lOMoAR cPSD| 10103054
Exam 4 Review
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Symptoms of and treatment for varicose
veins
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Symptoms: heavy, achy feeling or
pain after prolonged sitting or
standing, which is relieved by
walking or limb elevation. Some
may feel pressure or an itchy,
burning, tingling throbbing, or
cramp-like leg sensation.
Treatment: Sclerotherapy Drug is
Venoactive drug. Transcutaneous
therapy and high intensity pulsedlight therapy.
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Risks: Age (people older than 65),
HTN and CAD are primary risk
factors; Others are Diabetes,
Metabolic Syndrome, Advanced
Age, Tobacco Use, Vascular
Disease, Congenital Abnormalities
(septal defects), infiltrative
cardiomyopathies, infections,
inflammatory processes, persistent
dysrhythmias and toxins (ETOH).
Risk factors: (Modifiable) HTN,
CAD, diabetes, metabolic syndrome,
tobacco use, and vascular disease;
obesity and high serum cholesterol;
(Non-modifiable) advanced age,
ethnicity, family history/genetics
Sclerotherapy procedure
Complications/organ damage from HF
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IV injection of a liquid or foam (any
kind of liquid) sclerosing substance
that chemically ablates or destroys
the treated veins.
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Self care for venous insuffiency
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Self care includes frequently
elevating legs above the level of the
heart to reduce edema; Begin a daily
walking program; avoid trauma to
the limbs; provide proper foot and
leg care to avoid further trauma;
eat a proper diet of adequate high
protein (meat, beans, cheese, tofu),
vit A (green leafy veggies), vit C
(citrus fruits, tomatoes,
cantaloupe), and zinc (meat,
seafood); maintain normal glucose
levels; daily moisturizing is
important to reduce itching and skin
cracking; proper wound care
Risk factors for HF
Pleural Effusion (fluid between 2
layers that cover the lung and line
the chest wall); Dysrhythmias and
dyssynchronous contractions
(Atrial and ventricular
dysrhythmias), hepatomegaly,
cardiorenal syndrome, and anemia.
Risk factors for endocarditis
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IV drug abuse, infection, valve
replacement, oral surgery (3-6
months), surgery, and IV line
placement; INVASIVE CATHETERS
Symptoms of mitral valve regurgitation
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Acute: generally, poorly tolerated.
New systolic murmur with
pulmonary edema. Cardiogenic
shock develops rapidly.
Chronic: weakness, fatigue,
EXERTIONAL DYSPNEA,
lOMoAR cPSD| 10103054
palpitations, S3 gallop, holosystolic
murmur
Nursing care for post-TEE
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Patient may not eat or drink until
gag reflex returns; monitor patient
until sedation resolves; sore throat
is temporary; a designated driver
is needed if test is done in the
outpatient department.
SE of ace inhibitors, calcium channel
blockers, diuretics, beta blockers, nitrates
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Ace: dry cough, HYPERKALEMIA,
fatigue, dizziness, HA, loss of taste
CCB: fatigue, HA, nausea, rash,
dizziness, flushing, and peripheral
edema.
Diuretics: HYPOKALEMIA,
HYPONATREMIA, HA, dizziness,
thirst, increased blood sugar, muscle
cramps
BB: fatigue, dizziness, bradycardia,
hypotension, wheezing from
bronchospasm, weight gain,
depression, and sexual dysfunction
Nitrates: HA (most common),
dizziness, weakness, ORTHO HYPO
Nursing interventions for pulmonary edema
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Ongoing monitoring of VS, O2 sat,
weight, mentation, ECGs and
indications of fluid overload and
decrease organ perfusion
Assess vital every 4 hours
High-fowler’s position
Non-invasive positive pressure
ventilation (non-rebreather but if
worse, BiPAP)
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Record I/O and daily weights;
assess for edema, ascites, JVD,
S3/S4 heart sounds, crackles,
hypoxia, worsening renal function
Hemodynamic monitoring
(intraarterial BP, PAWP,CO)
• Cardioversion (A-Fib)
• GOTTA HELP THEM BREATH!!
Pre-op care cardiac catheter.
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Assess allergies; contract dye
Perform baseline assessment
including VS, pulse ox, heart and
breath sounds, neurovascular
assessment of extremities (skin
temp, skin color, sensation)
Withhold food/fluids for 6-12 hrs
before
Assess baseline labs values
(cardiac biomarkers, creatinine)
Explain use of local anesthesia at
insertion site, placement of
catheter, flushed feeling when dye
is injected, and possible fluttering
sensation of heart as catheter is
passed
Give sedation and other drugs, as
ordered
Post-op cardiac catheter
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Perform assessment and compare
to baseline; VS; pulse ox, and
heart/breath sounds. Note
hypotension or hypertension and
signs of pulmonary emboli
(respiratory difficulty).
Assess neurovascular status
including peripheral pulses, color,
and sensation of extremity per
agency protocol.
lOMoAR cPSD| 10103054
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Place compression device over
arterial site to achieve hemostasis,
if indicated
Observe insertion site for
hematoma and bleeding every 15
min for 1 hr and then per agency
protocol.
Monitor ECG for dysrhythmias or
other changes (ST segment
elevation)
Monitor pt for chest pain and
other sources of pain or discomfort
Maintain bedrest as ordered for
femoral access
Maintain IV and/or oral fluid
intake and monitor urine output
Teach pt and caregiver about
discharge care, including s/s to
report to HCP (site complications,
return of chest pain), and any
activity restrictions
arterial spasm at the arm or
anastomosis site
Care of patients with infective endocarditis
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Care of patient during and after MI
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REMEMBER THE RISK FOR HF;
ALSO AFTER O2, EKG
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Care AND DIAGNOSTICS of patient with
HF
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COMPLICATIONS OF HF:
HYPOTENSION, LOW URINARY
OUTPUT
Arm precautions post CABG
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Care: monitor sensory and motor
function of the hand; patient with
radial artery harvest should take a
calcium channel blocker and/or a
long-acting nitrate for around 3
months to reduce the incidence or
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Avoid people with infections,
especially upper respiratory tract
infections, and to report cold, flu,
and cough symptoms; avoid
excessive fatigue, plan rest periods
use good oral hygiene and schedule
regular dental visits
Treat with antibiotics every 4-6 wks
After initial treatment at home,;
make sure patient has adequate
nursing care for IV antibiotics
Monitor body temp; elevated temp
may mean that antibiotic is
ineffective, and patient may be at
risk for stroke, pulmonary edema,
and HF; tell patients to recognize s/s
of these complications (change in
LOC, dyspnea, chest pain,
unexplained weight gain)
Get physical and emotional rest but
patient may also wear SCD to
perform ROM exercises, deep
breathing and coughing every 2
hours;
Teach how to reduce risk for
infection; explain importance of
follow-up
COMPLICATIONS: PERICARIAL
EFFUSION (BUILD UP OF FLUID
IN THE PERICARDIUM) AND
CARDIAC TAMPONADE
(DEVELOPS AS PERICARDIAL
EFFUSION VOLUME
INCREASES
AND COMPRESSES THE HEART)
Hypokalemia’s effect on cardiac rhythm
lOMoAR cPSD| 10103054
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Effect: impaired repolarization,
resulting in a flattened T wave,
depressed ST segment, and the
presence of a U wave; P waves peak
and QRS complex is prolonged;
there is an increased incidence of
heart block and potentially lethal
ventricular dysrhythmias.
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Findings: right ventricular heaves,
increased HR, murmurs, JVD, lower
extremity edema, weight gain,
ascites, anasarca, hepatomegaly
Normal sinus rhythm characteristics
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P WAVE BEFORE EVERY QRS
Patient teaching for permanent pacemaker
Cardiac tamponade assessment findings
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Findings: Chest pain, confused,
anxious, restless, decreased CO,
muffled heart sounds, narrowed
pulse pressure, tachypnea, and
tachycardia, JVD
Indications AND TEACHING for SL
nitroglycerin
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Indications: pt can take it once
every 5 min if still feeling chest pain
and/or symptoms of angina
Pt may experience HA, dizziness,
and flushing but this is normal
Advise pt to also get up slowly but
ortho hypo will also occur
Report any pain such as increasing
frequency, nighttime angina, or
angina at rest
DASH diet
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Dietary Approaches to Stop
Hypertension; teaches you that you
should eat fruits, veggies, fat-free or
low-fat milk and milk products,
whole grains, fish, poultry, beans,
seeds, and nuts.
Lowers BP and reduces low-density
lipo-protein LDL cholesterol.
Assessment findings in right HF
Digoxin toxicity signs and symptoms
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Lack of appetite, N/V/D
HA, confusion, anxiety, or delusions
Restlessness, weakness, or
depression
Changes in vision such as blurred
vision or seeing ‘halos around bright
objects’
Fast, slow, or irregular HR or
palpitations
CV findings in the elderly
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Decreased cardiac reserve, HF, S4
may be present
Difficulty in isolating apical pulse
Decreased response to exercise and
stress; slowed recovery from activity
Decreased amplitude of QRS
complex and slight lengthening of
PR, QRS, and QT intervals;
Irregular cardiac rhythms;
decreased maximal HR; decreased
HR variability
Systolic murmur (aortic or mitral)
possible w/o a sign of CVD
AAA repair complications
lOMoAR cPSD| 10103054
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Endoleak (most common; seepage of
blood back into the old aneurysm);
Aneurysm growth above or below
the graft; aneurysm rupture; aortic
dissection; bleeding; renal artery
occlusion caused by stent migration,
graft thrombosis, incisional site
hematoma, and incisional infection
Potentially lethal complication in an
emergency repair of a ruptured AAA
is the development of a
intraabdominal hypertension (IAH)
with associated abdominal
compartment syndrome
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Stress test patient prep and teaching
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Care of patient with AAA (Symptoms of
rupture; care to avoid rupture)
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Labs for MI
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Labs: cardiac troponin I or T
Creatinine, Urea, Electrolytes,
ABGs, Lipids, Full Blood Count
(H&H, WBC, RBC, platelets),
CKMB, Myoglobin
Cardioversion precautions
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Precautions: make sure an airway is
maintained
If patient is with supraventricular
tachy or VT with pulse and becomes
hemodynamically unstable,
synchronized cardioversion should
be done ASAP
Start initial energy at 50 to 100
joules (biphasic defib) and 100
joules (monophasic defib) and
increase if needed
If patient becomes pulseless or goes
into VF, switch off and perform
defib.
Prep BEFORE: tell patients to wear
comfortable clothes and shoes that
can be worn for running or walking;
tell patient to report any symptoms;
Beta-blockers may be held 24 hours
before the test because they blunt the
HR and limit the patient’s ability to
achieve maximal HR (NO HEART
MEDS); caffeine held for 24; smoke
and strenuous exercise held for 3 hr
before the test; obtain baseline VS
and 12-lead ECG
During: monitor VS and ECG
during each stage of exercise and
after until all VS and ECG changes
have returned to normal/baseline;
monitor patient’s response
throughout procedure for any signs
of distress (angina, SOB)
Care for venous leg wounds
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Compression therapy is important
for healing; assess arterial status to
make sure that PAD isn’t present;
show patient how to correctly apply
compression therapy and ‘show
back’; tell pt to replace every 4-6
months
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Avoid standing or sitting for long
periods of time for this decreases
blood return
Elevate legs above the heart to
reduce edema
Encourage daily walking program
once wound heals
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lOMoAR cPSD| 10103054
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Avoid trauma to the limbs
Foods high in PROTEIN
Give prescribed analgesics,
antibiotics, or other drugs
Teach pt and caregiver about
manifestations, complications, and
treatment of venous insufficiency
Pericarditis care (inflammation of the
pericardial sac, often with fluid
accumulation)
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Precautions for Reynauds
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Precautions: Tell patients to avoid
temp extremes and wear loose, warm
clothing as protection from the cold,
including gloves when handling cold
objects.
Stop using all tobacco products and
avoid caffeine and other drugs that
have vasoconstrictive effects
(cocaine, amphetamines, ergotamine,
pseudoephedrine)
Have adequate stress management
strategies.
Immerse hands in warm water often
to decrease vasospasm.
LIMIT EXACERBATIONS
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STEMI (ST elevated MI) IS IN THE
LEFT ANTERIOR VENTRICLE o
MEDICAL EMERGENCY;
ARTERY MUST BE OPEN
WITHIN 90 MIN OF
PRESENTATION TO
RESTORE BLOOD AND
O2
TO THE HEART MUSCLE
AND LIMIT THE INFARCT
SIZE
TROPONIN
MONA
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Math
***Go over objectives before every chapter
and be able to answer them
Treat the underlying problem and the
symptoms; bed rest; keep HOB up to
45 degrees and provide overbed table
support; drug therapy (NSAIDS,
Corticosteroids; avoid ETOH for risk
of GI bleed; PPI can help with
stomach acid); Prepare for possible
Pericardiocentesis (needle is inserted
in the pericardial space to remove
fluid for analysis and relieve heart
pressure);
Explain procedure and possible
causes of pain to reduce anxiety;
important for the pt who previously
had angina or MI BEST LAB FOR
MI!
MORPHINE, O2 THERAPY,
NITROGLYCERIN, ASPIRIN
CO = SV x HR
• AMOUNT OF BLOOD PUMPED
BY EACH VENTRICLE IN 1 MIN;
AMOUNT OF BLOOD EJECTED
FROM THE VENTRICLE WITH
EACH HEARTBEAT (STROKE
VOLUME x TIMES HR PER MIN)
Discharge teaching after MI
Time frame for thrombolytic therapy with
MI
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Treatment of STEMI with
lOMoAR cPSD| 10103054
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thrombolytic therapy aims to limit
the infarction size by dissolving the
thrombus in the coronary artery to
reperfuse the heart muscle.
The goal is to give the thrombolytic
with 30 MIN OF THE PATIENT’S
ARRIVAL TO THE ED
MAP calculation: SBP + 2DBP / 3
What is a good MAP?
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The normal MAP range is between
70 and 100 mmHg. Mean arterial
pressures that deviate from this range
for prolonged periods of time can
have drastic negative effects on the
body.
Normal EF (50%-75) and signs of poor EF
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Signs: SOB; heart palpitations;
edema in the legs, feet of belly;
fatigue or exhaustion