RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
1.
2.
3.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the client
situations.
Compare and contrast the normal
anatomy and physiology to the
pathophysiology of disease
processes in the cardiovascular
system across the lifespan.
Analyze factors included in the
assessment of the client experiencing
complex problems of the
cardiovascular system, including the
developmental and cultural
considerations.
Clinical Objectives
Take a client history using structured and
unstructured data collection tools to obtain
physical, psychosocial, spiritual, cultural,
familial, occupational, environmental
information, risk factors, and client
resources.
Learning Opportunities
READ:
Lewis (2011)
Perform assessment to identify health status
and monitor for change in health status.
VIDEOS:
#0144-12 Lead EKG
II. Anatomy & Physiology of the Cardiovascular
System.
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
B. Pathophysiology of cardiovascular system
1. Alteration in perfusion
Validate and report assessment data using
assessment tools.
#M018-Physical AssessmentThe Heart
Identify complex multi-system health care
problems of clients.
COMPUTER SIMULATIONS:
III. Cardiovascular assessment
A. Interview
1. Chief complaint
2. History of present illness.
3. Prior medical history
4. Medication history (prescription/nonprescription)
5. Family/social/occupational history
6. Knowledge of health maintenance
7. Identify risk factors for cardiovascular
disease.
B. Physical exam
1. Level of consciousness
2. Heart sounds (S1, S2, S3, S4,
murmurs)
3. Telemetry, heart rate & rhythm
Incorporate multiple determinants of health
in clinical care when providing care for
individuals and families.
I.
Content Outline
Application of terms
A. Afterload
B. Bruit
C. Cardiac output
D. Cardiac tamponade
E. Gallop rhythm
F. Preload
G. Stroke volume
H. Thalassemia
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Analyze and interpret health data of clients.
Formulate nursing diagnoses based upon
analysis of health data.
Implement nursing care to promote health
and manage acute and chronic health
problems and disabilities.
Perform therapeutic and preventive nursing
measures and administer treatments and
medications as authorized by law and
determined by the BNE.
Identify short and long-term goals/outcomes,
select interventions, and establish priorities
for care in collaboration with the client.
Lehne (2010)
McKinney (2009)
#5028-Physical Examination of
the Cardiovascular System
(Laser)
#5043-Critical Care NursingCritical Thinking:
Cardiovascular Care
Review Level II Cardiovascular
Medications
MEDCOM ONLINE FILMS
VIDM109-T Basic Cardiac
Monitoring: Understanding
Fundamentals
VIDM259-T Cardiac
Auscultation: the Process of
Basic Cardiac Auscultation
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
Peripheral pulses/point of maximal
impulse (PMI)
5. Color (central & peripheral)
6. Neurovascular assessment of affected
extremities
a. Pain
b. Pallor
c. Pulses
d. Paresthesia
e. Paralysis
f. Piokiothermia (coldness)
g. Capillary refill
7. Vital signs
a. B/P lying, sitting, standing
b. HR, Rhythm
8. Activity level
9. Chest pain
10. Peripheral/sacral edema
11. Jugular vein distention
12. Intake/output/daily weights
C. Diagnostic tests
1. Laboratory studies
a. Cardiac enzymes
b. Lipid profile
c. Drug levels
d. Electrolytes
e. Coagulation studies
(1) Prothrombin (PT)
(2) International normalized ratio
(INR)
(3) Partial thromboplastin time
(PTT)
g. Hemoglobin electrophoresis
2. Radiology/Imaging
a. Cardiac catheterization
b. Nuclear cardiology
c. Angiograph
4.
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Clinical Objectives
Serve as model & resource for health
education & information.
Select and carry out safe and appropriate
activities to assist client to meet basic
physiologic needs, including: circulation,
nutrition, oxygenation, activity, elimination,
comfort, rest and sleep.
Act as a role model in maintaining client
confidentiality.
Assume accountability when using
independent clinical judgment and
established protocols.
Evaluate, document, and report responses to
medications, treatments, and procedures and
communicate the same to other health care
professionals clearly and accurately.
Apply change strategies to achieve stated
outcomes.
Use evaluation tools to measure processes
and outcomes.
Use critical thinking as a basis for decision
making in nursing practice.
Participate in the evaluation of care
administered by the interdisciplinary health
care team.
Use organizational & management skills
when utilizing resources to meet
goals/outcomes, & enhance quality of
Learning Opportunities
VID78584-T Heart
Medications: Anatomy Review
and Angina
VID78587-T Heart Medications:
Antiarrhythmic Agents, Part I
VID78588-T Heart Medications:
Antiarrhythmic Agents, Part II
VID78585-T Heart
Medications:
Blood Pressure Medications and
Anticoagulants
VID78586-T Heart
Medications:
Heart Failure Medications and
Cholesterol Lowering Agents
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
Other
a. Electrocardiogram
(1) Continuous monitoring;
telemetry
(2) 12 Lead EKG
(3) Holter monitoring
b. Echocardiogram
c. Stress test
d. Electrophysiology studies (EPS)
D. Cultural influences
1. Hereditary/genetic influences
2. Environmental
3. Health beliefs/practices
E. Developmental
1. Age specific assessment data
a. Heart sounds
b. Vital signs
c. Breathing patterns
d. Fluid/electrolytes
e. Nutritional
2. Behavioral/emotional response to
health care providers
3.
4.
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected complex
cardiovascular problems and
associated technology.
IV. Complex Cardiovascular Problems
A. Angina/myocardial infarction
B. Valvular disorders
1. Stenosis
2. Insufficiency
3. Mitral valve prolapse
C. Aortic aneurysm
D. Peripheral vascular disorder
1. Arterial
2. Venous
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Clinical Objectives
nursing care and level of client satisfaction.
Consult with, utilize and make referrals to
community agencies and health care
resources to provide continuity of care.
Advocate on behalf of the client with other
members of the interdisciplinary health care
team.
Learning Opportunities
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
5.
Discuss analysis, planning,
implementation and evaluation for
the nursing management of clients
with complex cardiovascular
problems.
Content Outline
E. Dysrhythmia
1. Minor
a. Bradycardia
b. Tachycardia
c. Premature ventricular
contractions
d. Atrial fibrillation
e. Supraventricular tachycardia
2. Major
a. Ventricular tachycardia
b. Ventricular fibrillation
c. Asystole
d. Complete heart block
F. Hemodynamic monitoring
1. Arterial lines
2. Central venous pressure
3. Pulmonary artery pressure monitoring
4. Intraortic balloon pump
a. Venous stasis ulcer
b. Venous insufficiency
G. Sickle cell disease
H. Anemias
1. Iron Deficiency
2. Vitamin B-12 (pernicious)
3. Aplastic
4. Folic Acid deficiency
V. Selected nursing diagnoses/nursing
implementation/evaluation.
A. Alteration in tissue perfusion
1. Independent interventions
a. Neurovascular assessment
b. Position client
c. Maintain body temperature
d. Promote factors that improve
blood flow
e. Exercise
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Clinical Objectives
Learning Opportunities
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
f. Prevent trauma
g. Nutritional support
h. Maintain fluid balance
2. Collaborative interventions
a. Administer medications and
monitor for desired
effects/adverse effects/side
effects
(1) Anticoagulants
(2) Antiplatelet aggregator
(3) Antidysrthymics
(4) Antianginal
(5) Antihypertensives
b. Oxygen support
c. Surgical modalities
(1) Abdominal aortic aneurysm
repair
(2) Femoral-popliteal by-pass
(3) Ligation/vein stripping
(4) Lumbar sympathectomy
(5) Percutaneous transluminal
angioplasty (PCTA)
(6) Coronary artery bypass graft
(CABG)
d. Cardioversion
e. Defibrillation
3. Recognition of complications
a. Thrombus/embolus
b. Surgical complications
c. Amputation
4. The client will have improved tissue
perfusion as evidenced by:
a. neurovascular status WNL
b. increased activity tolerance
c. decreased pain
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Clinical Objectives
Learning Opportunities
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
B. Pain
1. Independent interventions
a. Assess the pain
(1) Believe the client
(2) Age specific scale
(3) Location, type, precipitating
factors alleviating factors
b. Rule out complications
(1) What is the worse thing this
pain could be and rule it out?
(2) Is the pain
expected/unexpected?
(3) List specific assessment data
to rule out complications
c. Take an action
(1) Notify the doctor if a
complication
(2) Administer appropriate
medications (see
collaborative)
d. Independent nursing interventions
(1) Imagery
(2) Distraction
(3) Environment
(4) Therapeutic communication
(5) Position client
e. Safety
f. Evaluation
2. Collaborative interventions
a. Administer medications and
monitor for desired
effects/adverse effects/side effects
(1) Narcotics
(2) Nitrates
(3) Thrombolytics
(4) Nonopioids
(5) NSAIDS
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Clinical Objectives
Learning Opportunities
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
(6) Around the clock (ATC)
analgesics
b. Oxygen support
c. Respiratory therapy
3. Recognition of complication
a. Unrelieved pain
4. The client will state (indicate) that the
pain has decreased.
C. Altered health maintenance: Knowledge
deficit
1. Client teaching
a. Assess readiness to learn, ability,
knowledge
b. Avoid aggravating factors
c. Promotion of alleviating factors
d. Reportable signs/symptoms
e. Medication teaching
f. Rest/activity
g. Risk factors
h. Life style modifications
i. Nutrition
(1) Low fat
(2) Low cholesterol
(3) Low salt
j. Maintenance of fluid balance
k. Health promotion activities
l. Genetic counseling
2. Community Resources
a. American Heart Association
b. Mended Heart Association
c. Cardiac rehabilitation
d. National Association for Sickle
Cell Disease
3. The client will have improved health
maintenance as evidenced by:
a. Identifying aggravating and
alleviating factors.
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Clinical Objectives
Learning Opportunities
RNSG 2535 – Integrated Client Care Management
Unit II - Care of the Client Experiencing Cardiovascular Problems
Behavioral Objectives
Content Outline
Identifying reportable signs and
symptoms
c. Describing the purpose, correct
administration and side effects of
prescribed medications.
d. Identify risk factors.
e. Modification of life style
f. No post op complications
g. Utilizing community resources.
D. Ineffective Individual coping: Anxiety,
fear, powerlessness, dependence.
See Unit III-Care of the Client
Experiencing Respiratory Problems)
E. Altered family processes
1. Identify causative and contributing
factors
a. Family, significant others
2. Provide ongoing information
3. Assist family with appraisal of
situation
4. Initiate health teaching and
referrals
a. Spousal support Groups
b. Grief Support Groups
c. Parent support groups
5. The family will have improved family
processes as evidenced by:
a. Participating in planning/care
of client
b. Verbalizing feelings to nurse
and each other
c. Verbalizing feelings of grief
d. Maintaining functional
family unit.
e. Facilitating client from sick
role to well.
Clinical Objectives
Learning Opportunities
b.
N:Soph\Fall\RNSG 2535\Unit II Cardiovascular
Revised 05/10
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