115-nclex-rn review made incredibly easy, fifth edition (incredibly easy...

26 Cardiovascular system

Cardiovascular refresher (continued)CARDIOGENIC SHOCKKey signs and symptoms Cold, clammy skin Hypotension (systolic pressure below 90 mm Hg) Narrow pulse pressure Oliguria (urine output of less than 30 ml/hour) Tachycardia or other arrhythmias

Key test results ECG shows myocardial infarction (MI) (enlarged Q wave, ele-vated ST segment).

Key treatments Intra-aortic balloon pump Adrenergic agent: epinephrine Cardiac glycoside: digoxin (Lanoxin) Cardiac inotropes: dopamine, dobutamine, inamrinone (Amrinone), milrinone Diuretics: furosemide (Lasix), bumetanide (Bumex), metolazone (Zaroxolyn) Vasodilators: nitroprusside (Nitropress), nitroglycerin Vasopressor: norepinephrine (Levophed)

Key interventions Assess cardiovascular status, including hemodynamic vari-ables, vital signs, heart sounds, capillary refill, skin temperature, and peripheral pulses. Assess respiratory status, including breath sounds and arterial blood gas levels. Administer I.V. fluids, oxygen, and medications, as prescribed.

CARDIOMYOPATHYKey signs and symptoms Murmur, third (S3) and fourth (S4) heart sounds

Key test results ECG shows left ventricular hypertrophy and nonspecific changes.

Key treatments Dual-chamber pacing (for hypertrophic cardiomyopathy) Beta-adrenergic blockers: propranolol (Inderal), nadolol (Corgard), metoprolol (Lopressor) for hypertrophic cardiomyopathy Calcium channel blockers: verapamil (Calan), diltiazem (Cardizem) for hypertrophic cardiomyopathy Diuretics: furosemide (Lasix), bumetanide (Bumex), metolazone (Zaroxolyn) for dilated cardiomyopathy Inotropic agents: dobutamine, milrinone, digoxin (Lanoxin) for dilated cardiomyopathy Oral anticoagulant: warfarin (Coumadin) for dilated and hyper-trophic cardiomyopathy

Key interventions Monitor ECG. Assess cardiovascular status, vital signs, and hemodynamic variables. Administer oxygen and medications, as prescribed.

CORONARY ARTERY DISEASEKey signs and symptoms Angina (chest pain) that may be substernal, crushing, or com-pressing; may radiate to the arms, jaw, or back; usually lasts 3 to 5 minutes; and usually occurs after exertion, emotional excite-ment, or exposure to cold but can also develop when the client is at rest

Key test results Blood chemistry tests show increased cholesterol (decreased high-density lipoproteins, increased low-density lipoproteins). ECG or Holter monitoring shows ST-segment depression and T-wave inversion during an anginal episode.

Key treatments Activity changes, including weight loss, if necessary Dietary changes, including establishing a low-sodium, low-cholesterol, low-fat diet with increased dietary fiber (low-calorie only if appropriate) Antilipemic agents: cholestyramine (Questran), lovastatin (Mevacor), simvastatin (Zocor), nicotinic acid (Niacor), gemfib-rozil (Lopid), colestipol (Colestid) Low-dose aspirin therapy

Key interventions Obtain ECG during anginal episodes. Assess cardiovascular status, including vital signs and hemo-dynamic variables. Administer nitroglycerin for anginal episodes. Administer oxygen therapy during anginal episodes. Monitor intake and output. Monitor laboratory studies.

ENDOCARDITISKey signs and symptoms Chills Fatigue Loud, regurgitant murmur

Key test results Echocardiography may identify valvular damage. ECG may show atrial fibrillation and other arrhythmias that accompany valvular disease. Three or more blood cultures in a 24- to 48-hour period identify the causative organism in up to 90% of clients.

313419NCLEX-RN_Chap03.indd 26313419NCLEX-RN_Chap03.indd 26 4/8/2010 7:01:36 PM4/8/2010 7:01:36 PM

/ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth 8 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /FlateEncode /AutoFilterGrayImages false /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 1200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects true /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile (None) /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False

/CreateJDFFile false /Description > /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ > /FormElements false /GenerateStructure false /IncludeBookmarks false /IncludeHyperlinks false /IncludeInteractive false /IncludeLayers false /IncludeProfiles false /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /DocumentCMYK /PreserveEditing true /UntaggedCMYKHandling /LeaveUntagged /UntaggedRGBHandling /UseDocumentProfile /UseDocumentBleed false >> ]>> setdistillerparams> setpagedevice















































































115-nclex-rn review made incredibly easy, fifth edition (incredibly easy...

Documents