Cardiovascular Disorders Practice Flashcards

NCLEX Priority Defaults and Clinical Reasoning

• The fundamental clinical decision-making framework for nursing care involves evaluating the ABCs (Airway, Breathing, and Circulation).

• Assess whether the patient is clinically stable or unstable before proceeding with interventions.

• The primary nursing default is to assess the client thoroughly before implementing any nursing intervention.

• Interventions should always prioritize options that are the safest and least invasive for the patient.

Cardiac Anatomy and Physiology

• The heart is divided into four primary chambers:

  • Right Atrium (RA)

  • Right Ventricle (RV)

  • Left Atrium (LA)

  • Left Ventricle (LV)

• Cardiac valvular structures include:

  • Atrioventricular (AV) Valves: These consist of the Tricuspid valve (right side) and the Mitral valve (left side).

  • Semilunar Valves: There are two semilunar valves, the Pulmonary valve and the Aortic valve.

Sequential Blood Flow Through the Heart

1. Blood enters via the Superior Vena Cava and Inferior Vena Cava.

2. Right Atrium.

3. Tricuspid Valve.

4. Right Ventricle.

5. Pulmonary Valve.

6. Pulmonary Arteries (carrying oxygen-poor blood to the lungs).

7. Pulmonary Veins (carrying oxygen-rich blood from the lungs).

8. Left Atrium.

9. Mitral Valve.

10. Left Ventricle.

11. Aortic Valve.

12. Aorta.

Comprehensive Cardiac Data Collection

• Health History: Collect medical and surgical history to identify pre-existing conditions.

• General Appearance: Observe overall habitus and signs of distress.

• Vital Signs: Monitor blood pressure, taking note of specific trends or elevations.

• Weight: Essential for monitoring fluid status.

• Auscultation and Palpation:

  • Heart and lung sounds.

  • Pulse rate and quality.

• Skin Assessment:

  • Flushed appearance.

  • Pallor.

  • Edema.

• Respiratory Assessment: Assess for crackles in the lungs.

• Mental Status: Monitor for confusion, which may indicate low oxygen levels, or anxiety.

Orthostatic Blood Pressure Nursing Guidelines

As outlined in Nursing Guidelines 22-1 for assessing postural changes:

1. The client must lie down for at least $3$ minutes.

2. Assess the initial blood pressure and pulse.

3. Assist the client to a sitting position, remaining prepared to steady them if they become dizzy or faint.

4. Reassess BP and pulse within $30$ seconds of the client sitting.

5. Repeat the assessment with the client standing.

6. Calculate the difference in systolic (SBP) and diastolic (DBP) pressures between the different positions.

7. Calculate the difference in heart rate (HR) between positions.

8. Postural Change Criteria: A client manifests postural changes if the BP decreases by more than $10\,mmHg$ from the previous measurement and the heart rate increases by $10\%$ or more.

Arterial and Venous Data Collection

Arterial Assessment (P.A.T.C.H.E.S.)

• P: Pulses

• A: Appearance

• T: Temperature

• C: Capillary Refill

• H: Hardened texture

• E: Edema

• S: Sensation

Venous Assessment

• Objective Findings:

  • Presence of edema.

  • Changes in skin coloration.

  • Visible dilated veins.

  • Presence of ulcers.

  • Verification that pulses are present.

• Subjective Findings: Client reports of feeling heavy in the extremities.

• History: History of Deep Vein Thrombosis (DVT), cellulitis, or trauma.

Hypertension (HTN)

Physiological Foundation

• Blood pressure is determined by Cardiac Output and Peripheral Vascular Resistance.

• Systole: The contraction of the Left Ventricle.

• Diastole: The relaxation of the heart.

• Regulation: BP rises due to the Sympathetic Nervous System and the Renin-Angiotensin System.

Classification of Blood Pressure in Adults ($18$ Years or Older)

• Normal: Systolic $\text{Less than } 120\,mmHg$ AND Diastolic $\text{Less than } 80\,mmHg$.

• Elevated: Systolic $120-129\,mmHg$ AND Diastolic $\text{Less than } 80\,mmHg$.

• Stage 1 Hypertension: Systolic $130-139\,mmHg$ OR Diastolic $80-89\,mmHg$.

• Stage 2 Hypertension: Systolic $140\,mmHg$ or higher OR Diastolic $90\,mmHg$ or higher.

• Hypertensive Crisis: Systolic $\text{Higher than } 180\,mmHg$ AND/OR Diastolic $\text{Higher than } 120\,mmHg$.

Essential (Primary) Hypertension

• Accounts for $95\%$ of all hypertension cases.

• Causes: Aging, genetics, being overweight, sedentary lifestyle, high sodium intake, and alcohol consumption.

• Prognosis: This is a lifelong condition; if unmanaged, it leads to Myocardial Infarction (MI) and stroke.

Clinical Manifestations and Assessment

• Known as the "silent killer."

• Cues: Headache, blurred vision, and spontaneous nosebleeds.

• Diagnostics: Evaluations focus on how hypertension has affected other body organs and establishing a baseline health profile.

Medical and Nursing Management

• Non-Pharmacologic: Weight management, exercise, reducing fats, limiting alcohol, reducing sodium, smoking cessation, and relaxation techniques.

• Drug Therapy: Diuretics, ACE inhibitors, Angiotensin II receptor blockers, Alpha blockers, Beta-blockers, Direct vasodilators, and Calcium Channel Blockers.

• Nursing Role:

  • Obtain baseline BP before administering medications.

  • Encourage lifestyle changes and medication compliance.

  • Educate on symptoms, exercise, and family participation.

  • Recheck BP after medication administration to evaluate effectiveness.

Malignant Hypertension

• Characterized by severe, rapidly progressive elevation in blood pressure.

• Diastolic pressure rises above $120\,mmHg$.

• Causes inflammation of the arterioles in the eyes.

Heart Failure (HF)

Etiology and Manifestations

• The heart cannot sustain the body's metabolic needs.

• Often occurs following MI, HTN, Diabetes Mellitus (DM), or valve disease.

• General Cues: Fatigue, angina, oliguria (low urine output), weight gain, restlessness, and respiratory manifestations.

Left-Sided Heart Failure

• Characterized by a weak Left Ventricle.

• Primarily affects the LUNGS.

• Symptoms: Restlessness, confusion, paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, cough, crackles, wheezes, blood-tinged sputum, orthopnea, tachycardia, exertional dyspnea, and cyanosis.

Right-Sided Heart Failure

• Characterized by a weak Right Ventricle.

• Causes peripheral congestion and inability to accommodate venous return.

• Key Symptom: Peripheral edema.

Diagnostics and Management

• Tests: Ejection Fraction, EKG, Echocardiogram, Serum blood tests (especially BNP), and Arterial Blood Gases (ABGs).

• Medical Management:

  • Increase cardiac efficiency using Cardiac Glycosides like Digoxin.

  • Lower oxygen demand and reduce pulmonary edema.

  • Use Diuretics (monitored via urine output and weight).

  • Diet restrictions, Pacemakers, Oxygen therapy, Anxiety therapy.

  • Anticoagulants for patients with Atrial Fibrillation (A-fib).

• Nursing Management:

  • Track daily weight and vital signs.

  • Monitor urinary output and measure abdominal girth.

  • Auscultate lung sounds and assess activity tolerance.

  • Support smoking cessation.

Infections and Inflammatory Disorders

Rheumatic Carditis

• Induced by antibodies resulting from group A streptococcal pharyngitis.

• Leads to permanent valve damage.

• Nursing focus: History of illness, medication adherence, and monitoring for complications.

Infective Endocarditis

• Infection of the inner membrane of the heart and valves.

• Cues: Lesions on hands/feet, petechiae, and heart murmurs.

• Management: IV antibiotics, valve replacement for severe cases, bed rest during flare-ups, monitoring for emboli, and daily weights.

Cardiomyopathy

• Structural changes in the heart muscle.

• Three Primary Types:

  • Dilated: "Floppy" muscle with enlarged ventricles.

  • Hypertrophic: "Thickened" muscle and stiff septum.

  • Restrictive: "Stiffened" ventricle walls.

• Signs and Symptoms: Murmurs (often the first sign), angina, syncope, and dyspnea.

• Management: Biopsy for diagnosis, medications, symptom journals, and oxygen.

Valvular Disorders

• Normal Function: Ensuring unidirectional flow. The Mitral and Aortic valves are most commonly affected; Tricuspid and Pulmonary are less frequent.

• Etiology: Stenosis (narrowing), insufficiency/regurgitation, congenital defects, or Rheumatic Fever.

• Functional Definitions:

  • Stenosis: The valve does not open properly (should be open but is restricted).

  • Regurgitation: The valve does not close properly (should be closed but allows backflow).

• Nursing Management: Assist with Activities of Daily Living (ADLs), provide symptom relief, record I&O, monitor daily weights and edema, administrative medications, and emphasize dental care hygiene.

Coronary Artery Disease (CAD) and Myocardial Infarction (MI)

Arteriosclerosis and Atherosclerosis

• Arteriosclerosis: Hardening of the arterial walls, often related to aging.

• Atherosclerosis: Filling of the arterial lumen with lipid plaque, resulting in decreased elasticity and oxygen supply to tissues (ischemia), often linked to hyperlipidemia.

CAD Manifestations and Diagnostics

• Cues: Chest pain (Angina) that is typically relieved by stopping activity; progresses to Myocardial Infarction.

• Diagnostics: Lipid profile, Angiogram, and Cardiac Catheterization.

CAD Medical and Surgical Management

• Goals: Restore blood flow and reduce workload.

• Interventions: Oxygen, Angiogram (goal within $90$ minutes), Percutaneous Transluminal Coronary Angioplasty (PTCA/Balloon Angioplasty), Stent placement, Atherectomy, and Coronary Artery Bypass Graft (CABG) surgery.

Myocardial Infarction (MI)

• Defined as prolonged total occlusion of coronary arterial blood flow.

• Emergency Management (MONA):

  • M: Morphine (if pain is unrelieved by Nitroglycerin; monitor SBP).

  • O: Oxygen.

  • N: Nitroglycerin (SL or Spray).

  • A: Aspirin.

• Nursing Actions: 12-lead EKG, assess pain details, maintain IV access patency, collect baseline labs.

• Complications: Arrhythmias, cardiogenic shock, ventricular rupture, ventricular aneurysm, arterial embolism, venous thrombosis, pulmonary embolism, pericarditis, and mitral insufficiency.

• Later Nursing Care: Encourage rest, decrease risk factors via AHA diet, medication compliance, cardiac rehab, and antihyperlipidemic medications.

Peripheral Vascular Disorders

Peripheral Artery Disease (PAD)

• Caused by atherosclerosis leading to ischemia, necrosis, and tissue loss.

• The 5 Ps: Pain, Pulselessness, Pallor, Polar (coldness), and Paresthesia.

• Claudication: Pain caused by ischemia during exercise; Doppler is used to compare pressure with the arm.

• Arterial Ulcers: Located on toes or dorsum of the foot; wound bed appears pale and is very painful.

• Management: Antiplatelet medications (ASA), fibrinolytics (clot busters ending in -ase/kinase), weight loss, exercise, smoking cessation, and foot care (supportive shoes).

Venous Insufficiency and Ulcers

• Cues: Edema, open wounds, and darker skin pigmentation.

• Management: Promote venous return via elevation and compression; focus on wound healing.

Raynaud\u2019s Disease

• Intermittent arteriole spasms causing chronically cold, numb, cyanotic extremities with throbbing pain.

• Diagnostics: Cold Stimulation Test.

• Management: Prevention, reducing pain, promoting circulation, and ceasing tobacco use.

Buerger\u2019s Disease (Thromboangiitis Obliterans)

• Small arterioles become inflamed and clot off; strongly linked to tobacco use.

• Cues: Cyanosis/redness, thin skin, poor hair growth, gangrenous areas, prolonged capillary refill, and pulses that disappear with activity.

• Management: Exercises, stopping smoking, avoiding trauma, and keeping warm.

Thrombophlebitis and DVT

• Inflammation of the vein due to a thrombus.

• Diagnostics: Ultrasound of the extremity.

• Management: Anticoagulant therapy and prevention teaching.

Aneurysm

• An enlarged, dilated part of an artery caused by arteriosclerosis, trauma, or congenital defects.

• Cues: A pulsating mass (depends on location).

• Diagnostics: Transesophageal Echocardiogram (TEE).

• Management: Control hypertension to prevent rupture, surgical grafts.

Questions and Discussion

Q: If a patient with hypertension is willing to implement lifestyle changes to reduce his blood pressure, which change would be the most beneficial?

• 1. Eating more fiber

• 2. Balancing rest with exercise

• 3. Taking time for more leisure activities

• 4. Giving up smoking cigarettes

• Note: Smoking cessation is a critical cardiovascular intervention.

Q: Which points should be included in the discharge planning of a client who has heart failure? (Select all that apply)

• A) Weigh yourself daily.

• B) Take your blood pressure before taking digoxin.

• C) Increase your carbohydrate intake.

• D) Take your diuretic early in the morning.

• Correct: A, B, and D are standard HF teaching points.

Q: Which statement by a CAD client indicates understanding of a low-cholesterol diet?

• A) \u201cBroiled chicken, with the skin removed, contains no cholesterol.\u201d

• B) \u201cEat fish rather than red meat because it contains no cholesterol.\u201d

• C) \u201cIt is permissible to use polyunsaturated oils to fry food.\u201d

• D) \u201cEgg whites do not contain cholesterol.\u201d

• Correct: D. Egg whites are cholesterol-free, whereas yolks contain cholesterol.