Cardiovascular Care Made Incredibly Easy

368 Pages·2014·23.001 MB·English

by  Mary Ann McLaughlin MSN RN

Cardiovascular Care
m ade
Incredibly
Easy!
Clinical Editor
Mary Ann Siciliano McLaughlin, MSN, RN
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Staff Care has been taken to confirm the accuracy of the
information presented and to describe generally
accepted practices. However, the authors, editors, and
Senior Acquisitions Editor publisher are not responsible for errors or omissions or
for any consequences from application of the informa-
Shannon Magee
tion in this book and make no warranty, expressed or
Product Manager implied, with respect to the currency, completeness, or
accuracy of the contents of the publication. Application
Ashley Fischer
of the information in a particular situation remains the
professional responsibility of the practitioner.
Senior Production Project Manager
Cynthia Rudy The authors, editors, and publisher have exerted every
effort to ensure that drug selection and dosage set forth
Manufacturing Manager in this text are in accordance with current recommenda-
Kathleen Brown tions and practice at the time of publication. However,
in view of ongoing research, changes in government
Marketing Manager regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader
Mark Wiragh
is urged to check the package insert for each drug for
Design Coordinator any change in indications and dosage and for added
warnings and precautions. This is particularly important
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when the recommended agent is a new or infrequently
Production Service employed drug.
Absolute Service, Inc. Some drugs and medical devices presented in the
publication have Food and Drug Administration (FDA)
clearance for limited use in restricted research settings.
Third Edition It is the responsibility of the health care provider to
ascertain the FDA status of each drug or device planned
for use in their clinical practice.
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tomer service department at [phone] or fax orders
Second Edition © 2009 by Wolters Kluwer Health | to [phone]. International customers should call
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permission from the copyright owner, except for brief
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Materials appearing in this book prepared by individuals Library of Congress Cataloging-in-Publication Data
as part of their official duties as U.S. government McLaughlin, Mary Ann Siciliano, 1968- author.
employees are not covered by the above-mentioned Cardiovascular care made incredibly easy /
copyright. To request permission, please contact Mary Ann Siciliano McLaughlin. — Third edition.
p. ; cm.
Lippincott Williams & Wilkins at Two Commerce Square,
Preceded by: Cardiovascular care made incredibly
2001 Market Street, Philadelphia, PA 19103, via email at
easy. 2nd ed. c2009.
[email protected], or via our website at lww.com Includes bibliographical references and index.
(products and services). ISBN 978-1-4511-8884-4 (paperback)
I. Cardiovascular care made incredibly easy.
Printed in China Preceded by (work): II. Title.
[DNLM: 1. Cardiovascular Diseases—nursing.
WY 152.5]
RC674
616.1'20231—dc23
2013043524
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Contents
Contributors and consultants iv
Not another boring foreword v
1 Anatomy and physiology 1
2 Assessment 17
3 Prevention and risk reduction 41
4 Diagnostic tests and procedures 54
5 Treatments 95
6 Arrhythmias 141
7 Inflammatory and valvular disorders 224
8 Degenerative disorders 248
9 Vascular disorders 282
10 Emergencies and complications 303
Appendices and index
Practice makes perfect 327
Selected references 352
Index 355
iii
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Contributors and consultants
Helen Ballestas, PhD, ANP-BC, RN Angela M. Kelly, RNC, DNP, APN Shafeah M. Morrison, APN, FNP-BC
Assistant Professor Assistant Clinical Professor Nursing Faculty
Adelphi University Rutgers University Family Practitioner
Garden City, N.Y. Camden, N.J. Rutgers School of Nursing
CEO Women’s Healthcare Nurse Practitioner Stratford, N.J.
Nurse Practitioners in Adult Health Cumberland Obstetrics & Gynecology
Services, PLLC Vineland, N.J. Susan Sample, MSN, CRNP, MBA
Mineola, N.Y. Service Line Administrator
Colleen Lad, RN, MSN, PCCN Cardiovascular Services
Margaret T. Bowers, RN, DNP, FNP, AACC Clinical Education Specialist St. Mary Medical Center
Assistant Professor Intermediate Care Units Langhorne, Pa.
Nurse Practitioner Saint Luke’s Health System
Duke University School of Nursing Kansas City, Mo. Rita M. Tassinari, MSN, RN
Durham, N.C. Simulation Coordinator
Theresa M. Leonard, RN, BSN, CCRN Education Department
Fiona S. Johnson, RN, MSN, CCRN PCI Data Manager Berkshire Health Systems
Clinical Education Consultant Decision Support Services Pittsfield, Ma.
Clinical Education Stony Brook Medicine
Memorial Health University Medical Stony Brook, N.Y.
Center
Savannah, Ga. Mary Ann Siciliano McLaughlin, MSN, RN
Nursing Faculty
Rutgers School of Nursing
Stratford, N.J.
iv
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Not another boring foreword
If you’re like me, you’re too busy to wade through a foreword that uses pretentious
terms and umpteen dull paragraphs to get to the point. So let’s cut right to the chase!
Here’s why this book is so terrific:
It will teach you all the important things you need to know about cardiovascular
care. (And it will leave out all the fluff that wastes your time.)
It will help you remember what you’ve learned.
It will make you smile as it enhances your knowledge and skills.
Don’t believe me? Try these recurring logos on for size:
Advice from the experts—tips and tricks from other cardiovascular care nurses on
how to best perform cardiovascular care
Peak technique—clear, concise explanations about the best ways to perform cardio-
vascular procedures
Now I get it!—simplified explanations of difficult concepts related to the cardiovas-
cular system
No place like home—key information about adapting care to a home environment
Memory joggers—acronyms and other mnemonics that aid recall of important
information.
See? I told you! And that’s not all. Look for me and my friends in the margins
throughout this book. We’ll be there to explain key concepts, provide important care
reminders, and offer reassurance. Oh, and if you don’t mind, we’ll be spicing up the
pages with a bit of humor along the way to teach and entertain in a way that no other
resource can.
I hope you find this book helpful. Best of luck
throughout your career!
Nurse Joy
v
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1
AAnnaattoommyy aanndd pphhyyssiioollooggyy
JJuusstt tthhee ffaaccttss
In this chapter, you’ll learn:
♦ components of the heart
♦ the way in which the heart contracts
♦ the heart’s role in blood flow.
A look at the cardiovascular system
The cardiovascular
system is a complex
network that helps
The cardiovascular system (sometimes called the circulatory
sustain life.
system) consists of the heart, blood vessels, and lymphatics. This
network brings life-sustaining oxygen and nutrients to the body’s
cells, removes metabolic waste products, and carries hormones
from one part of the body to another.
Right to the lungs…and left to the body
The heart consists of two separate pumps: The right side pumps
the blood to the lungs, and the left side pumps the blood to the
rest of the body.
Where the heart lies
About the size of a closed fist, the heart lies beneath the sternum
in the mediastinum (the cavity between the lungs), between the
second and sixth ribs. In most people, the heart rests obliquely
or tilted, with its right side below and almost in front of the left.
Because of its oblique angle, the heart’s broad part (base) is at
its upper right, and its pointed end (apex) is at its lower left. The
apex, also called the PMI or point of maximal impulse, is where
heart sounds can be heard the loudest.
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ANATOMY AND PHYSIOLOGY
2
Heart structure
Surrounded by a sac called the pericardium, the heart has a
wall made up of three layers: the endocardium (endo = inner),
the myocardium (myo = middle), and the epicardium (epi = outer).
Within the heart lie four chambers (two atria, a right side and a
left side, and two ventricles, also a right side and a left side) and
four valves (two atrioventricular [AV] and two semilunar valves).
(See Inside the heart.)
Inside the heart
Branches of right
pulmonary artery
Aortic arch
Superior vena cava
Pulmonary Branches of left
semilunar valve pulmonary artery
Right atrium Left atrium
Right pulmonary
veins Left pulmonary
veins
Tricuspid valve Aortic semilunar
valve
Chordae tendineae Mitral valve
Right ventricle Left ventricle
Interventricular
Papillary muscle muscle
Myocardium
Inferior vena cava
Descending aorta
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HEART STRUCTURE
3
The pericardium
The pericardium is a fibroserous sac that surrounds the heart
and the roots of the great vessels (those vessels that enter and
leave the heart). It consists of the fibrous pericardium and the
serous pericardium.
Fibrous fits freely
The fibrous pericardium, composed of tough, white fibrous tissue,
fits loosely around the heart, protecting it.
Serous is smooth
The serous pericardium, the thin, smooth inner portion, has two
layers:
(cid:129) The parietal layer lines the inside of the fibrous pericardium.
(cid:129) The visceral layer adheres to the surface of the heart.
And fluid in between
Between the fibrous and serous pericardium is the pericardial
space. This space contains pericardial fluid, which lubricates the
surfaces of the space and allows the heart to move easily during
contraction.
Sure, I have a wall
up, but my myocardial
layer helps me to
The wall contract.
The wall of the heart consists of three layers:
The epicardium, the outer layer (and the visceral layer of the
serous pericardium), is made up of squamous epithelial cells
overlying connective tissue.
The myocardium, the middle layer, forms most of the
heart wall. It has striated muscle fibers that cause the heart
to contract.
The endocardium, the heart’s inner layer, consists of endothelial
tissue with small blood vessels and bundles of smooth muscle.
The chambers
The heart contains four hollow chambers: two atria and two
ventricles.
Upstairs…
The atria, or upper chambers, are separated by the interatrial
septum. They receive blood returning to the heart and pump blood
to the ventricles, or lower chambers.
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ANATOMY AND PHYSIOLOGY
4
…where the blood comes in
Memory
The right atrium receives blood from the superior and inferior jogger
venae cavae. The left atrium, which is smaller but has thicker
If you can
walls than the right atrium, forms the uppermost part of the heart’s
remember
left border. It receives blood from the two pulmonary veins. that there
are two distinct heart
Downstairs…
sounds, you can re-
The right and left ventricles, which are separated by the interven- call that there are
two sets of heart
tricular septum, make up the two lower chambers. The ventricles
valves. Closure of
receive blood from the atria. Composed of highly developed muscu-
these valves produces
lature, the ventricles are larger and have thicker walls than the atria.
the heart sounds
frequently known as
…where the blood goes out
the “lub-dub.” The
The right ventricle pumps blood to the lungs. The left ventricle, first heart sound is
which is larger than the right, pumps blood through all other created when the
atrioventricular (AV)
vessels of the body.
valves close. Again,
this valvular closure
The valves makes the first heart
sound, the lub. Clo-
The heart contains four valves: two AV valves and two semilunar sure of the semilunar
(SL) valves produces
valves.
the second heart
Forward flow only sound, the dub.
The valves allow forward flow of blood through the heart and
prevent backward flow, or regurgitation. The valves open and
close in response to pressure changes caused by ventricular
The semilunar
contraction and blood ejection. The two AV valves separate the valves, which
atria from the ventricles. The tricuspid valve, or right AV valve, prevent blood
prevents backflow from the right ventricle into the right atrium. backflow into
The mitral valve, or left AV valve, prevents backflow from the left the ventricles,
are shaped like
ventricle into the left atrium. One of the two semilunar valves is
half-moons.
the pulmonic valve, which prevents backflow from the pulmonary
artery into the right ventricle. The other semilunar valve is the aor-
tic valve, which prevents backflow from the aorta
into the left ventricle.
On the cusps
The tricuspid valve has three triangular cusps,
or leaflets. The mitral, or bicuspid, valve con-
tains two cusps, a large anterior and a smaller
posterior. Chordae tendineae (tendinous cords)
attach the cusps of the AV valves to papillary
muscles in the ventricles. The semilunar valves
have three cusps that are shaped like half-moons.
(See Heart valves.)
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