LESSON PLAN ON

COR PULMONALE
H.NO:19501400007

EXTERNAL EXAMINER INTERNAL EXAMINER

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 STUDENT PROFILE

H.NO : 19501400007

Course : MSc Nursing 1st Year

Subject : Nursing Education

Method of Teaching : Lecture com Discussion

Group : Bsc(N) 2nd year

Number : 55

Place : Bsc Nursing 2nd year class room

Date : 24/03/2021

Time : 10 AM

Duration : 20- 30 Mints

AV aids : OHP, Black Board, PPT, Flash card,Chart

Supervised by : Mrs.k. Renuka Madam

Assist Professor, GCON, Hyderabad

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STUDENT TEACHER OBJECTIVES:

By the end of the session on the student teacher is able to gain skills.

• Introduce the topic effectively

• Improve skills in organizing the content.
• Gain skills in explanation.
• Develop skills in preparing, presenting the suitable AV aids.
• Improve skills in method of questioning.
• Improve and develop skills in demonstration of procedures.
• Gain skill in controlling the group.
• Gain skills in management of time.

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 OBJECTIVES

GENERAL OBJECTIVE: : By the end of the presentation the group will be able gain indepth knowledge regarding Cor
pulmonale.

SPECIFIC OBJECTIVES

 Introduce the topic of Cor pulmonale.

 Define Cor pulmonale .
 Relate the etiology Cor pulmonale.
 Discuss the causes of Cor pulmonale.
 Describe the pathophysiology of Cor pulmonale.
 Clinical manifestations of Cor pulmonale.
 Enlist the diagnostic investigations of Cor pulmonale.
 Management of Cor pulmonale.
 Evaluate of complications of Cor pulmonale.

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Sl.No Specific Time Content Teaching & AV Evaluation
Objectives learning method Aids

1 Introduction : According To the Maslow’s theory of Discussion Black

1 Introduce the min Hierarchy of needs the most basic needs of Human being are Method board
topic
the physiological need are food, clothing, air, shelter, water
etc;

This air inspired by humans go through a complex system of

blood vessels to reach thetissues and this is pumped out
2 Review the through the heart which may dysfunction leading to right or

Anatomy and 5 left sided failure Discussion PPT

Physiology of min method

Heart Anatomy and physiology: Anatomy of Heart:

 Upper most covering of heart is called as

“Pericardium”, the cardiac muscle layer is called as
“Myocardium” while innermost heart layer is
“Endocardium.

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  Heart has four chambers upper two are called as right Discussion
and left atriums while lower two are called as right and method
left ventricles.
 Atriums are separated from each other by “interatrial
septum”.
 Atriums are separated from ventricles by
“Atrioventricular septum”.
 Ventricles are separated from each other by
“Interventricular septum”.
 Blood supply to heart itself is goes through a tiny artery
called as “Coronary Artery”.

Valves in Hart:

 Various valves present in heart prevent the backward

flow of the blood.
 The heart has total Four valves one placed between
each atrium and ventricle and one valve rests at exit
point of each ventricle as follows,
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 1. Tricuspid valve: Present between right atrium and right
ventricle, also called as “Right atrioventricular
Valve”.
2. Bicuspid Valve: Present between left atrium and left
ventricle, also called as “left atrioventricular Valve.”
and as “Mitral Valve”.
3. Pulmonary Artery: Located at base of “Pulmonary
artery”.
4. Aortic Valve: Located at base of “Aorta” it is also

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 called as “Semilunar Valve” Lecture method

Physiology of Heart:

 Contractions of hart are called as “Systole” while

relaxation of heart is called as “Diastole”.
 The right side of heart deals with deoxygenated blood
while right side of heart deals with oxygenated blood.
2  The right atrium receives deoxygenated blood from
min veins during diastole and then pushes it to the right
ventricle through right atrioventricular valve.
 During systole the deoxygenated blood from right
atrium enters the pulmonary artery and is transported to
the lungs for oxygenation.
 Oxygenated blood from lungs enters the left atrium via
pulmonary veins.
 Oxygenated blood from right atrium enters right PPT
ventricle through left atrioventricular valve.
 During systole the pure blood from left ventricle enters Lecture method

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 Aorta and then circulated to the entire body.
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Electrical Conduction:
min
 The normal rhythmical heart beat, called sinus rhythm,
is established by the sinoatrial node (SA Node), the
heart's pacemaker.
 Here an electrical signal is created that travels through
the heart, causing the heart muscle to contract.
 The sinoatrial node is found in the upper part of the
right atrium near to the junction with the superior vena Discussion
cava. method
 The electrical signal generated by the sinoatrial node
3min travels through the right atrium in a radial way, It
travels to the left atrium via Bachmann's bundle, such
that the muscles of the left and right atria contract
together.
 The signal then travels to the atrioventricular node
(AV Node).
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  This is found at the bottom of the right atrium in the Black
atrioventricular septum—the boundary between the board
right atrium and the left ventricle.
 The septum is part of the cardiac skeleton, tissue within
the heart that the electrical signal cannot pass through, Discussion
which forces the signal to pass through the method
atrioventricular node only.
 The signal then travels along the bundle of His to left
and right bundle branches through to the ventricles of
the heart.
 In the ventricles the signal is carried by specialized
tissue called the Purkinje fibers which then transmit
the electric charge to the heart muscle.
Describe
Cardiac Cycle:
briefly
 The cardiac cycle refers to the sequence of events in introductio
which the heart contracts and relaxes with every Ppt n of
heartbeat. corpulmon

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  The period of time during which the ventricles contract, ale
forcing blood out into the aorta and main pulmonary
artery, is known as systole, while the period during
which the ventricles relax and refill with blood is known Lecture method

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min

as diastole.
 The atria and ventricles work in concert, so in systole
when the ventricles are contracting, the atria are relaxed
and collecting blood.
 When the ventricles are relaxed in diastole, the atria
contract to pump blood to the ventricles.
 At the beginning of the cardiac cycle, the ventricles are

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 relaxing as they do so, they are filled by blood passing
through the open mitral and tricuspid valves. Lecture method
 After the ventricles have completed most of their filling,
the atria contract, forcing further blood into the
ventricles and priming the pump.
 Next, the ventricles start to contract, as the pressure
rises within the cavities of the ventricles, the mitral and
tricuspid valves are forced shut.
 As the pressure within the ventricles rises further,
exceeding the pressure with the aorta and pulmonary
arteries, the aortic and pulmonary valves open.
 Blood is ejected from the heart, causing the pressure
within the ventricles to fall.
 Simultaneously, the atria refill as blood flows into the
right atrium through the superior and inferior vena
cavae, and into the left atrium through the pulmonary
veins.
 Finally, when the pressure within the ventricles falls

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 below the pressure within the aorta and pulmonary
arteries, the aortic and pulmonary valves close.
 The ventricles start to relax, the mitral and tricuspid
valves open, and the cycle begins again.

Cardiac Output:

 Cardiac output (CO) is a measurement of the amount

of blood pumped by each ventricle (stroke volume) in
one minute.
 This is calculated by multiplying the stroke volume
(SV) by the beats per minute of the heart rate (HR). So
that: CO = SV x HR.
 The cardiac output is normalized to body size through
body surface area and is called the cardiac index.
 Preload refers to the filling pressure of the atria at the
end of diastole, when they are at their fullest.
 A main factor is how long it takes the ventricles to fill—
if the ventricles contract faster, then there is less time to
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 fill and the preload will be less.
 Preload can also be affected by a person's blood
volume.
 The force of each contraction of the heart muscle is
proportional to the preload.
 Afterload, or how much pressure the heart must
generate to eject blood at systole, is influenced by
vascular resistance.
 It can be influenced by narrowing of the heart valves
(stenosis) or contraction or relaxation of the peripheral
blood vessels.
 The strength of heart muscle contractions controls the
stroke volume.
 This can be influenced positively or negatively by
agents termed inotropes.
 These agents can be a result of changes within the body,
or be given as drugs as part of treatment for a medical
disorder.

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  Inotropes that increase the force of contraction are
"positive" inotropes, and include sympathetic agents
such as adrenaline, noradrenaline and dopamine.
“
 Negative" inotropes decrease the force of contraction
and include calcium channel blockers

Define Definition:-
3 3 OHP
Corpulmonale. Cor pulmonale is a condition that most commonly arises
MIN
out of complications from high blood pressure in the
pulmonary arteries (pulmonary hypertension). It's also
known as right-sided heart failure because it occurs
within the right ventricle of your heart
- Brunner and suddharth
abnormal enlargement of the right side of the heart as a
result of disease of the lungs or the pulmonary blood
vessels.
- Lewis
Lecture method

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 Illustrate the 2 Incidence: The incidence rate may vary from 0.5 to 31.5
4. incidence of min per 100000 people each year, depending on the studied
Corpulmonale population. Ppt
The prevalence is lower in developing countries. In Asian
populations, for example, the prevalence ranges from 5.3 to
63.6 per 100000 people, whereas in North America, it
ranges from 37.5 to 238 per 100000 people.
Lecture
In India: an incidence of 6.02/105 per year and a crude method
prevalence rate of 44.3/105 inhabitants.

Causes of corpulmonle include:

Enlist the causes This type of right-sided heart disease can develop slowly or
5. of Corpulmonle
suddenly, and it is always caused by lung disease. COPD is
leaflets
the most common cause of cor pulmonale, but there are others
as well.1 Often, cor pulmonale is more severe if you also have

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 other types of heart disease, such as an arrhythmia or a history
2 of a heart attack.
min
Common causes of cor pulmonale include:

 Cystic fibrosis Causes of

 Sleep apnea corpulmon
 Scleroderma of the lungs ale
 PE (blood clot in the lungs) Discussion
 Lung tissue damage method
 Acute respiratory distress syndrome (ARDS)
 Interstitial lung disease (ILD)
 Lung cancer

COPD is a common cause of heart failure, especially cor

pulmonale. COPD is a group of pulmonary diseases that
include emphysema and chronic bronchitis, which are Black
progressive conditions that are associated with a number of board
complications.

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 PATHOPHYSIOLOGY:
6. Explain DUE TO ANY ETIOLOGICAL FACTORS
pathophysiology 3
of corpulmonale min IMPOPER BACK FLO W OF BLOOD lecture method chart
Explain the
PROLONGED LOW OXYGEN LEVELS pathophysi
ology
INCREASED PRESSURE ON THE RIGHT SIDE OF THE
HEART

RIGHT SIDED HEART FAIURE

Symptoms Discussion
7. Enlist the Shortness of breath or light-headedness during activity is method Pamlets
various clinical often the first symptom. You may have a fast heart beat and
manifesations feel like your heart is pounding.\
Over time, symptoms occur with lighter activity or even
while at rest. They may include: List down

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  Fainting spells with activity the clinical
 Chest discomfort, usually in the front of the chest manifestati

 Chest pain ons and

 Swelling of the feet or ankles diagnostic

evaluations
 Symptoms of underlying disorders (wheezing, coughing)
of
Exams and Tests:
corpulmon
The health care provider will perform a physical exam.
ale
This may reveal:
Discussion
 Fluid build up in the belly area (abdomen)
method
 Abnormal heart sounds
 Bluish skin (cyanosis)
 Liver swelling
 Swelling (distension) of the neck veins, which is a sign of
high right-heart pressures
 Ankle swelling
8.
chart
DIAGNOTIC EVALUATION:

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  Blood antibody tests
enlist the
diagnostic  Blood test for brain natriuretic peptide (BNP)
evaluation of Explain he
cor pulmonale  Chest x-ray diagnosis
of
 CT scan of the chest
corpulmon

 Echocardiogram ale
Discussion
2  Lung biopsy (rarely performed) method
min
 Measurement of blood oxygen by arterial blood gas
PPT
(ABG)

 Pulmonary function tests

 Right heart catheterization

9.
 Ventilation and perfusion scan of the lungs (V/Q scan)

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 2
Management:
min

Medical management:

The goal of treatment is to control symptoms. It is

important to treat medical problems that cause pulmonary
hypertension, which can lead to cor pulmonale. Many Discussion
treatment options are available. If you are prescribed method
medicines, they may may be taken by mouth (oral),
received through a vein (intravenous or IV), or breathed
in (inhaled).Your doctor will decide which medicine is
best for you. You will be closely monitored during
treatment to watch for side effects and to see how well

2 the medicine works for you. Never stop taking your

MIN medicines without talking to your doctor. Other PPT

Describe the treatments may include:

management of
 Blood thinners to reduce the risk of blood clots
cor pumonale

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  Oxygen thearpy at home

 A lung or heart-lung transplant, if medication does not

work Other important tips to follow:

 Avoid pregnancy
2min
 Avoid strenuous activities and heavy lifting

 Avoid traveling to high altitudes

 Get yearly flu vaccine, as well as other vaccines such as Discussion

the pneumonia vaccine Method Describe
the
 Stop smoking Pleurisy
managema
Surgical management: nt of
1. Venesection: it is used with caution is some patients corpulmon
who have severe secondary polycythemia due to chronic ale
hypoxia

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 2. Transplantation of lung and heart

Nursing management

The nurse should assess the client for the clinical

manifestations of CHF, especially in high-risk clients
Lecture method
 Impaired gas exchange related to fluid in the alveoli:

Auscultation of breath sounds every 4 hours

Encourage to turn cough and deep breath PPT

Maintain Fowler’s position

Administer oxygen

Monitor ABG

Intubation and mechanical ventilation

 Decreased cardiac output related to heart failure

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 and dysrhythmias

Vital signs every hour

Lung and heart sounds every 2 hours

Administer oxygen

Hourly urine output

Assess changes in mental status Lecture method

Small meals

 Fluid volume excess related to reduced cardiac

output and Na and water retention:

IO chart

Fowler’s position

Frequent oral care

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 Daily weighing

Assess jugular vein distension, peripheral edema, and hepatic

engorgement

Fluid restriction

2-4 g salt diet

 Decreased peripheral tissue perfusion related to

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reduced cardiac output:

Monitor peripheral pulses

Color and temperature of skin

Keep extremities warm

Assess for thrombophlebitis

Active or passive ROM

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  High risk for impaired skin integrity related to
reduced peripheral tissue perfusions

Change position every 2 hours

Pressure mattress

Heel protectors

Enlist the
 High risk for digitalis toxicity related to impaired
complications
excretion:
of cor
pulmonale Assess for hypokalemia, heart block

Serum digitalis levels and potassium

Enlist the
Complications: complicati
ons
 Exertional syncope
 Hypoxia and significantly limited exercise tolerance
 Peripheral edema

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  Peripheral venous insufficiency
 Tricuspid regurgitation
 Hepatic congestion and cardiac cirrhosis
 Death

Summary:

Through this Class the student hve learnt about the

definition , incidence , causes, clinical manifestations, typs
and management of cor pulmonale.

Conclusion:

As student nurses recognising early symptoms is very

important and educating people regarding prevention of
corpulmonle.

Bibliography

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  Brunner and Siddartha Text book of “Medical and
Surgical Nursing” volume 2 south Asian edition ,
published by Wolters Kluwer New Delhi

 Williams Hopper’s Text Book of “Medical and Surgical

nursing” Fifth edition, Joypee brother’s publishers

 Joyce. M. Black’s Text book of “ Medical Surgical

Nursing” 5th editions Joypee brothers publishers

 www.wikipedia.com

 www.slide share.com

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Ppt

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 OHP

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 OHP

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Explain the
Medical
Management for
Otitis Media

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Explain the
surgical
management for
Otitis media

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Explain the
Nursing
Management
For Otitis
Media.

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