28

Cardiovascular system

Cardiovascular refresher (continued)

HYPOVOLEMIC SHOCK (CONTINUED)
Key test results
Blood tests show elevated potassium, serum lactate, and
BUN levels; increased urine specific gravity (greater than 1.020)
and urine osmolality; decreased blood pH; decreased partial
pressure of arterial oxygen; increased partial pressure of arterial
carbon dioxide; and possible decreased hemoglobin and hematocrit (if the client is bleeding).
ABG analysis reveals metabolic acidosis.
Key treatments
Blood and fluid replacement
Control of bleeding
Key interventions
Record blood pressure, pulse rate, peripheral pulses,
respiratory rate, and pulse oximetry every 15 minutes and monitor
the ECG continuously. A systolic blood pressure lower than
80 mm Hg usually results in inadequate coronary artery blood
flow, cardiac ischemia, arrhythmias, and further complications
of low cardiac output. When blood pressure drops below
80 mm Hg, increase the oxygen flow rate and notify the physician
immediately.
Insert large-bore (14G) I.V. catheters and infuse normal saline,
lactated Ringers solution, and appropriate blood products as
indicated.
Insert an indwelling urinary catheter to measure hourly urine
output. If output is less than 30 ml/hour in adults, increase the
fluid infusion rate but watch for signs of fluid overload such as
an increase in pulmonary artery wedge pressure (PAWP). Notify
the physician if urine output doesnt improve. An osmotic diuretic
such as mannitol (Osmitrol) may be ordered.
Monitor hemodynamic parameters (CVP, pulmonary artery
pressure [PAP], and PAWP).
During therapy, assess skin color and temperature and
note any changes. Cold, clammy skin may be a sign of
continuing peripheral vascular constriction, indicating progressive shock.
MYOCARDIAL INFARCTION
Key signs and symptoms
Crushing substernal chest pain that may radiate to the jaw,
back, and arms; lasts longer than anginal pain; is unrelieved
by rest or nitroglycerin; may not be present (in asymptomatic
or silent MI); in women, possible atypical symptoms of pain or
fatigue

Key treatments
Anticoagulants: aspirin, dalteparin (Fragmin), enoxaparin
(Lovenox), heparin I.V. after thrombolytic therapy
Thrombolytic therapy: alteplase (Activase), streptokinase
(Streptase), reteplase (Retavase); should be given within 6 hours
of onset of symptoms but most effective when started within
3 hours
Oxygen therapy
Nitrate: nitroglycerin I.V.
Analgesic: morphine I.V.
Key interventions
Assess cardiovascular and respiratory status.
Obtain an ECG reading during acute pain.
Administer medications.
MYOCARDITIS
Key signs and symptoms
Arrhythmias (S3 and S4 gallops, faint S1)
Dyspnea
Fatigue
Fever
Key test results
ECG typically shows diffuse ST-segment and T-wave abnormalities (as in pericarditis), conduction defects (prolonged PR
interval), and other supraventricular arrhythmias.
Endomyocardial biopsy confirms the diagnosis, but a negative
biopsy doesnt exclude the diagnosis. A repeat biopsy may be
needed.
Key treatments
Bed rest
Antiarrhythmics: amiodarone (Cordarone), procainamide
Antibiotics: according to sensitivity of infecting organism
Cardiac glycoside: digoxin (Lanoxin) to increase myocardial
contractility
Diuretic: furosemide (Lasix)
Key interventions
Assess cardiovascular status frequently to monitor for signs
of heart failure, such as dyspnea, hypotension, and tachycardia.
Check for changes in cardiac rhythm or conduction.
Stress the importance of bed rest. Assist with bathing as
necessary; provide a bedside commode. Reassure the client that
activity limitations are temporary.

Key test results

ECG shows an enlarged Q wave, an elevated or a depressed
ST segment, and T-wave inversion.

313419NCLEX-RN_Chap03.indd 28

4/8/2010 7:01:36 PM