Cardiovascular Nursing Bullet Points Part I

Legend:

Very Important Information

Must-know Information
Good-to-know Information

During digoxin therapy, conditions that may predispose a client to digitalis

toxicity include hypokalemia, hypomagnesemia, hypothyroidism, hypoxemia,
advanced myocardial disease, active myocardial ischemia, and altered autonomic
tone.
Hyperkalemia Check the patients ECG to rule out potentially lethal arrhythmias
such as ventricular fibrillation.
Beta1-receptor sites are mainly located in the heart.
Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
Common signs of lidocaine toxicity include confusion and restlessness.
Lidocaine exerts its antiarrhythmic effect in 1-2 minutes after IV bolus
administration.
Serum CK-MB can be detected 4 to 6 hours after the onset of chest pain. These
levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
I.V push atropine is used to treat symptomatic bradycardia.
Dobutamine is used to treat heart failure and low cardiac output.
Amiodarone is used to treat ventricular fibrillation and unstable ventricular
tachycardia.
Lidocaine is used to treat v-fib., v-tach., and ventricular ectopy.
Ischemic myocardial tissue changes cause elevation of the ST segment,
a peaked or inverted T wave, and a pathologic Q wave.
First-degree heart block presents with a prolonged PR interval and it is the least
dangerous AV heart block.
A prolonged QRS complex indicates a conduction delay in the His-Purkinje
system.
Nitroglycerine side effects include headache, hypotention, dizziness, and flushing
since it is a VASODILATOR.
Vasodilators, beta-adrenergic blockers, and calcium channel blockers
are the three major drug classes used to treat angina pectoris.
Common side effects of beta-adrenergic blockers (e.g., propranolol) include
nausea and vomiting, depression, fatigue, and impotence.
Common side effects of calcium channel blockers (e.g., nifedipine) include
flushing, dizziness, headache, and pedal edema.
Decreased cardiac output is the greatest threat to the survival of a client with
cardiomyopathy.

To help prevent airway obstruction and risk for aspiration, position a

client with hemiparesis on the affected side.
Fine crackles are the breath sounds most commonly auscultated in clients with
heart failure.
To correct v-tachycardia in a conscious client with a detectable pulse and blood
pressure, administer an antiarrhythmic such as amiodarone. If pulse is
undetected, administer a precordial thump. If this measure fails to convert the
abnormal rhythm, initiate defibrillation.
A classic sign that indicates an extending AAA is increased abdominal and back
pain. This indicates that the aneurysm is pressing downward on the lumbar
nerve root.
Troponin (a protein marker) is the best serum indicator of MI!
One-person CPR:
o Establish unresponsiveness
o Call for help
o Assess for breathing while opening the airway
o Deliver two breaths
o Check for carotid pulse
A cholinergic blocking agent may delay the effects of SL nitroglycerine as it may
cause dry mouth.
First-degree AV block is a conduction disturbance in which electrical impulses
flow normally from the SA node through the atria, but are delayed at the AV
node.
During the first week of recovery from MI, monitor for a pericardial friction rub
which may have resulted from inflamed pericardial sac.
Graham Steells murmur is a high-pitched, blowing murmur heard during the
diastole which may have resulted from pulmonary insufficiency (e.g., pulmonary
hypertension or a congenital valve defect).
Ejection clicks are associated with mitral valve prolapse or a rigid, calcified aortic
valve. It is high-pitched.
PT determines a clients response to oral anticoagulant therapy. This must be
maintained at 1.5 to 2.5 times the control value.
PTT determines the effectiveness of heparin therapy.
INR ranges:
o Anticoagulant therapy 2 to 3
o Mechanical prosthetic heart valve 2.5 to 3.5
o Survivors of acute MI 2.5 to 3.5
Bleeding time measures how long a small puncture wound to stop bleeding.
Mitral stenosis causes a diastolic, rumbling, low-pitched murmur heard at the
apex.
Oral hydrazalide (for hypertension) must be taken with food.

Austin Flint murmur is a mid-diastolic aortic regurgitation murmur usually heard

best using the bell of the stethoscope over the mitral area/apex. Its a lowpitched, murmur sound.
In cardiac tamponade, the QRS complexs amplitude decreases!
In patients with rheumatic heart fever, bed rest must be continued until ESR has
stabilized, resting pulse rate is 60 to 100, the client can maintain normal
temperature without salicylates, and a pericardial friction rub disappears
completely.
Standard management for the client with DVT includes bed rest for 5 to 7 days,
elevation of limb, warm moist heat application, and analgesics (acetaminophen)
as needed.
Ambulation in DVT is contraindicated to avoid dislodgement of thrombus and
travel to the lungs!
Sclerotherapy involves injecting a sclerosing agent into the vein to damage the
vein wall and close it off.
Tingling sensation and paresthesias after vein ligation must be reported to the
physician right away.
Patients with arterial disease must avoid elevation of legs unless instructed to do
so as part of an exercise program (e.g., Buerger-Allen exercises), or unless vein
stasis is also present.
ACE inhibitors nursing considerations:
o Instruct client to change positions slowly
o Avoid standing positions for lengthy periods of time
o Avoid extreme warmth
Some mineral water are high in sodium!!! Check labels!!!
Toxic shock syndrome is caused by infection and often is associated with tampon
use. DIC is a common complication of this disease.
Intraaortic balloon pump is commonly used for cardiogenic shock.
IABP is contraindicated in clients with aortic insufficiency and thoracic and
abdominal aneurysms.
Clients with uncontrolled atrial fibrillation is at risk for low cardiac output. Assess
for hypotention, palpitations, chest pain/discomfort, pulse deficit, fatigue,
weakness, dizziness, syncope, SOB, and distended neck veins.
Quinidine sulfate is the drug used for a-fib/flutter. Instruct the client to take it
with food and to wear a Medic Alert bracelet!
The PR interval represents the time it takes for the cardiac impulse to spread
from atria to the ventricles. Normal range for this is 0.12 to 0.20 seconds.
Hypertension can result to renal dysfunction which then result to
microalbuminuria and proteinuria.
Rheumatic heart disease commonly occurs in children after an infection of group
A beta-hemolytic streptococcal pharyngitis.

Tip: diuretics may be delayed before a big event (e.g., parties, meetings),
consequently to delay urination, but not skipped or the client may end up with a
heart failure exacerbation.
Objective guideline for resumption of sexual activity post-MI is the ability to
climb two flights of stairs comfortably is a good guideline.
Clients with pacemaker can resume swimming four months after application.
They must avoid being near a running engine and high-end frequency power
waves.
Post-pacemaker implantation, the client must keep the affected sides arm near
the body for 1 to 3 weeks.
Pneumatic antishock garment is a temporary measure for hypovolemic shock.
Monitor vascular status of the lower extremity as this garment can compromise
blood flow to this area.

References:

Lippincott NCLEX-RN Questions & Answers

Saunders NCLEX-RN Questions & Answers
Delmars Complete Review for NCLEX-RN

For more study outlines/aids and other concerns, e-mail me at eppingkhalid@live.com

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God bless!