CARDIOLOGY  Management

HYPERTENSION
CONTENT  Diet: Low fat diet
1. CAD (Atherosclerosis)  Exercise
2. Angina pectoris  Medications (Anti-HPN)
3. Myocardial infarction/Heart attack o Vasodilators
4. CHF a. Calcium Channel Blockers
5. Abdominal aortic aneurysm  Amlodipine
6. Raynaud’s vs. Buerger’s  Nifedipine
 Nicardipine
b. Ace Inhibitors
CAD (Atherosclerosis)
 Enalapril
 Plaque formation in the coronary artery
 Captopril
 Plaque  Made of cholesterol  Clogged   Lisinopril
Decreased tissue perfusion in the heart (heart muscles c. Angiotensin Receptor Blockers
can die)  Telmisartan
 Losartan

Action: Dilates blood vessel  Lowers blood pressure

Side effect: Hypotension
Nursing responsibility: Check for BP before administering
medication
Ace Inhibitors:
 WOF: Angioedema, Cough, Elevated potassium level 
Notify physician because these are adverse effects
 Angioedema: Swelling of lips and tongue
 May lead to development of the following
 Angina o Beta Blockers
 Myocardial Infarction (MI)  Metoprolol
 Congestive Heart Failure (CHF)  Propranolol
 Dysrhythmias  Bisoprolol
 Risk factors Action: Decreases heart rate  Lowers blood pressure
Non-modifiable Modifiable risk factors Nursing responsibility: Check HR before administering, less than
risk factors Focus of nursing care 60 bpm  hold Beta Blockers
Family history Hypertension Contraindicated to patients with respiratory problems (COPD) 
Age Cigarette smoking  It has Beta Blockers causes bronchoconstriction
- Male: 40 nicotine  Effect:
- Female: 55 Vasoconstriction, hardening of
Race
o Diuretics
blood vessels
- Black Americans (arteriosclerosis), increased
 Loop diuretics (Potassium waster)
- Caucasians viscosity of blood  Increased  May cause hypokalemia
Gender risk of clot formation   Potassium sparing diuretics
- Male: Increased risk Obstruction of coronary artery  May cause hyperkalemia
of morbidity Increased cholesterol  Thiazide diuretics
- Female: Increased - Normal: < 200 mg/dl  May cause hypokalemia and
risk of mortality (Late - HDL: More than 40 hypercalcemia
detection, late  Good for the CIGARETTE SMOKING
treatment  poor heart
prognosis  Stop cigarette smoking
- LDL: Less than 140
INCREASED CHOLESTEROL
 Bad for the heart
Diabetes mellitus
 Diet: Low cholesterol diet  Avoid fast food, fried food,
oily food
- Low insulin
- Sugar cannot enter  Exercise
the cell  Cellular  Medications
starvation  o Anti-lipemic
Convert fats to  Simvastatin
glucose  Atorvastatin
(Gluconeogenesis)  Rosuvastatin
causes production of Side note for anti-lipemic
biproduct  - Cholesterol is formed in the liver  Formed at dawn
Cholesterol - Anti-lipemic should be given at evening
- Increased viscosity - Medication acts in the liver
of blood - Statins are hepatotoxic  Monitor liver function test
Stress (AST/ALT)
- Monitor for signs of hepatotoxic  jaundice, icteric
sclera  Stop medication
- Adverse effects: Rhabdomyolysis  manifested by
muscle pain  Notify physician

NCLEX INAP SIR LEOJ AFALLA ICG BINWAG

 DIABETES MELLITUS
 Diet
 Exercise
 Insulin or OHA
STRESS
 Stress reduction technique
o Yoga, Tai chi
ANGINA PECTORIS
 Cause: Imbalance in the oxygen demand and
supply due to CAD
 Increased oxygen demand, decreased oxygen
supply
 2 types
 Stable
o There is a precipitating factor  Predictable
a. Exercise
b. Eating large meals
c. Exposure to cold
d. Emotional stress
o Location of pain  Retrosternal chest pain
that radiates to left arm, shoulder, jaw, back
that lasts for less 15 minutes
o ECG findings  T wave inversion, ST
depression  Indicates myocardial ischemia
o Management (Purpose: Balance oxygen
demand and supply)
a. Stop activity that causes chest pain 
Rest
b. Oxygen if available
c. Nitroglycerin (Vasodilator)
 Maximum of 3 doses with interval of
5 minutes per dose
 Route: Sublingual, patch
 Best site for patch: Hairless area
proximal to the heart
 Unstable/Pre-infarct angina
o No precipitating factor  Unpredictable
o Location of pain  Substernal chest pain,
epigastric chest pain radiates to left arm,
shoulder, jaw that lasts for more than 15
minutes
o Not responding to rest and nitroglycerin
o ECG findings  T wave inversion, ST
elevation  Indicates myocardial injury
o Management
a. Rush the patient to the nearest hospital
MYOCARDIAL INFARCTION/HEART ATTACK
 Necrosis in the myocardium  Myocardium is
deprived of oxygen
 Decreased oxygen that enters heart muscle
because coronary artery is clogged
 Signs and symptoms
 Chest pain
o Characteristic: Crushing substernal chest
pain  They manifest levine’s sign
o Not all experiences chest pain like patients
with DM and elderly patients  Because of
nerve damage that radiates to left side of the
body (arm, shoulder, jaw, back) that lasts for
30 minutes
 Changes of level of consciousness (elderly)
NCLEX INAP SIR LEOJ AFALLA
 Nausea and vomiting  Sympathetic nervous
system activation
 Diaphoresis  Sympathetic nervous system
activation
 Increased anxiety; Feeling of impending doom 
Sympathetic nervous system activation
 Cool clammy pale skin  Sympathetic nervous
system activation
 Diagnostic test
 Troponin I
o Normal: 0-0.4; More than 0.4 (elevated 
necrosis)
 Creatinine Kinase-MB (CK-MB)
 ECG
o T wave inversion  Indicates myocardial
ischemia
o ST elevation  Indicates myocardial injury
o Pathologic Q wave  Indicates myocardial
necrosis
 Management
 During acute stage (Emergency management)
o O2 (2-3 lpm via nasal cannula)  to increase
oxygen in the myocardium to prevent further
necrosis
o Aspirin (ASA)  to prevent further clot
formation
o Nitroglycerin  to promote vasodilation
o Morphine sulfate  WOF respiratory
depression  Bedside: Naloxone (Narcan)
 After acute stage  Clot buster
1. Surgery: Percutaneous transluminal coronary
angioplasty (PTCA)
a. Insertion of catheter going to the affected
coronary artery  Dilate balloon  insert
stent to flatten plaque formation
b. Administers contrast medium
PRE-OP
c. NPO for 6-12 hours before surgery
d. Assess for allergy to iodine/seafood  If
allergic, not allowed to PTCA
e. Check kidney function test prior to PTCA
specifically Creatinine (it should be within
normal range)
 Normal: 0.6-1.2 mg/dl; More than 1.2
 Will have difficulty to eliminate
contrast medium
 Contrast medium is a kidney killer 
toxic to kidney
f. Check if patient has taken Metformin 
Withhold for 24 hours prior to
administration of contrast medium 
causes lactic acidosis  toxic to kidneys
POST-OP
g. After PTCA  Flat on bed, bed rest, avoid
flexion on hip area
h. If patient walks, there is a big chance that
the clot in femoral area will be removed 
can cause bleeding or can travel to lower
extremities that can cause acute arterial
occlusion in the lower extremities
2. Surgery: Coronary Artery Bypass Graft
(CABG)
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 a. Makes a bypass  New vein (saphenous
vein  from the legs)
POST-OP
b. After CABG  Avoid lifting, pushing,
pulling for 6 weeks
c. Avoid bath tub  Soaks incision 
Increases risk for infection
d. WOF: Redness, swelling and drainage in
the incision sites
e. Avoid crossing of legs  Decrease blood
supply in affected leg if patient does leg
crossing
3. Medication
a. Thrombolytics
 Dissolves clots; Lysis of clots
 Contraindicated: Patients with history
of cerebral aneurysm (dilated blood
vessels in the brain that can rupture)
 Examples: Reteplase, Urokinase,
Streptokinase, Alteplase, t-PA  Via
IV route
 Side effect: Bleeding  Stop
thrombolytics because it means there
is toxicity
 Antidote: Aminocaproic acid (Amicar)
4. Rehabilitation
a. Anticoagulants  to prevent further clot
formation
Heparin Warfarin
(Coumadin)
Route: Parenteral  SQ, Route: Oral
IV Monitor: PT
Monitor: PTT  Normal if taking
 Normal if taking Warfarin: 15-25
Heparin: 38-88 seconds
seconds)  More than 25
 More than 88 seconds 
seconds  Toxicity
Toxicity Antidote: Vitamin K
Antidote: Protamine Diet: Avoid green leafy
sulfate vegetables  Rich in
Fast-acting; Short-term vitamin K
effect Slow-acting; Long-term
effect

b. Beta Blockers, Calcium Channel Blockers,

Ace Inhibitors  to relax the heart
c. Health teachings
 Diet: Low sodium intake, limit oral fluid
intake (2 grams of Sodium per day, 2
liters of fluid per day)
 Reduce: Stress, alcohol intake,
caffeinated products, cholesterol
 Exercise: 30 minutes per session, 5
times a week = 150 minutes per week
 Stop smoking
 Sex
 2 flights of stairs without DOB and
chest pain
 Best time to do sexual activities:
Morning  Because heart is well-
rested
 Avoid using Viagra
 Bring Nitroglycerin
 In case chest pain happens during
sex, stop and take Nitroglycerin
(same instructions)
NCLEX INAP SIR LEOJ AFALLA ICG BINWAG
 CONGESTIVE HEART FAILURE
 Inability of the heart to pump to meet the body’s  Positioning
oxygen demand   cardiac output   tissue Upright position
o
Sitting position
o
perfusion (kidneys are mostly affected)   kidneys 
 Diet
RAAS will be activated  (1) Renin will make
o Low sodium diet; WRONG  Restricted sodium
Angiotensin  Angiotensin I  Angiotensin II = will
o Limit oral fluid intake
cause vasoconstriction  (2) Aldosterone = Sodium  For severe pulmonary edema/acute exacerbation
retention, water retention  Fluid volume excess o Positioning: High fowler’s or upright
o O2
Right sided heart failure Left sided heart failure o Diuretics/Morphine sulfate
Right ventricle cannot pump Left ventricle cannot pump  Avoid NSAIDs  Ibuprofen, Naproxen
properly  Backflows to properly  Backflows to left o NSAIDs promotes water retention  It will increase
right atrium  Backflows to atrium  Backflows to fluid volume excess
jugular vein, spleen, lungs
peritoneal cavity, legs ABDOMINAL AORTIC ANEURYSM (AAA)
 Jugular vein distention  Pulmonary edema  Causes
 Hepatosplenomegaly - Difficulty of breathing  Atherosclerosis (most common)
 Ascites - Orthopnea  Hypertension
 Dependent edema - Crackles  Trauma in the abdominal aorta
- Cough  Infection
- *Pink frothy sputum  Risk factors
 Acute  Cigarette smoking
exacerbation of HF
(Too many fluid in  Age  More than 65 years old
the lungs  Alveoli  Male
have ruptured)  Family history
 Marfan syndrome
 Diagnostic test  Signs and symptoms
BNP
  Earliest sign: None
o More than 100 (for clients with HF)  Late stage
o Indication that heart cannot pump o Abdominal/Back pain
 Management  Goal:  cardiac output, eliminate o Pulsating abdominal mass
excess water o Impending rupture: Severe abdominal/back pain
 Digoxin o Ruptured
o Positive inotropic effect  Increases the force of a. There will be internal bleeding  Blood will
contraction accumulate in peritoneal cavity
b. Increased abdominal girth
o Negative chronotropic effect  Decreases the heart
c. Bluish discoloration of scrotal area
rate
o Nursing responsibility d.  BP (because of bleeding),  HR,  RR
a. Monitor heart rate  Less than 60 bpm or  Management  Goal: Prevent the enlargement/rupture
more than 120 bpm  Withhold Digoxin   Control blood pressure  Anti-HPN medications
Give only if HR is within normal range  Control cholesterol  Low fat diet, anti-lipemics
b. Monitor potassium level  Avoid the following  Increases intraabdominal
 Digoxin hates potassium  Digoxin can pressure
cause hypokalemia o Frequent abdominal palpation
 If potassium level is less than 3.5  o Excessive coughing
Withhold o Sneezing
 Hypokalemia can cause Digoxin toxicity o Blowing of nose
c. Monitor Digoxin therapeutic level o Bending on the waist
 Normal: 0.5-2 meq/L  For ruptured aneurysm  Surgery
 Toxicity level: More than 2 o Open abdominal surgery  Removes damage
 Manifestations part of abdominal aorta  Replaces synthetic tube
 Vomiting and graft  *Graft leakage (there is bleeding that
 Anorexia accumulates in peritoneal cavity)  Notify physician
 Nausea immediately
 Diarrhea a. Indication of graft leakage
 Abdominal pain  Increased abdominal girth
 Toxic to the optic nerve  Green  Bluish discoloration of scrotal area
yellow vision  Decreased urinary output
 Antidote: Digibind
 Diuretics
o Loop diuretics
o Potassium sparing diuretics  Hypokalemia
o Thiazide diuretics
o Nursing responsibility
a. Take diuretics in the morning
b. Check blood pressure before administering
c. After administering, check weight  Weight
loss (effective)
d. This is given because there is excess fluid
NCLEX INAP SIR LEOJ AFALLA ICG BINWAG
 BUERGER’S DISEASE RAYNAUD’S PHENOMENON
 Inflammation of the arteries and veins usually located in  Vasospasm of arteries usually located in the upper
the lower extremities extremities
 Causes  Causes
 Unknown  Unknown (Primary Raynaud’s Disease)
 Autoimmune  Connective tissue disorders (e.g. SLE, Scleroderma)
 Risk factors  Secondary Raynaud’s Phenomenon
 Cigarette smoking  Carpal Tunnel Syndrome  Secondary Raynaud’s
 Male Phenomenon
 < 45 years old  Risk factors
 Signs and symptoms  Lower extremities  Cigarette smoking
 Decreased tissue perfusion  Female
o Pallor  Cold environment (Western, Northern America)
o Pain especially during activities (Intermittent  Signs and symptoms  Upper extremities
claudication)  Decreased tissue perfusion
o Poikilothermia o Flag sign
o Paresthesia a. Blue  Cyanosis
o Necrosis (Gangrene)  Severe cases b. White  Pallor
 Management  Goal: Prevent progression (No cure) c. Red  Erythema
o Stop cigarette smoking o Pain
o Proper foot care o Poikilothermia
a. Inspect lower extremities daily  to see if there o Paresthesia
is impaired skin integrity  Management
b. Wash lower extremities daily especially in  DOC: Calcium Channel Blockers to promote
between toes vasodilation
c. Avoid putting lotion in between toes  Stop cigarette smoking
d. Avoid going outside barefooted  Avoid exposure to cold environment
e. Always wear closed shoes with socks   Avoid stress
canvas or leather  Avoid caffeinated products
f. Instruct client to cut the toe nails straight
across; Do not cut sides of nails 
g. Do not self-manage foot problems; Consult
podiatrist

NCLEX INAP SIR LEOJ AFALLA ICG BINWAG