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24 Cardiovascular system

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Cardiovascular refresherABDOMINAL AORTIC ANEURYSMKey signs and symptoms Commonly asymptomatic

Key test results Chest X-ray shows aneurysm.

Key treatments Abdominal aortic aneurysm resection

Key interventions Assess cardiovascular status, and monitor and record vital signs. Monitor intake and output and laboratory studies. Observe the client for signs of hypovolemic shock from aneurysm rupture, such as anxiety, restlessness, severe back pain, decreased pulse pressure, increased thready pulse, and pale, cool, moist, clammy skin.

ANGINAKey signs and symptoms Pain that may be substernal, crushing, or com-pressing; may radiate to the arms, jaw, or back; and usually lasts 3 to 5 minutes; usually occurs after exertion, emotional excitement, or exposure to cold but can also develop when the client is at rest; in women, may manifest as atypical symp-toms of pain, such as indigestion, back pain, and less severe complaints of substernal pain

Key test results Electrocardiogram (ECG) shows ST-segment depression and T-wave inversion during anginal pain.

Key treatments Percutaneous transluminal coronary angioplasty or coronary artery stent placement

Key interventions Assess for chest pain and evaluate its charac-teristics. Administer medications, as prescribed. Hold nitrates and notify physician for systolic blood pressure less than 90 mm Hg. Hold beta- adrenergic blocker and notify physician for heart rate less than 60 beats/minute. Obtain 12-lead ECG during an acute attack.

ARRHYTHMIASKey signs and symptomsAtrial fibrillation Commonly asymptomatic Irregular pulse with no pattern to the irregularity Asystole Unresponsive Apnea Cyanosis No palpable blood pressure Pulselessness Ventricular fibrillation Unresponsive Apnea No palpable blood pressure PulselessnessVentricular tachycardia Diaphoresis Hypotension Weak or absent pulse Dizziness

Key test resultsAtrial fibrillation ECG shows irregular atrial rhythm, atrial rate possibly greater than 400 beats/minute, irregular ventricular rhythm, QRS complexes of uniform configuration and duration, indiscernible PR interval, and no P waves (fibrillation waves).Asystole ECG shows no atrial or ventricular rate or rhythm and no discernible P waves, QRS complexes, or T waves.Ventricular fibrillation ECG shows rapid and chaotic ventricu-lar rhythm, wide and irregular or absent QRS complexes, and no visible P waves. Ventricular tachycardia ECG shows ventricular rate of 140 to 220 beats/minute, wide and bizarre QRS complexes, and no discernible P waves. Ventricular tachycardia may start or stop suddenly.

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