30

Cardiovascular system

Cardiovascular refresher (continued)

PERIPHERAL ARTERY DISEASE (CONTINUED)
In saddle block occlusion, check distal pulses for adequate
circulation. Watch for signs of renal failure and mesenteric
artery occlusion (severe abdominal pain) and cardiac arrhythmias, which may precipitate embolus formation.
In iliac artery occlusion, monitor urine output for signs of renal
failure from decreased perfusion to the kidneys as a result of
surgery. Provide meticulous catheter care.
In both femoral and popliteal artery occlusions, monitor
peripheral pulses. Assist with early ambulation, but discourage
prolonged sitting.
RAYNAUDS DISEASE
Key signs and symptoms
Numbness and tingling that are relieved by warmth
Typically, blanching of the skin on the fingers, which then
becomes cyanotic before changing to red (after exposure to cold
or stress)
Key test results
Arteriography reveals vasospasm.
Key treatments
Activity changes: avoidance of cold
Smoking cessation (if appropriate)
Surgery (used in fewer than one-quarter of clients): sympathectomy
Calcium channel blockers: diltiazem (Cardizem), nifedipine
(Procardia)
Key interventions
Warn against exposure to the cold. Tell the client to wear
mittens or gloves in cold weather or when handling cold items or
defrosting the freezer.
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE
Key signs and symptoms
Carditis
Temperature of 100.4 F (38 C) or greater
Migratory joint pain or polyarthritis
Key test results
Blood tests show elevated white blood cell count and erythrocyte sedimentation rate and slight anemia during inflammation.
Cardiac enzyme levels may be increased in severe carditis.
C-reactive protein is positive (especially during the acute
phase).
Key treatments
Bed rest (in severe cases)
Surgery: corrective valvular surgery (in cases of persistent
heart failure)

313419NCLEX-RN_Chap03.indd 30

Antibiotics: erythromycin (Erythrocin), penicillin (Pfizerpen)

Nonsteroidal anti-inflammatory drugs: aspirin, indomethacin
(Indocin)
Key interventions
Before giving penicillin, ask the client if hes ever had a hypersensitivity reaction to it. Even if the client has never had a reaction to penicillin, warn that such a reaction is possible.
Instruct the client to watch for and report early signs of heart
failure, such as dyspnea and a hacking, nonproductive cough.
Warn the client to watch for and immediately report signs of
recurrent streptococcal infection sudden sore throat, diffuse
throat redness and oropharyngeal exudate, swollen and tender
cervical lymph glands, pain on swallowing, a temperature of 101
to 104 F (38.3 to 40 C), headache, and nausea. Urge the client
to stay away from people with respiratory tract infections.
THORACIC AORTIC ANEURYSM
Key signs and symptoms
Ascending aneurysm
Pain (described as severe, boring, and ripping and extending to
the neck, shoulders, lower back, or abdomen)
Unequal intensities of the right carotid and left radial pulses
Descending aneurysm
Pain (described as sharp and tearing, usually starting suddenly
between the shoulder blades and possibly radiating to the chest)
Transverse aneurysm
Dyspnea
Pain (described as sharp and tearing and radiating to the
shoulders)
Key test results
Aortography, the definitive test, shows the lumen of the aneurysm, its size and location, and the false lumen in a dissecting
aneurysm.
Chest X-ray shows widening of the aorta.
Computed tomography scan confirms and locates the aneurysm and may be used to monitor its progression.
Key treatments
Surgery: resection of aneurysm with a Dacron or Teflon graft
replacement, possible replacement of aortic valve
Analgesic: morphine
Antihypertensives: nitroprusside (Nitropress), labetalol
(Trandate)
Negative inotropic: propranolol (Inderal)
Key interventions
Monitor the clients blood pressure, PAWP, and CVP. Also
evaluate pain, breathing, and carotid, radial, and femoral pulses.

4/8/2010 7:01:36 PM