Disorders of the Cardiovascular System


CHAPTER 14






Disorders of the Cardiovascular System


 

 





LEARNING OUTCOMES






 


Upon completion of this chapter, the nurse will:



1.  Summarize the different disorders of the cardiovascular system


2.  Examine approaches to assess different disorders of the cardiovascular system


3.  Determine approaches that can be used for more than one cardiovascular disorder


CARDIOVASCULAR DISORDERS


The cardiovascular disorders can be categorized according to the structures affected. The cardiac disorders listed would be the ones most commonly identified for disease management telephonic care. Some cardiac disorders require hospitalization for treatment, such as disseminating intravascular coagulation and sudden cardiac death, and would not be appropriate for telephonic care.


For the heart, these disorders would be:



  Myocardial infarction


  Angina


  Dysrhythmias


  Heart failure


  Valvular dysfunction


  Endocarditis


  Coronary artery disease


For the arterial system, these disorders include:



  Atherosclerosis


  Peripheral arterial disease


  Hypertension


  Aneurysms


Disorders associated with the venous system include:



  Peripheral venous disease


  Varicose veins


  Deep vein thrombosis


For the lymphatic system, the client might experience:



  Lymphedema


  Enlarged/swollen lymph glands


Disorders associated or that affect the blood system include:



  Anemia


  Sickle cell disease


  Leukemia


  Lymphoma


  Hemophilia


ASSESSING DISORDERS OF THE HEART


Remember that the client is already diagnosed with a heart problem. When providing telephonic care, you are assessing the client’s current condition, symptoms, and if anything has changed or needs to be referred to the doctor/health care professional.


 
























































































































































































Health Problem


Question


Recovering from an acute myocardial infarction


How are you feeling right now?


 


Are you experiencing any chest pain similar to the pain that you had when you had your “heart attack?”


 


How is your energy level?


 


How much sleep are you getting each night?


 


How many rest periods (and for how long) are you taking each day?


 


Are you scheduled to attend cardiac rehabilitation? When do you attend?


 


Are you taking all of your medications as prescribed?


  Do you have any questions about the medications, the expected effects, or any side effects that you might be experiencing?


 


Have you been told when you can:


  Return to work?


  Resume normal activity?


 


Have you been prescribed a special diet to follow?


  Do you have any questions about the diet?


History of angina


Describe the type of chest pain that you usually experience


 


What are you supposed to do when you have the chest pain?


  Are you following what you are supposed to do when you have the chest pain?


 


Do you have a bottle of nitroglycerin tablets to use?


 


Are the pills in the original bottle from the pharmacy?


 


Have you had the nitroglycerin pills replaced within the last 6 months?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care when you are having the chest pain?


Diagnosed with an atrial dysrhythmia


What medication are you taking for the dysrhythmia?


 


Do you have to have your blood drawn periodically?


 


Does your medication dose change after having your blood drawn?


 


Are you experiencing any bleeding or bruising since starting to take the medication for the dysrhythmia?


 


Did you have or are you scheduled to have any surgery or procedures to correct the dysrhythmia?


  When did you have the procedure/when is the procedure scheduled?


 


Do you have a pacemaker?


  When was it inserted?


  When was it last checked?


  When was the battery last changed?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the dysrhythmia?


Diagnosed with a ventricular dysrhythmia


What medication are you taking for the dysrhythmia?


 


Did you have or are you scheduled to have any surgery or procedures to correct the dysrhythmia?


  What did you have done/what are you scheduled to have done?


  When did you have the procedure done/when are you scheduled to have the procedure done?


 


Do you have a pacemaker?


  When was it inserted?


  When was it last checked?


  When was the battery last changed?


 


Do you have something called an implanted defibrillator?


  Has it ever gone off?


  What did it feel like when it went off?


  Have you been directed to do anything in particular when it goes off?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the dysrhythmia?


Diagnosed with heart failure


How are you feeling right now?


 


What medications are you taking for your heart problem?


 


Are you routinely coughing?


  Is the cough new, since starting any medication?


  Are you producing any phlegm?


  What color is the phlegm?


 


Are you having any problems catching your breath?


 


Do you wear oxygen?


  All the time or only when short of breath?


  Do you have an oxygen concentrator in the home?


  Do you have a portable oxygen unit to use when you go out?


 


Are you having any swelling of the feet/ankles/lower legs?


 


Do your shoes feel tight?


 


Are your rings tight on your fingers?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the heart problem?


Valvular dysfunction


When were you told you had a problem with a valve in your heart?


 


Are you scheduled for surgery?


 


Did you have valve replacement surgery?


  Would you know what kind of valve was used as a replacement?


  Can you hear a click through your chest? (Mechanical valves will click. Bovine or porcine valves will not click.)


 


Are you taking any medication after having the valve replaced? (Mechanical valves will need lifetime anticoagulation. Bovine/porcine valves will not need any anticoagulation.)


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the valve problem?


Endocarditis


How are you feeling right now?


 


Were you told the reason for your heart infection?


 


Are you taking any medication right now for the infection?


  How long do you have to take it?


 


Have you been directed to avoid any activities because of the heart infection?


 


Have you been directed to change your diet because of the heart infection?


 


Have you been directed to change your lifestyle because of the heart infection? (Endocarditis has been associated with substance abuse.)


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the heart infection?


Coronary artery disease


How are you feeling right now?


 


What have you been told about the blockages in your heart vessels?


 


Have you had a procedure or surgery to place something called a stent in your heart vessels?


  When was this done?


 


Are you taking any medication since the stents were placed?


 


Are you scheduled or planning to have the vessels replaced?/Have you had the vessels replaced?


  When will this be done?/When was this done?


 


Are you on any new medication since the vessels were replaced?


 


Have you been directed to change your diet since the vessels were replaced?


 


Have you had to alter your activity status since the vessels were replaced?


 


Have you had to make lifestyle changes since the vessels were replaced? (Modifiable risk factors for coronary artery disease include weight reduction, exercise, smoking cessation, low-fat diet, low-sodium diet.)


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the heart vessels?


ASSESSING DISORDERS OF THE ARTERIAL SYSTEM






































































Health Problem


Question


Diagnosed with atherosclerosis/peripheral arterial disease


How are you feeling right now?


 


Do you have pain in your calves (back of your lower legs) when you walk?


 


Do your legs ache when sitting down?


 


Do you have numbness or tingling in your legs and feet?


 


Do the fronts of your lower legs look red when your feet are flat on the floor?


 


Do you smoke cigarettes?


  When did you start smoking?


  How much do you smoke each day?


  Have you considered stopping smoking? (Smoking is a modifiable risk factor for the development of atherosclerosis.)


 


Have you been directed to make any changes because of the atherosclerosis such as:


  A low-fat diet?


  Increasing activity/walking?


  Reducing body weight?


 


Are you taking or have been prescribed medications for the atherosclerosis?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the atherosclerosis?


Hypertension


How are you feeling right now?


 


Do you know what your last blood pressure measurement was?


 


What medications have you been prescribed for the high blood pressure?


  Are you taking the medication as directed?


  Are you experiencing any other effects from the medication?


 


Have you been directed to make any other changes to help reduce your blood pressure such as:


  Weight reduction?


  Increase activity/exercise?


  Smoking cessation?


  Low sodium diet (dietary approaches to stop hypertension [DASH] diet)?


  Stress management?


  Reduce alcohol intake?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the high blood pressure?


Diagnosed with or recovering from treatment for an aneurysm


How are you feeling right now?


 


Where is/was your aneurysm located?


 


How was it/is it going to be treated?


  What type of surgery did you have/are scheduled to have?


  When did you have/are scheduled to have the surgery?


 


Are you taking or prescribed any medications for the aneurysm (vessel weakness)?


  How often do you take this medication?


  Has your doctor/health care provider told you how long you will need to take the medication?


 


Have you been directed to make lifestyle changes such as:


  Smoking cessation?


  Weight reduction?


  Dietary changes?


  Measures to prevent constipation/straining at a stool?


  Avoiding prolonged sitting, lifting heavy objects, strenuous exercise?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the aneurysm (vessel weakness)?


ASSESSING DISORDERS OF THE VENOUS SYSTEM
























































































Health Problem


Question


Peripheral venous/vascular disease


How are you feeling right not?


 


Do your lower legs ever feel itchy?


 


Do your lower legs swell more after standing for long periods of time?


 


Do your legs ever start to hurt when standing?


 


What color is your skin over the front of your lower legs? (Cyanosis and brown pigmentation of the lower leg and feet are associated with peripheral vascular disease [PVD]).


 


Are there any areas of fluid leaking through the tissue on the front of your lower legs?


 


Do you have any open sores around your ankles?


 


Have you been directed to wear compression stockings?


 


Have you been directed to elevate your feet and legs throughout the day?


 


Do you smoke cigarettes?


  When did you start smoking?


  How much do you smoke each day?


  Have you considered stopping smoking? (Smoking is a modifiable risk factor for the development of PVD.)


 


Have you been directed to make any changes because of your veins such as:


  A low-fat diet?


  Increasing activity/walking?


  Reducing body weight?


 


Are you taking or have been prescribed medications for your veins?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the veins?


Varicose veins


How are your legs feeling right now?


 


Do your legs feel:


  Heavy?


  Fatigued/tired?


  Aching?


  Warm or hot?


 


Have you been directed to make any lifestyle changes such as:


  Smoking cessation?


  Weight reduction?


 


What treatment have you been prescribed for the varicose veins such as:


  Wearing compression stockings?


  Frequently elevating your legs?


  Increasing walking every day?


  Avoiding prolonged standing/sitting?


 


Have you been prescribed any medication to treat the varicose veins?


 


Are you considering/scheduled for surgery to treat the varicose veins?


  When is the surgery scheduled/was the surgery?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the varicose veins?


Deep vein thrombosis


How are you feeling right now?


 


Which leg/body part was affected by the blood clot?


 


What medication have you been taking for the blood clot?


  Do you have to have your blood checked periodically because of the medication?


  How long have you been told that you will need to take the medication?


 


Have you been directed to make any lifestyle changes because of the blood clot?


 


Have you been directed to avoid performing any activities because of the blood clot?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the blood clot?


ASSESSING DISORDERS OF THE LYMPHATIC SYSTEM














































Health Problem


Question


Diagnosed with lymphedema


Which body area is swollen/edematous?


 


Have you been told the reason why the body area is swollen?


 


What treatment have you been prescribed for the swelling such as:


  Elevating the limb?


  Wearing compression stockings?


 


Have you been directed to avoid any activities because of the swelling?


 


Have you been prescribed any medication for the swelling?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the swelling?


Enlarged/swollen lymph glands


Where are the swollen lymph glands/nodes located?


 


Have you been told why the lymph nodes have become swollen?


 


Are the swellings painful?


 


What are you doing to control the pain?


  Have you been prescribed medication for the pain?


 


Have you been prescribed any medication to treat the swelling?


  Is the medication helping reduce the swelling?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the swollen lymph nodes?


ASSESSING DISORDERS OF THE BLOOD SYSTEM





















































































Health Problem


Question


Anemia


What type/kind of anemia do you have?


 


How are you feeling right now?


 


What symptoms are you experiencing because of the anemia?


  Iron deficiency: brittle, spoon-shaped nails, cracks at the corners of the mouth, sore tongue, craving unusual items to eat?


  Vitamin B12 deficiency: paleness, weakness, sore red tongue, diarrhea, numbness, and tingling of the hands and feet?


  Folic acid deficiency: weakness and fatigue, paleness, shortness of breath, heart palpitations?


 


What have you been prescribed to treat the anemia?


  Oral supplement/replacements?


  Dietary changes?


  Reduce alcohol intake?


 


Have the treatments improved how you feel?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the anemia?


Sickle cell anemia


When were you first told that you have sickle cell anemia?


 


How are you feeling right now?


 


Have you had to be hospitalized for a crisis?


 


What medications have you been prescribed for the anemia?


 


Have you been directed to:


  Increase fluids?


  Get extra rest?


  Avoid stress?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the anemia?


Leukemia


What type of blood problem do you have? (Some clients may not want to say leukemia but call it something else such as “not enough white blood cells” or “a disease that causes me to be weak.”)


 


How long have you had this blood problem?


 


What type of treatment are you receiving for the blood problem?


  Chemotherapy?


  Radiation?


  Scheduled for a bone marrow transplant?


  Stem cell transplant?


 


How are you feeling right now?


 


What have you been directed to do to help improve your health?


  Avoid crowds?


  Practice good handwashing technique?


  Thoroughly wash fresh fruits and vegetables?


  Increase protein/calorie intake by eating small frequent meals?


  Use a soft toothbrush?


  Avoid strenuous activity or exercise?


  Use a bulk-forming laxative?


  Avoid all sharp objects?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the blood problem?


Lymphoma


What was used to diagnose your health problem?


  A swollen gland that would not heal?


  Fever?


  Night sweats?


  Fatigue?


  Weight loss?


  Abdominal pain?


  Nausea?


  Vomiting?


  Headaches?


 


How are you feeling right now?


 


What is being done to treat your health problem?


  Chemotherapy?


  Radiation?


  Stem cell transplant?


 


What have you been directed to do to help improve your health?


  Special skin care?


  Increase rest periods?


  Actions to reduce/prevent nausea?


  Increase protein/calorie intake with small frequent meals?


  Avoid strenuous activity or exercise?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the health problem?


Hemophilia


When were you first told you had a problem with your blood clotting?


 


What are your usual symptoms?



  Bruising?


  Swollen knees?


  Bleeding gums?


  Blood in your stool?


  Vomiting blood?


  Nosebleeds?

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Oct 5, 2017 | Posted by in NURSING | Comments Off on Disorders of the Cardiovascular System
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