26

Cardiovascular system

Cardiovascular refresher (continued)

CARDIOGENIC SHOCK
Key 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, elevated 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 variables, 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.
CARDIOMYOPATHY
Key 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 hypertrophic cardiomyopathy

313419NCLEX-RN_Chap03.indd 26

Key interventions
Monitor ECG.
Assess cardiovascular status, vital signs, and hemodynamic
variables.
Administer oxygen and medications, as prescribed.
CORONARY ARTERY DISEASE
Key signs and symptoms
Angina (chest pain) that may be substernal, crushing, or compressing; may radiate to the arms, jaw, or back; usually lasts 3 to
5 minutes; and usually occurs after exertion, emotional excitement, 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, lowcholesterol, low-fat diet with increased dietary fiber (low-calorie
only if appropriate)
Antilipemic agents: cholestyramine (Questran), lovastatin
(Mevacor), simvastatin (Zocor), nicotinic acid (Niacor), gemfibrozil (Lopid), colestipol (Colestid)
Low-dose aspirin therapy
Key interventions
Obtain ECG during anginal episodes.
Assess cardiovascular status, including vital signs and hemodynamic variables.
Administer nitroglycerin for anginal episodes.
Administer oxygen therapy during anginal episodes.
Monitor intake and output.
Monitor laboratory studies.
ENDOCARDITIS
Key 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.

4/8/2010 7:01:36 PM