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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.3
Activities
Classroom Choose from below to make 30 minutes
Online
6
DISCUSS
• Discuss the various classes of cardiac
drugs, including glycosides, antianginals,
antidysrhythmics, and miscellaneous and
emergency drugs.
• Discuss diet therapy and special issues
related to sodium and potassium intake for
the patient with a cardiac disorder.
• Discuss nursing interventions for the patient
with a pacemaker.
PRACTICE
• Divide the class into small groups, and
assign each group a class of drugs used to
treat cardiac disorders. Have each group
use a drug reference to identify one
commonly used medication in that class of
drugs and the nursing considerations for
RESEARCH
• Ask students to conduct online research
regarding the monthly cost of selected
medications prescribed for cardiac
conditions and to post their findings.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to post a video portraying a nurse providing
22 Chapter 36Cardiac Disorders ________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.3
Critical Thinking Question
A 68-year-old woman has recently undergone cardiac surgery for repair of a defective heart
valve. She has a midline chest incision. The registered nurse identifies a nursing diagnosis
of Ineffective breathing patterns related to general anesthesia and pain. What nursing
interventions would be appropriate for this patient to meet the goals of adequate
oxygenation for this nursing diagnosis?
Discussion Guidelines: Nursing interventions that would be appropriate for this patient include
coughing and deep-breathing to promote expansion of the lungs, mobilize secretions, and prevent
Instructor Notes/Student Feedback
_______________________________________________________________ Chapter 36Cardiac Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.4
Textbook Objectives Covered
9. Assist in developing nursing care plans for patients with cardiac disorders.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying cardiac disorders, including:
• Anatomy and physiology of the heart
• Nursing assessment of cardiac function
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• afterload (p. 685)
• arteriosclerosis (p. 708)
• atherosclerosis (p. 708)
• dysrhythmia (p. 711)
• hemodynamics (p. 718)
• murmur (p. 688)
• preload (p. 685)
• regurgitation (p. 726)
• syncope (p. 686)
24 Chapter 36Cardiac Disorders ________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.4
Student Preparation
Assignments 2 hours
READ – Textbook (pp. 708-735)
REVIEW
• Figure 36-8: Electrocardiographic changes with myocardial infarction (p. 713)
• Figure 36-9: Intracoronary stent (p. 713)
• Figure 36-10: Coronary artery bypass graft surgery (p. 714)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8, 9, 10, 12, 13 (p. 736)
ANSWER – Study Guide
• Part IA: 3, 4, 6, 9, 13, 14 (pp. 217-218)
• Part IB: 13 (p. 218)
• Part IH: 1-5 (p. 220)
READ – Textbook (pp. 718-736)
REVIEW
• Nursing Care Plan 36-1 (p. 719)
• Figure 36-15: Relationship between the cardiac cycle and the heart sounds (p. 729)
• Table 36-8: Criteria for Electrocardiogram Interpretation (p. 730)
• Figures 36-16 through 36–23: Dysrhythmias (pp. 731-733)
ANSWER – Text
• Review Questions for the NCLEX Examination: 11, 14 (p. 736)
ANSWER – Study Guide
• Part IA: 8 (p. 217)
• Part IJ: 1-3 (p. 220)
_______________________________________________________________ Chapter 36Cardiac Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.4
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 30
Coronary Artery Disease (CAD)
• Arteriosclerosis
• Abnormal thickening, hardening, loss of elasticity of arterial walls
• Atherosclerosis
• Form of arteriosclerosis; inflammatory disease that begins with endothelial injury and
progresses to the complicated lesion seen in advanced stages of the disease process
• Progression of lesions
• Fatty streak
TALKING POINTS:
• How does arteriosclerosis occur?
• If plaque formation occurs slowly, collateral circulation may develop.
Slide 31
Coronary Artery Disease (CAD) (cont.)
• Risk factors
• Nonmodifiable
• Age, gender, heredity, and race
• Modifiable
• Increased serum lipids, high blood pressure, cigarette smoking (nicotine),
diabetes mellitus with elevated blood glucose, obesity, sedentary lifestyle
• Other factors
• Stress, sex hormones, birth control pills, excessive alcohol intake, high
homocysteine levels
TALKING POINTS:
• What is the focus of patient education in reducing the risk factors for CAD?
• Healthy People 2020 has set several goals related to serum lipid levels; one of these is to
reduce the mean total blood cholesterol in adults to 177.9 mg/dL.
Slide 32
Angina Pectoris
• The most common symptom of CAD
• Demand for oxygen by myocardial cells exceeds supply
• Stable angina
• Occurs with exercise or activity and usually subsides with rest
• Unstable angina
• Variant angina
• Caused by coronary artery spasm; may not be associated with CAD
• Unpredictable and often occurs at rest
TALKING POINTS:
• What factors may precipitate angina?
26 Chapter 36Cardiac Disorders ________________________________________________________________
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LESSON 36.4
Slide 33
Angina Pectoris (cont.)
• Medical treatment
• Initial therapy for patients with angina
• A—Aspirin and antianginal therapy, ACE inhibitor
• B—Beta-blocker and blood pressure
Slide 34
Acute Myocardial Infarction (AMI)
• Risk factors for AMI
• Obesity, smoking, a high-fat diet, hypertension, family history, male gender, diabetes
mellitus, physical inactivity, and excessive stress
Slide 35
Acute Myocardial Infarction (cont.)
• Pathophysiology
• Begins with occlusion of a coronary artery
• Over 4 to 6 hours, ischemia, injury, infarction develop
• Ischemia results from a lack of blood and oxygen to a portion of the heart muscle
• If ischemia is not reversed, injury occurs
TALKING POINTS:
• Within 24 hours after an infarction, the healing process begins.
• By the third day, necrotic tissue has been broken down by enzymes and removed by
macrophages.
• Collateral circulation develops to supply the injured area, and scar tissue begins to form.
Slide 36
Acute Myocardial Infarction (cont.)
• Complications
• Dysrhythmias, heart failure, cardiogenic shock, thromboembolism, sudden cardiac
death, and ventricular aneurysm/rupture
• Signs and symptoms
TALKING POINTS:
• The pain may begin with or without exertion.
• How may the symptoms in women, older adults, and patients with diabetes differ from
those in other patients?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.4
Slide 37
Acute Myocardial Infarction (cont.)
• Medical diagnosis
• History and the physical signs and symptoms
• Laboratory evidence and ECG changes
• Cardiac markers
• Troponin, myoglobin, and cardiac enzymes
• Electrocardiogram
TALKING POINTS:
• Sublingual or intravenous NTG is administered to dilate coronary arteries and increase
blood flow to the damaged area.
• Oxygen is administered at 4 to 6 L/min to assist in oxygenating myocardial tissue to
support pumping activity and for repairing damaged tissue.
• Fibrinolytic therapy is recommended for patients with total occlusion.
• Beta-adrenergic blockers improve survival rates by decreasing the heart rate, reducing
the work of the heart, and lessening the oxygen demand of the myocardium.
• Why is percutaneous coronary intervention (PTI) preferred over bypass surgery?
Slide 38
Acute Myocardial Infarction (cont.)
• Medical treatment
• Drug therapy
• Sublingual or intravenous nitroglycerin
• Morphine or Demerol
• Oxygen
• Laser angioplasty
• Radiation therapy
• Coronary artery bypass graft surgery
Slide 39
Acute Myocardial Infarction (cont.)
• Assessment
• Ask patient to describe the pain, including type, location, duration, and severity
• Interventions
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LESSON 36.4
Slide 40
Heart Failure (HF)
• Cause and risk factors
• Two types
• Disorders that increase the workload of the heart
• Disorders that interfere with heart’s pumping ability
TALKING POINTS:
• Approximately 4.9 million Americans have heart failure and more than half a million new
cases of heart failure are diagnosed every year.
• How frequently does heart failure occur after age 65?
Slide 41
Heart Failure (cont.)
• Pathophysiology
• The LV, RV, or both fail as pumps
• Usually left side of heart fails first; right side fails as a result of the left-sided failure
• Compensation
TALKING POINTS:
• Heart failure can be classified as systolic HF resulting from ineffective pumping of the
ventricles or as diastolic HF resulting from impaired filling of the ventricles.
• Compensation occurs through what three mechanisms?
Heart Failure: Signs and Symptoms
• Left-sided heart failure
Slide 43
Heart Failure: Signs and Symptoms (cont.)
• Right-sided heart failure
• Increased central venous pressure, jugular venous distention, abdominal
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 36.4
Slide 44
Heart Failure
• Medical diagnosis
• History, physical examination, radiographs, and laboratory test results
TALKING POINTS:
• A chest radiograph may reveal hazy lung fields, distended vasculature, and cardiomegaly.
• Laboratory tests indicative of HF are decreased serum sodium and hematocrit from
Slide 45
Heart Failure (cont.)
• Medical treatment
• Treatment of underlying problem
• Drug therapy
• ACE inhibitors, diuretics, beta-adrenergic blockers, inotropic agents, cardiac
glycosides, and nitrates. In addition, certain patients will benefit from B-type
natriuretic peptide
• Intraaortic balloon pump (IABP)
TALKING POINTS:
• The intraaortic balloon pump (IABP) is a temporary device used in the intensive care unit
to increase cardiac output and coronary artery perfusion.
Slide 46
Heart Failure (cont.)
• Assessment
• Heart sounds, rate, and rhythm
• Jugular vein distention
• Baseline respiratory assessment of rate, rhythm, and breath sounds is vital
Slide 47
Heart Failure (cont.)
• Interventions
• Decreased cardiac output
• Impaired gas exchange
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LESSON 36.4
Slide 48
Cardiomyopathy (CMP)
• Disease of the heart muscle
• Cause often unknown; may be secondary to another disease process
• Usually leads to heart failure
• Three types: dilated, hypertrophic, and restrictive
Slide 49
Cardiomyopathy (cont.)
• Pathophysiology
• Dilated cardiomyopathy: dilation of the ventricle and severely impaired systolic
function
TALKING POINTS:
• What chamber of the heart is most affected by cardiomyopathy?
Slide 50
Cardiomyopathy (cont.)
• Signs and symptoms
• Dilated cardiomyopathy: dyspnea, fatigue, left-sided heart failure, and moderate to
severe cardiomegaly
Slide 51
Cardiomyopathy (cont.)
• Medical diagnosis
• Echocardiography
• Chest radiography
TALKING POINTS:
Slide 52
Cardiomyopathy (cont.)
• Medical treatment
• Dilated cardiomyopathy: positive inotropic drugs, diuretics, ACE inhibitors and
vasodilators; heart transplant
_______________________________________________________________ Chapter 36Cardiac Disorders 31
LESSON 36.4
Slide 53
• Guide the patient to make lifestyle changes
Cardiomyopathy (cont.)
• Assessment
• Primarily for heart failure
• Be alert for dyspnea, cough, edema, dysrhythmias, and decreased cardiac output
• Interventions
• Similar to that of patients with HF
Cardiac Transplantation
• The first heart transplantation was performed in 1967 in South Africa by Dr. Christiaan
Barnard
Slide 55
Cardiac Transplantation (cont.)
• Donor and recipient organs carefully matched
• Recipient must be free of infection at the time of transplantation
• Patient prepped as any open-heart procedure
• Cardiopulmonary bypass initiated; recipient’s heart is removed except for the posterior
portions of the atria
• Donor heart trimmed and anastomosed to the remaining native heart
• Patient removed from bypass, heart restarted, and chest is closed
Slide 56
Cardiac Transplantation (cont.)
• Aftercare similar to that of coronary artery bypass surgery
• Hemodynamic monitoring, ventilation, cardiac assessment, care of chest tubes, and
accurate intake and output measurements are vital
• Modified protective isolation used
Slide 57
Infective Endocarditis (IE)
• Cause and risk factors
• Primarily affect the valves
• Incidence has decreased with the use of antibiotics, but there has been a resurgence
of the problem in intravenous drug abusers
• Patients with valvular disease also at risk
TALKING POINTS:
• Organisms present in the blood easily colonize valves damaged by rheumatic heart