapter 36 Homework Have Them Present Their Information The Class

32 Chapter 36Cardiac Disorders ________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

Slide 58

Infective Endocarditis (cont.)

• Pathophysiology

• Pathogens, usually bacteria, enter the bloodstream by any of the previously

mentioned means

• The pathogen accumulates on the heart valves and/or the endocardium and forms

vegetations

Slide 59

Infective Endocarditis (cont.)

• Complications

• Heart failure and embolization

• Signs and symptoms

• Fever, chills, malaise, fatigue, and weight loss

• Chest or abdominal pain; may indicate embolization

• Petechiae inside the mouth and on the ankles, feet, and antecubital areas

Slide 60

Infective Endocarditis (cont.)

• Medical diagnosis

• History, physical examination, results of lab studies

• Echocardiography

• Serial blood cultures; elevated WBC

TALKING POINTS:

• A history of recent dental or surgical procedures may precede IE.

9

Slide 61

edema), and embolization

Infective Endocarditis (cont.)

• Assessment

• Review patient’s history for risk factors, recent invasive procedures, pathologic

cardiac conditions, and onset of symptoms

Slide 62

Infective Endocarditis (cont.)

• Interventions

• Administer prescribed antibiotics

• Assess cardiac output and monitor for complications

_______________________________________________________________ Chapter 36Cardiac Disorders 33

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

7

Slide 63

Pericarditis

• Cause and risk factors

• Inflammation of the pericardium

• May be primary disease or associated with another inflammatory process

• The disease may be acute or chronic

• Acute pericarditis caused by viruses, bacteria, fungi, chemotherapy, or AMI

(Dressler syndrome)

• Chronic pericarditis caused by tuberculosis, radiation, or metastases

Slide 64

Pericarditis (cont.)

• Pathophysiology

• In acute pericarditis, inflammatory process increases amount of pericardial fluid and

inflammation of the pericardial membranes

Slide 65

Pericarditis (cont.)

• Complications

• Pericardial effusion or accumulation of fluid in the pericardial space

• May lead to cardiac tamponade

• Signs and symptoms

• Chest pain

• Most severe on inspiration

Slide 66

Pericarditis (cont.)

• Medical diagnosis

• Serial ECGs

• Echocardiogram

• Creatine kinase-MB fraction (CK-MB)

• Blood cultures

• Medical treatment

TALKING POINTS:

• How can you differentiate the pain of pericarditis with that of angina?

34 Chapter 36Cardiac Disorders ________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

9

Slide 67

Pericarditis (cont.)

• Assessment

• Assessment of heart sounds especially important

• Interventions

• Rest and reduction of activity

7

Slide 68

Valvular Disease

• If valves damaged, blood no longer flows in one direction

• Stenosis is narrowing of the valve opening, limiting the amount of blood ejected from one

chamber to the next

Slide 69

Valvular Disease (cont.)

• Mitral stenosis: narrowing of the opening in the mitral valve that impedes blood flow from

the LA into the LV

• Mitral regurgitation: allows blood to flow back into the LA during diastole

• Mitral valve prolapse: one or both leaflets enlarges and protrudes into the LA during

systole

Electrocardiogram Monitoring

• 12-lead electrocardiogram

• Looks at heart from 12 directions or perspectives

TALKING POINTS:

• What cardiac events occur during the P wave, QRS complex, and the T wave?

_______________________________________________________________ Chapter 36Cardiac Disorders 35

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

9

Slide 71

Electrocardiogram Monitoring (cont.)

• Interpretation of electrocardiograms

• Heart’s electrical activity represented by deflections, positive and negative, from the

baseline

• P wave, QRS complex, and T wave

• Criteria for interpreting electrocardiograms

• Rate calculation

• Rhythm

TALKING POINTS:

Slide 72

Electrocardiogram Monitoring (cont.)

• Interpretation of electrocardiograms

• Normal sinus rhythm

• The most common cardiac rhythm is sinus in origin because the impulse

7

Slide 73

Hemodynamic Monitoring

• Central venous catheter

• Placed through the skin, into a venous access (brachial, femoral, subclavian, or

TALKING POINTS:

• The pressure in the RA (called right atrial pressure [RAP] or central venous pressure

[CVP]) can be measured.

• This measurement is used as an indication of fluid volume.

• What do measurements below normal indicate? Above normal?

36 Chapter 36Cardiac Disorders ________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

Slide 74

Hemodynamic Monitoring (cont.)

• Pulmonary artery catheter

• Swan-Ganz catheter

• Longer than the central venous catheter

• Inserted like the central venous catheter and is threaded through the RA, tricuspid

TALKING POINTS:

• The purpose of a pulmonary artery catheter is to measure right-sided heart pressures and

pulmonary artery pressures and to assess left-sided heart function.

• What is the normal pulmonary capillary wedge pressure?

Slide 75

Hemodynamic Monitoring (cont.)

• Arterial line

• Provides a direct measurement of systolic and diastolic blood pressures

TALKING POINTS:

Activities

Classroom Choose from below to make 30 minutes

Online

7

DISCUSS

• Discuss the cardiac transplant procedure.

Describe criteria for donors and recipients

• Discuss sudden cardiac death. Describe the

diagnostic testing required for patients who

survive sudden cardiac death.

• Discuss the procedure for an implantable

CREATE

• Ask students to prepare and record a video

of a nurse providing education on prevention

of atherosclerotic heart disease. Ask

students to post constructive comments on

each other’s videos.

_______________________________________________________________ Chapter 36Cardiac Disorders 37

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

7

PRACTICE

• Divide the class into three groups, and

assign each group one of the following

cardiac disorders: coronary artery disease

(CAD), acute myocardial infarction (AMI), or

congestive heart failure (CHF). Have each

group develop a presentation about the

disorder that includes the pathophysiology,

• Divide the class into several teams, and take

turns asking the teams quiz questions

regarding each cardiac disorder in this

lesson. Some example of questions might

be: What are the risk factors associated with

infective endocarditis? What are some

complications of cardiomyopathy? How is

sudden cardiac death treated? The team

with the most correct answers is the winner.

• Divide the class into groups, and present

each group with the following scenario: A

POST & COMMENT

• Post the following discussion topic online

and have students comment. Discuss

arteriosclerosis and atherosclerosis,

including the risk factors, signs and

symptoms, and medical treatment.

• Post the following discussion topic online

and have students comment. Discuss the

• Post the following discussion topic online

and have students comment. Discuss the

signs and symptoms of mitral and aortic

stenosis.

• Post the following discussion topic online

and have students comment. Discuss the

signs and symptoms of aortic regurgitation.

Describe the causes, heart sounds, and

medical treatment.

• Post the following discussion topic online

and have students comment. Discuss the

signs and symptoms of acute myocardial

38 Chapter 36Cardiac Disorders ________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 36.4

9

DISCUSS

• Present the image collection PPT slides with

various dysrhythmias and ask students to

identify various dysrhythmias

• Divide the class into groups, and assign

each group a nursing diagnosis from the

textbook that is associated with the

disorders from this lesson. Have each group

develop a list of nursing interventions with

rationales that would be used to meet the

goals. Then have the students discuss their

interventions and rationales with the class.

POST & COMMENT

• Post the following discussion topic online

and have students comment. List at least

five nursing interventions for a patient

experiencing myocardial infarction, heart

failure, infective endocarditis, and valve

disorders. Ask students to prioritize their

interventions. Ask students to post

constructive comments on each other’s

postings.

Critical Thinking Question

A 53-year-old man presents to the emergency department with severe chest pain that has

lasted for the past 2 hours, radiating down his left arm. The pain is unrelieved by sublingual

nitroglycerin given by paramedics en route to the hospital. The patient is overweight and

has a history of hypertension; he is a smoker and has a family history of heart disease. The

provider suspects that the patient is experiencing an acute myocardial infarction. What tests

will the provider likely order and what medications should the nurse be prepared to

administer?

Discussion Guidelines: The patient will be attached to a cardiac monitor to evaluate his heart’s

Instructor Notes/Student Feedback

_______________________________________________________________ Chapter 36Cardiac Disorders 39

Introduction to Medical-Surgical Nursing, 6th ed.

36

Assessments for

Cardiac Disorders

CHAPTER OBJECTIVES

Lesson 36.1:

2. Describe the flow of blood through the heart and coronary vessels.

4. State the order in which normal impulses are conducted through the heart.

Lesson 36.2:

5. Explain the nursing considerations for patients having procedures to detect or evaluate cardiac

disorders.

Lesson 36.3:

6. Identify nursing implications for common therapeutic measures, including drug, diet, or oxygen

therapy; pacemakers and cardioverters; cardiac surgery; and cardiopulmonary resuscitation.

Lesson 36.4:

7. Explain the pathophysiology, risk factors, signs and symptoms, complications, and treatment for

selected cardiac disorders.

Assessments by Lesson & Objective

Lesson 36.1

1

Study Guide

• Part IB: 9(p. 218)

• Part IF: 1-5 (p. 219)

• Part IIN: 1 (p. 221

Evolve Instructor Resources

• Test Bank 35

Evolve Student Resources

2

Study Guide

• Part IA: 15 (p. 218)

• Part IL: A-M (p. 221)

• Part IIN: 2 (p. 221)

3

Study Guide

• Part IB: 2, 6, 7, 11, 12 (p. 218)

• Part IM: A-E (p. 221)

Evolve Student Resources

• NCLEX Review: 10

40 Chapter 36Cardiac Disorders ________________________________________________________________

Introduction to Medical-Surgical Nursing, 6th ed.

Assessments by Lesson & Objective

4

Study Guide

• Part IA: 7, 12, (p. 217)

• Part IB: 3-5, 8, 14 (p. 218)

• Part IC: 1 (p. 218)

Evolve Instructor Resources

• Test Bank: 36, 40

Evolve Student Resources

• NCLEX Review: 9

5

Study Guide

Evolve Instructor Resources

• Test Bank: 5, 6, 16, 17, 18, 20, 21

Evolve Student Resources

• NCLEX Review: 3, 4, 5

• Prioritization: 5, 6

Lesson 36.3

6

Study Guide

• Part IIN: 31-35, 38-43, 46-47 (p. 224-225)

Evolve Instructor Resources

• Test Bank: 7, 8, 11, 22, 23, 24, 25, 29, 30, 31, 32

Open Book Quiz: 8, 10

Evolve Student Resources

• NCLEX Review: 2, 7, 8

• Prioritization: 1-4

Lesson 36.4

7

Study Guide

• Part IA: 3, 4, 6, 9, 13, 14 (p. 217-218)

• Part IB: 13 (p. 218)

• Part IH: 1-5 (p. 220)

Evolve Instructor Resources

• Test Bank: 2, 3, 4, 10, 12, 13, 38

• Open Book Quiz: 8, 10

Evolve Student Resources

• Prioritization: 7

_______________________________________________________________ Chapter 36Cardiac Disorders 41

Introduction to Medical-Surgical Nursing, 6th ed.

Assessments by Lesson & Objective

Lesson 36.2

8

Study Guide

• Part IA: 1, 2, 5, 10, 11 (p. 217)_

Evolve Instructor Resources

Lesson 36.4

9

Study Guide

• Part IA: 8 (p. 217)

• Part IJ: 1-3 (p. 220)

Evolve Instructor Resources

• Test Bank: 9, 15, 19, 26, 27, 28, 33, 34, 37

Evolve Student Resources

Instructor’s Notes/Student Feedback