Cardiovascular Nursing

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1.

ACE inhibitors

-ACE -I (drugs ending in "pril" captopril)

-Inhibit conversion of angiotension I to
angiotension II resulting in reduced salt
and water retention.

2.

ACE inhibitors

-Promote vasodilatation and diuresis

decreasing blood volume, resulting in a
decrease in the heart's workload
-May be the first medication prescribed
-Monitor patient for hyperkalemia and
hypotension.

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Acute Coronary
Syndrome or
Acute Myocardial
Infarction

Life threatening condition characterized

by the formation of localized necrotic
area within the myocardium

Aldosterone
antagonists
(ALDO ANT)

-Methyldopa (Aldomet), clonidine

(Catapres)
-Acts on CNS, affecting norepinephrine

Angina
Diagnostic
Findings

-ECG
Resting
Exercise
-Coronary Angiogram
Remains the gold standard in diagnosing
the percentage of blockage in coronary
arteries.

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Angina Pectoris

Clinical syndrome usually characterized

by episodes of pain or pressure in
anterior chest, caused by insufficient
coronary blood flow.

Angina
Pharmacologic
Therapy

-Nitrates
*Dilates vessels, causing decreased
peripheral resistance, decreased BP and
pooling of blood in the body
- adrenergic blockers
*Decrease HR, BP and contractility of
heart
-Calcium channel blockers
*Act on SA node to slow heart rate and
decrease strength of heart muscle
contraction
-Antiplatelet and Anticoagulants
*Prevents platelet aggregation and
subsequent thrombosis, which impedes
blood flow
-Oxygen

Angina
Precipitating
Factors

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-Physical exertion
-Temperature extremes
-Eating a heavy meal
-Emotional stress
-Smoking
-Sexual activity.

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Angiotensin
Receptor Blockers
(ARB)

-Angiotensin receptor blockers (drugs

ending in "sartan" losartan or Cozaar)
-Block the effects of angiotensin II at
the receptor site.
-Reduces peripheral resistance.

Arterial Ulcers

-Typically small, circular and deep

-On tips of toes or in the web spaces
between the toes
-Gangrene of toe results from trauma
to area
-Pain is described as intermittent
claudication.
-No Edema (not enough blood)

Arteriosclerosis
Medical
Management

-Avoid particular stimuli

*Cold
*Tobacco
*Stress
-Pharmacologic
*Calcium channel blocker (nifedipine:
low dose vasodilator)

Arteriosclerosis
Nursing Diagnosis

-Ineffective or altered peripheral tissue

perfusion r/t compromised circulation
-Chronic pain r/t impaired ability of
peripheral vessels to supply tissues
with oxygen
-Risk for Impaired Skin Integrity r/t
decreased peripheral circulation
-Deficient knowledge regarding selfcare activities.

Arteriosclerosis
Nursing
interventions

-Improving Peripheral Arterial

Circulation
*Position of extremity
*Exercise
-Promoting Vasodilation and
Preventing *Vascular Compression
*Smoking cessation.
*Warm blanket to abdomen.
*Avoid cold temperatures.
*Adequate loose fitting clothing.

Arteriosclerosis
Nursing
interventions (2)

-Relieving Pain
*Analgesic administration
*Slow increase in exercise and
formation of collateral circulation
-Maintaining Tissue Integrity
*Avoid trauma to area
*Sturdy, well fitting foot wear.
*Careful examination and care of feet.
*Good nutrition for cell health.

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Arteriosclerosis
Prevention and
Medical
Management

Atherosclerosis

Atherosclerosis
Risk Factors

-Modification of Risk Factors

-Lower cholesterol
*Diet
*Medications
-Maintain normal blood pressure
-Smoking cessation
-Increasing activity
-Manage diabetes
-Surgery to clear occlusion in artery.
Accumulation of lipids, calcium, blood
components, and fibrous tissue on the
intima of large and medium-sized
arteries.
-Modifiable
*Nicotine
*Diet
*Hypertension
*Diabetes
*Obesity
*Stress
*Sedentary lifestyle
*C-reactive protein

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Benign

-Premature atrial contractions (PAC)

-Premature ventricular contractions
(PVC) Coffee excess.

19.

Beta Blockers

-Drugs ending in "olol" atenolol

-Block the sympathetic nervous system
(beta-adrenergic receptors) to slow
heart, reduce its pumping force and
lower BP.

20.

Beta-blockers

-Reduces stimulation and slows the

heart
-Side effects may include dizziness,
hypotension and bradycardia.
-Hold them if Bp is >60 Bpm

Blood Chemistry
Tests related to
Cardiovascular
System

-Na+
control of fluid volume
-K+
major role in cardiac electrophysiologic
function
*Hypokalemia
*Hyperkalemia
-Ca++
*neuromuscular activity and
automaticity
*Hypocalemia
*Hypercalemia
-FBS or Hemoglobin A1C

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Blood Pressure
Classification

Systolic Diastolic
Normal <120 <80
Hypertension <140-159 < 90-99

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Brain (B-Type)
Natriuretic
Profile (BNP)

-Secreted by the ventricular walls in

response to an increase in preload or fluid
in the ventricles
-Used for diagnosis, monitoring and as a
prognostic tool for Heart Failure
-Results are quickly done.

Buerger's
Disease:

-Recurring inflammatory process of small

and intermediate vessels
-Most often occurs in men ages 20-35
-Generally in lower extremities.

Calcium
Channel
Blockers

(diltiazem) Cardiazem , (amlodipine)

Norvasc
-Inhibits the movement of calcium into the
cardiac and smooth muscle cells
-Smooth muscle tone is lost which causes
vasodilation in coronary and peripherial
arteries.

Calcium
Channel
Blockers
Nursing
Implications

-Assess for irregular heart, dizziness or

edema
-Do not discontinue suddenly (risk for
depression)
-Observe for hypotension.

Cardiac
Catheterization

-Insertion of catheter into heart under

fluoroscopy, to obtain information about
oxygen saturations, structures,
performance of valves, assess coronary
artery perfusion, and pressure readings
within heart chambers
-Inserted into vein for right side of heart
and artery for left side

Cardiovascular
Angiography

-Done via cardiac catheterization

-Dye injected into vessels during
catheterization to make them visible on xray to check patency, injury, or aneurysms
*Cardiac
*Peripheral (carotid, renal, femoral).

Cholesterol

-LDL: Normal less than 160mg/dl

-HDL: women: 35-85, men: 35-70
-Triglycerides: Normal100-200 mg/dl.

Chronic
Venous Stasis
Clinical
Manifestations.

-Edema
-Altered pigmentation in gaiter area
-Pain
-Stasis dermatitis
-Skin is dry, cracked, itches and can easily
become infected.

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Classification of
Valvular Heart
Disease

Coronary Artery
Disease

Coronary Artery
Disease symptoms

Diagnostic profile
for acute MI

Digitalis: digoxin
(Lanoxin)

Diuretics

-Stenosed valves
Narrow opening that reduces the flow
of blood from one chamber to the next.
-Insufficient (incompetent) valve
Improper closure of valve that allows
blood to regurgitate (flow backward)
and returns to the chamber it came
from.
-Prolapse
Stretching of an atrioventricular heart
valve leaflet into the atrium during
systole.
-There are no symptoms in 80% of
patients
-Must be a critical deficit in blood
supply to heart in proportion to
demands for oxygen and nutrients
-Most common manifestation of
myocardial ischemia is acute onset of
chest pain.
-Continuum related to location and
degree of vessel obstruction
-Angina pectoris
-Myocardial infarction
-Heart failure
-Sudden cardiac death.
Plasma analysis of key cardiac isoenzymes and other bio-markers:
-CK and CK-MB
-Myoglobin
-Troponin T and I
-Increases force of myocardial
contraction and slows conduction
through AV node
-CO is increased and body is better
perfused.
-Small therapeutic window.
-Loop diuretics
Lasix (furosemide)
-Thiazide diuretics
(hydrochlorothiazide, hydrothiazide)
-Potassium sparing diuretics.

Dysrhythmias

Life threatening (Ventricle

dysrhytmias)
-Ventricular tachycardia (Flush back)
-Ventricular fibrillation (quiver)
-Asystole (no heart activity)
(Decrease cardiac output and tissue
perfusion)

Electrocardiogram
(ECG)

-A graphic study of the electrical

activity of the myocardium to determine
transmission of cardiac impulses
through the muscles/conduction tissue.

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Endocarditis
Nursing
Management

-Monitor temperature
-Assess heart sounds
-Signs and symptoms of embolization and
organ damage.

Endocarditis
Nursing
Management
and Process.

-Diagnosing and treating group A betahemolytic streptococcal pharyngitis

(common in school-age children) can
prevent rheumatic fever and rheumatic heart
disease
-Teaching people to recognize and seek
medical treatment for streptococcal
pharyngitis.

Endocarditis
Symptoms

-Fever (intermittent/absent)
-Heart murmur
-Headache
-Small, painful nodules on fingers.

Exercise
Cardiac
Stress Test

-Walking on a treadmill - usually 9 to 12

minutes with increases in speed and incline
of treadmill every 2 to 3 minutes based upon
protocol used
-Exercise bicycle - with increase in
resistance at set intervals.

Exercise
Cardiac
Stress Test
Interventions

-Pt. needs to fast for 4 hours before test and

avoid stimulants (tobacco, caffeine)
-Some cardiac medications (beta adrenergic
blockers) may be held
-Equipment to be used and need to have an
IV
-Symptoms to report during testing.

Heart Failure
Diagnostic

-B-type natriuretic peptide (BNP) is key

indicator of Heart Failure
-Low pulse oximetry readings <90%
-X-ray may reveal fluid infiltrates.

Heart Failure
Nursing
Planning and
Interventions

-Promoting Activity Tolerance

*Goal should be for patient to engage in 3045 minutes of physical activity per day
*Choice of exercise needs to consider other
medical conditions
*Enroll in rehabilitation program.

Heart Failure
Nursing
Planning and
Interventions
(2)

-Managing Fluid Volume

*Administer medications
*Assess fluid balance (I & O/Weigh patient
daily/Dependent edema [gravity based])
Auscultate lung sound for crackles)
*Determine the degree of jugular venous
distention
*Monitor apical pulse for rate, rhythm and
extra heart sounds. (Due to extra pressure)
*Monitor blood pressure.
*Assess skin turgor and mucous membranes.
*Assess for symptoms of fluid overload.

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Hypertension
Assessment and
Diagnostic
Evaluation

-Retinal examination
-Urinalysis for renal damage
-Blood Chemistry
*Electrolytes
*FBS
*Total and HDL cholesterol levels
*BUN or Creatinine
- 12 lead EKG
-Chest x-ray.

Hypertension
Clinical
Manifestations

-Usually NO symptoms other than

elevated blood pressure
-Symptoms seen related to vascular
and organ damage
*Left ventricular hypertrophy
*Heart failure
*Renal failure
*Stroke
- Are seen late and are serious.

Improve Respiratory
Function

-Administer O2 and monitor

saturations levels
-T, C, DB
-Prevent fluid overload in lungs

Left Sided Heart

Failure

Left Sided Heart

Failure Clinical
Manifestation

Left Sided Heart

Failure Clinical
Manifestation (2)

Lifestyle
Modifications
Hypertension

-Blood backs up into the pulmonary

system causing pulmonary
congestion or fluid in the lungs.
-Cardiac output is decreased which
means less blood enters the systemic
circulation
-The body than does not receive
oxygen and nutrients.
-Pulmonary congestion/edema
*Dyspnea
*Orthopnea
*PND paroxysmal nocturnal dyspnea
*Cough that is dry at first but than
becomes moist over time and is
sometimes blood tinged
*Crackles (Dry cough).
-Decreased cardiac output
*Decreased oxygen saturation
*Cerebral hypoxia/ Confusion
*Oliguria (decreased urine output)
*Weak pulses
*Fatigue and weakness
-Clinical Manifestations of Heart
Failure may not be detected until the
disease is advanced
-Weight reduction.
-Dietary approaches.
-Dietary sodium reduction.
-Physical activity.
-Moderation of alcohol
consumption.

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Medical
Management
Hypertension

-SBP 140 or less

-DBP 90 or less
Persons with diabetes mellitus or chronic
renal disease have a lower goal pressure
of 130/80.

MI

-Unrelieved ischemia of > 15 minutes

causes irreversible damage to the
myocardium (necrosis)
-Area of the myocardium is permanently
destroyed.

MI Other
therapies

-Oxygen
-Bed rest
-Continuous ECG monitoring
-Evaluate for indications for reperfusion
therapy
*Percutaneous coronary intervention
*PTCA -Percutaneous Transluminal
*Coronary Angioplasty
*Coronary Artery Stent Placement
*Artherectomy
*Thrombolytic therapy.

MI
Pharmacological
Therapy

-ASA 162-325 mg
-Nitroglycerin
-Morphine
-Beta-blocker
-Heparin
-ACE inhibitor within 24 hours (acts on
BP).

MI Symptoms

-Shortness of breath, indigestion, nausea,

anxiety
-Cool, pale and moist skin.
-Symptoms cannot always be
distinguished .

Modifiable Risk
Factors:
Essential
Hypertension

-Obesity
-Sedentary life style
-Alcohol
-Stress
-Smoking
-High sodium diet
-Oral contraceptives
-Decreased Estrogen
-Elevated serum cholesterol

Myocarditis

-Uncommon infection of the heart muscle

caused by viral, bacterial or fungal
infection
-Infection causes immune response which
damages heart muscles causing dilation
of heart and degeneration of heart
muscles
-Presenting symptoms are flu-like
-Organism must be identified and then
treated.

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Myocarditis
Nursing
Management

-Treat infections
-Rest
-Fluids
-Monitor for dysrhythmias (SOB, Skips)
-Monitor for heart failure.

Non-modifiable
Risk Factors:
Essential
Hypertension

-Family history
-Age
-Gender
-Race & ethnicity

Nursing
Implications:
ACE

-Hypotension reversed by fluid

replacement
-Used with thiazide diuretic and
digoxin.

Nursing
Implications:
ALDO ANT

-Rebound htn is common (educate

continue taking to avoid rebound)
-SE: dry mouth, drowsiness dizziness,
nasal congestion, severe depression,
constipation, fatigue, headache,
sleepiness.

Nursing
Implications:
ARB

-Monitor for hyperkalemia.

Nursing
Implications Beta
Blockers

-Check heart rate (60) and BP before

giving
-May cause mental depression
-Indicated for patients with stable and
silent angina
-Avoid sudden discontinuation.

Nursing
Management and
Process

Nursing
Responsibility for
cardiac
catheterization

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-The diagnosis
-Progressive nature of the disease
-Teatment plan
-Signs and symptoms of heart failure
-To report new symptoms or changes in
-symptoms to the health care provider
-The need for prophylactic antibiotic
therapy before any invasive procedure.
-Prior to procedure:
*Confirm consent has been signed
*NPO 8-12 hours
*ECG monitoring
*Patent IV line
*Resuscitation equipment on hand
-After procedure:
*Assess site for hematoma, circulation
to affected extremity, ECG, HR
*Bed rest for 2-6 hours with leg straight
*Monitor for chest pain.

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Percutaneous
Coronary
Intervention

-Percutaneous transluminal coronary

angioplasty (PTCA) is used to open blocked
coronary arteries and resolve ischemia
-Balloon, at tip of catheter, is inflated and
plaque is pushed against the wall
-Stent may be placed over the balloon and
left in place
-Fluoroscopy is used to guide catheter.

Pericarditis

-Inflammation of the pericardium

(membranous sac that surrounds heart)
-Has multiple causes : bacteria, virus,
fungus, parasites, renal failure, MI, chest
trauma.

Pericarditis
Nursing
Management

-Assess and treat pain

-Bed rest to promote healing
-Elevate HOB and lean forward to decrease
pain and dyspnea
-Education and reassurance that the pain is
not a heart attack
-Monitor for heart failure.

Pericarditis
Symptoms

-Creaky or scratchy friction rub heard most

clearly at the left lower sternal border
-Chest pain that becomes worse when the
patient takes a deep breath or lie down
-May be relieved when patient leans
forward and/or is in sitting position.

Peripheral
Vascular
Disorders
Symptoms

Depends on the organ or tissue affected

-Intermittent claudication - hallmark
Aching/cramping that occurs with same
degree of exercise or activity and relieved
with rest
-Pain at rest.

Pharmacologic
Cardiac Stress
Imaging

-Patients who cannot walk on treadmill or

use exercise bike may undergo
pharmacologic stress test with imaging
-Vasodilation of coronary arteries with
medications mimics the effect of exercise

Process for the

Patient with
Hypertension

Assessment
-Proper measuring of BP at frequent
intervals
-Assess apical and peripheral pulse
-Monitor electrolytes and instruct patient on
electrolyte replacement therapy if
applicable.

Promote
adequate
tissue
perfusion

-Bedrest
-Oxygen therapy.

Pulmonary
Embolism
Symptom

-SOB

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Raynaud's Disease

-Intermittent arterial vasoocclusion, usually of the fingertips

or toes
-Brought on by trigger such as cold
or stress
-Often occurs in young women.
-White hands.

Reduce venous stasis

and prevent
ulcerations

-Avoid prolong standing, sitting or

crossing the legs
-Elevation of legs above the heart
-Sleep with the foot of the bed
elevated
-Use of elastic compression
stockings

Relieving Pain and

Other
Signs/Symptoms of
Ischemia

-Administration of medications
-Oxygen therapy
-Bed rest with elevation of head
and torso.

Report immediately to
the physician or clinic

-Weight gain of more than or

equal to 2-3 lbs in 1 day or 5 lb in 1
week
-Loss of appetite
-Unusual shortness of breath with
activity
-Swelling of ankles, feet or
abdomen
-Persistent cough
-Development of restless sleep;
increase in the number of pillows
needed to sleep

Right Sided Heart

Failure

Right Side Heart

Failure Clinical
Manifestation

Stable Angina

-Blood backs up into the systemic

circulation.
-Fluid accumulates behind the
chambers that fail first.
-Congestion occurs in the liver,
gastrointestinal tract and
periphery (arms and legs).
-Pronounced jugular neck vein
(JVD).
-Pitting edema
(Peripheral/Perineal/sacral).
-Ascitis (Pain).
-Hepatomegaly.
-Weight gain. (2-3 lbs in 1 day or 5
lb in 1 week)
-Increase urine output.
-Frequent nocturnal urination.
-Infrequent predictable and
consistent pain
-Occurs on exertion, by a
predictable degree of exercise
-Treatable with rest or
nitroglycerides or both.

Stage 2 HTN
without
compelling
indications

-Continue lifestyle modifications

-Usually on 2-drug combination
-Thiazide diuretic (HCTZ) and ACE1/ARB/BB/CCB

Step Care
Management of
Hypertension

-Step 1
Lifestyle modifications (Diet, exercise)

Therapies Heart
Failure

-Nutritional Therapy
*Low-sodium (2-3 g/day) diet
*Avoid excessive fluid intake
-Oxygen therapy
*May become necessary as heart failure
progresses
*Based on patient SpO2.

Thrombosis
Clinical
Manifestations

-Edema and swelling.

-Warm skin and erythema.
-Tenderness.
-Homans is an unreliable sign.

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Types of Angina

-Stable
-Unstable.

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Unstable Angina

-Triggered by an unpredictable degree of

exertion or emotions
-May occur at rest and last longer than
stable angina
-Increasing frequency and severity over
time that is not relieved by rest and
NTG.

Use of
Nitroglycerine

-When pain occurs instruct patient to

Stop activities and rest
-Use NTG
*Repeat every 5 minutes if pain is not
relieved
*Call 911 if the pain is not relieved in 15
minutes.

Valvular Heart
Disease

Occurs when valves are compromised

and do not open and close properly.

Varicose Veins

-Abnormally dilated, tortuous,

superficial veins caused by incompetent
venous valves
-Impaired blood return due to
incompetent valves
-Seen more frequently in women and in
people whose occupations require
prolonged standing.

Varicose Veins
Clinical
Manifestations

-Dull aches, muscle cramps, increased

muscle fatigue, ankle edema and
heaviness of the legs
-Cause of chronic venous insufficiency
-More susceptible to injury and
infections.

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Varicose Veins Nursing Process

-Instruct patient to avoid standing for extended periods of time

-Elevate legs when seated
-Compression stocking should be worn
-Weight reduction
-Exercise
Weight reduction, if factor

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Venous Stasis

-Results from obstruction of venous valves in legs or a reflux of blood through

the valves.

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Venous Thrombosis Causes

-Endothelial damage (Surgery)

-Venous stasis (rest)
-Altered or hyper-coagulation (surgery, hepatic diseases, Birth control pills)

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Venous Ulcers

-Feet and ankles are edematous

-Ulcerations are in area of the medial or lateral malleolus
-Typically are large, superficial and highly exudative
-Superficial (Not Deep)

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Women's hearts are:

Smaller and have smaller cardiac arteries

Cardiac arteries occlude more easily
resting rate
stroke volume
ejection fraction

Women tend to have atypical signs/symptoms

of MI:

-Shoulder/upper back pain

-SOB
-Fatigue.

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