The Cardiovascular System

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The Cardiovascular System
Rachel S. Natividad, RN, MSN, NP
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Review A P
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Circulation through the Heart
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Diagnostic Studies

• CBC
• WBC
• RBC
• HGB
• HCT

• COAGULATION
• Platelet count
• PT/INR
• PTT/APTT
• CXR

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Blood Components

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Blood ComponentsWhite Blood Cell Differential

• WBC Count
• Measurement of total number of leukocytes
  (4,000-11,000/uL)
• Granulocytes
• Neutrophils (55-70)
• Segmented neutrophils (Segs)
• Immature band neutrophils (Bands/Stabs) (0-3)
• Eosinophils (1-2)
• Basophils (lt1)
• Agranulocytes
• Lymphocytes (30-40)
• Monocytes (5-6)

2 Segs, 1 Band
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WBC Differential Cont.
NEUTROPHIL MATURATION

• Left Shift or Bandemia

Segmented Neutrophils (Mature)
Band Neutrophils (Immature)
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WBC Differential Cont.
Eosinophils (parasitic infections, allergies)
Basophils (inflammation from allergies)
Lymphocytes ( immune response)
Monocytes (phagocytic bacterial action)
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RBC Erythrocyte count

• Count of the number of circulating RBCs
• Altered in the same conditions that alter Hgb and
  Hct values

Erythrocytes
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Hemoglobin

• HGB LEVEL Measurement of the oxygen -carrying
  capacity of RBC
• Increased in
• Hemoconcentration (severe
• dehydration, burns, shock,
• vomiting), polycythemia vera
• Decreased in
• Anemias due to blood
• loss or poor nutrition
• Hemodilution (fluid volume excess)
• other anemias

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Hematocrit

• The percentage of whole blood volume composed of
  erythrocytes
• Women 38-47
• Men 40-54
• Altered in same conditions that alter Hgb
• Also reflects pts state of hydration
• Hgb high or WNL with low Hct dehydration

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Case Study
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Patient Presents

• 69 year-old female admitted for left total hip
  replacement. Hx of DJD and DM type 2, asthma, and
  allergies.
• 2 POD
• PE Incision site appears red and edematous with
  moderate amt. purulent drainage, JP drain intact
  draining reddish tan colored drainage.
• VS Temp 100.9, Resp 22/min, P 98 BPM, BP
  138/88.
• CBC results 1 day post-op reveal ????

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CBC with Differential
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Coagulation Studies

• Monitoring hemostasis

Bleeding
Clotting
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Coagulation Studies

• Platelets critical to hemostasis and clot
  formation
• Platelet count measures the number of
  circulating platelets
• Normal range
• 150,000-400,000 mm3
• Monitor in patients receiving Lovenox

• -

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How would you proceed?

• You are to administer Lovenox 40 mg SQ once
  daily.
• Pt.s Plt. Count 250,000 mm3
• Pts Plt. Count 80,000 mm3
• Pts Plt. Count 450,000 mm3

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Coagulation Studies Cont.

• How long does it take for blood to clot?
• PT INR
• Assessment of extrinsic coagulation
• To monitor patients taking certain medications as
  well as to help diagnose clotting disorders
• Used primarily to evaluate oral anticoagulant
  therapy warfarin (Coumadin)

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Coagulation Studies Cont.

• PTT aPTT
• Assessment of intrinsic coagulation
• Used to monitor therapeutic Heparin

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• CXR
• Examine lung fields and heart size
• Check for normal heart size and contour, change
  in heart chambers, displaced heart, presence of
  extra fluid around the heart

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Cardinal Signs and Symptoms (pp 687-688)

• Chest Pain
• Palpitations
• Dyspnea
• Edema
• Fatigue

• Pallor
• Syncope

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Angina

• Chest pain due to reversible ischemia to
  myocardium
• reduced blood flow to the heart

Coronary Artery Disease
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Chest Pain Myocardial Infarction (MI)
CAD with Thrombosis

• Ischemia to the heart muscle is irreversible and
  results in tissue damage and necrosis
• Obstruction of blood flow
• Atheroma (plaque)
• Thrombosis
• Embolism

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Myocardial Infarction

• Diminished coronary perfusion
• Ischemia Angina
• Infarction Necrosis
• Fibrous scarring

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Chest Pain Pericarditis
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Pericarditis

• Inflammation of pericardium
• Pleuritic type chest pain
• pericardial scarring and fibrosis

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CHEST PAINS
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Locations of Chest Pain

• Other Symptoms
• SOB
• Diaphoresis
• N/V
• Cold/clammy skin
• Palpitations
• Fainting
• Loss of consciousness

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Heart Failure (Pump Failure)

• A disorder in which the heart loses its ability
  to pump blood efficiently throughout the body
• ?Cardiac Output

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Pathophysiology
Impaired Cardiac Function

• Failure to empty ventricles
• reduced delivery of blood into circulation
  (? CO)
• Increased ventricular pressures
• Elevated pulmonary and systemic pressures
• further ? CO
• Series of compensatory mechanisms

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Cardiac Function

• Recall that Cardiac Output (CO) is HR X SV
• Which consists of
• Contractility
• Preload filling of the heart during diastole
• Afterload the resistance against which the heart
  must pump

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Causes

• Acute/Chronic ? Problems
• CAD
• HTN (1)
• MI
• Valvular ? Disease

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Compensatory mechanisms of low CO

• Starlings Law/Ventricular dilation ? CO
• SNS stimulation ? HR and cardiac contractility
  ? CO
• Decreased renal blood flowincreasing Na H20
  retentionincreases blood volume, ? HR CO.

Ventricular hypertrophy cardiac contractility
? CO
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Clinical manifestations Pulmonary Congestion
(L) and Systemic Congestion (R)
Right Heart Failure
Left Heart Failure
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Left Heart Failure-Cont.

• Pulmonary edema
• The most severe manifestation of Left Heart
  Failure
• Fluid leak into the pulmonary interstitial spaces
  (Pulmonary congestion)
• Hypoxia and poor 02 exchange

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Clinical pictureLeft Heart Failure

• Dyspnea
• Tachypnea
• Cough orthopnea
• Paroxysmal nocturnal dyspnea
• Pale, possible cyanotic
• Clammy and cold skin
• Extra heart sounds S3, S4
• Crackles/Wheezes

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CXR Pulmonary edema
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Right Heart Failure

• Unresolved Left failure eventually leads to
  right sided failure by venous congestion in the
  systemic circulation
• Clinical picture
• JVD, hepatomegaly and dependent edema (LEs,
  thighs, abdomen-ascites)

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Review Subjective Data

• Pt. may c/o
• anxiety
• dyspnea at rest/on exertion (DOE) -most sensitive
• paroxysmal
• nocturnal dyspnea (PND)
• orthopnea
• productive cough with pink frothy sputum

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Review Objective Data

• PA may reveal
• Tachypnea/SOB
• Use of accessory muscles
• Wheezes/Crackles
• skin
• Clammy/cold
• gray/cyanotic
• peripheral edema
• JVD
• Ascites, enlarged spleen/liver

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Review Heart Failure

• Left Heart Failure pulmonary congestion
• Right Heart Failure systemic congestion
• Left Heart failure often leads to Right sided
  heart failure causing biventricular failure
• ? Cor Pulmonale