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1
Outline the structure and physiology of the cardiovascular system.
Concepts for Lecture
2. The heart is a hollow organ covered by the pericardium (double–
layered fibroserous membrane). The three layers of the heart are the
epicardium, myocardium, and endocardium. There are four hollow
from the atria to the ventricles and the ventricles to the great vessels,
but preventing backflow. Deoxygenated blood from the superior and
inferior vena cavae flows into the right atria, through the tricuspid
valve into the right ventricle, through the pulmonic valve into the
3. A closed system of blood vessels transports blood to the tissues and
returns it to the heart. The blood flows from the aorta into the arter-
ies, the arterioles, and into the capillaries. From the capillaries the
blood flows into venules and then veins, returning to the heart
C
HAPTER
51
CIRCULATION
S
UGGESTIONS FOR
C
LASSROOM
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CTIVITIES
•
Ask the students to review the chapter on the
cardiovascular system in their anatomy and phys-
iology textbooks.
• Review the RBC indices and other related
S
UGGESTIONS FOR
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LINICAL
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CTIVITIES
4. The blood consists of formed elements (blood cells) suspended in
fluid (plasma).
L
EARNING
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2
Identify major risk factors for the development of cardiovascular disease and
related health-promotion objectives from Healthy People 2020.
Concepts for Lecture
1. Factors influencing cardiovascular function include cardiac output
(amount of blood ejected from the heart each minute), stroke volume
L
EARNING
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UTCOME
3
Describe three major alterations in cardiovascular function.
1. Three major alterations in cardiovascular function are decreased
2. Cardiac output may be reduced by the following:
• Myocardial infarction (MI) reduces the effectiveness of muscle
contraction. Signs and symptoms of MI are variable and may in-
clude chest pain, substernal and/or radiating to the left arm and/or
jaw; nausea; shortness of breath; and diaphoresis.
• Heart failure may develop if the heart is unable to keep up with the
• Other diseases such as myocarditis and cardiomyopathy also can
• Very irregular or excessively rapid or slow heart rates can also
decrease cardiac output. With irregular or very rapid heart rates,
• Alterations in the structure of the heart can affect cardiac output.
Congenital heart defects result in abnormal blood flow and may
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UGGESTIONS FOR
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CTIVITIES
• Provide the students with examples of how
changes in stroke volume and rate can affect
cardiac output.
3. Impaired tissue perfusion is most often caused by atherosclerosis. As
vessels narrow and become obstructed, distal tissues receive less
blood, oxygen, and nutrients. Ischemia is a lack of blood supply due
to obstructed circulation. Any artery in the body may be affected by
atherosclerosis, although the effects are most often associated with
4.
Because most oxygen is transported to the tissues in combination with
hemoglobin, the problems of inadequate red blood cells (RBCs), low
hemoglobin levels, and abnormal hemoglobin structure can affect tissue
L
EARNING
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UTCOME
4
Outline the nursing management of a client with cardiovascular disease.
1. Nursing assessment of the cardiovascular system status includes a
history, physical examination, cardiac monitoring, and review of rel-
evant diagnostic data. A comprehensive nursing history should
include data regarding
• Current and past cardiovascular problems
• Family history of cardiovascular problems, such as high blood
pressure, increased cholesterol level, heart attack, and stroke
2. To examine the cardiovascular system, a nurse first evaluates blood
pressure in both arms (the results should be within 10 mmHg of each
other) and palpates peripheral pulses for their strength and equality.
CHAPTER 51 / Circulation 395
3. Much information about the cardiovascular system is obtained by
assessing the skin for color, temperature, hair distribution, lesions,
4. One noninvasive measure to assess for peripheral vascular disease is
the ankle/brachial index (ABI). The ABI determines arterial perfu-
sion in the feet and toes. The results can detect not only symptomat-
ic and asymptomatic peripheral vascular disease but also predict
5. Diagnostic studies may also be used as screening tools to identify
increased risk so that modifications can be made to reduce the risk of
6. Cardiac monitoring allows for continuous observation of the client’s
7. Hemodynamics is the study of the forces or pressures involved in
blood circulation. Hemodynamic studies or monitoring procedures
8. NANDA includes the following diagnostic labels for clients with
circulation problems:
• Ineffective Peripheral Tissue Perfusion: Decrease in blood circula-
9. When planning care, the nurse identifies nursing interventions that
will assist the client to achieve these broad goals:
10. Specific nursing activities can be selected to meet the client’s indi-
vidual needs. Examples of NIC interventions related to decreased
11. Implementations include promoting circulation, administration of
12.
Using the overall goals identified in the planning stage, the nurse collects
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5
Describe the critical nature of cardiopulmonary resuscitation.
Concepts for Lecture
1. Cardiopulmonary resuscitation (CPR) is a combination of oral resus-
citation and external cardiac massage that is intended to reestablish
cardiac function and circulation of blood.
A cardiac arrest is the cessation of cardiac function; the heart
stops beating. When it occurs, the heart no longer pumps blood to
L
EARNING
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UTCOME
6
Verbalize the steps used in applying a sequential compression device (SCD).
Concepts for Lecture
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 51–1: APPLYING A SEQUENTIAL COMPRESSION
DEVICE
Yes
No
1. Introduced self and verified client’s identity.
3. Gathered the appropriate equipment.
5. Provided for client privacy and draped the client appropriately.
6. Prepared the client.
a. Placed the client in the dorsal recumbent or semi-Fowler’s posi-
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Ensure that all students are currently certified in
CPR for health care providers, or provide certifi-
cation for all students.
• Invite an instructor in CPR to demonstrate the
use of an automated external defibrillator
(AED).
7. Applied the sequential compression sleeves:
8. Connected the sleeves to the control unit and adjusted the pressure as
needed.
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EARNING
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UTCOME
7
Recognize when it is appropriate to delegate aspects of applying a sequential
compression device to unlicensed assistive personnel.
Concepts for Lecture
1. Unlicensed assistive personnel (UAP) often remove and reapply the
SCD when performing hygiene care. The nurse should check that the
LEARNING OUTCOME
8
Demonstrate appropriate documentation and reporting when applying a
sequential compression device.
Concepts for Lecture
1. Record baseline assessment data and application of the SCD. Note
control unit settings. Assess and document skin integrity and neuro-