CH 24

Book cover for Understanding Medical-Surgical
Nursing, Seventh Edition.
Chapter 24
Nursing Care of
Patients With Occlusive
Cardiovascular Disorders
Copyright ©2023 F.A. Davis Company

Learning Outcomes
 Explain the etiologies, signs and symptoms,
and therapeutic measures of coronary artery
disease, angina pectoris, and
myocardial infarction.
 List data to collect for patients with coronary
artery disease, angina pectoris, or
 Describe therapeutic measures used to treat
coronary artery disease, angina pectoris, and
Learning Outcomes (continued)
 Explain the etiologies and signs and

symptoms for each of the peripheral
vascular disorders.
 Identify therapeutic measures used to treat
peripheral vascular disorders.
 Assist in planning nursing care for patients
with a peripheral vascular disorder.

Chapter Concepts
 Collaboration
 Comfort
 Health Promotion
 Nutrition
 Oxygenation
 Perfusion

Cardiovascular Disease
 Leading cause of disability/death in the

United States
 Affects quality of life and activities of
daily living
 Unmodifiable and modifiable factors lead
to cardiovascular disease (CVD).
 Education is important to prevent and
treat CVD.

Arteriosclerosis
 Artery/arteriole walls
• Thicken
• Lose elasticity
• Calcify

Atherosclerosis
 A type of arteriosclerosis
 Plaque formation in arteries
 Can begin in childhood and progress to
coronary artery disease (CAD)

Atherosclerosis (continued_1)
 Pathophysiology
• Injury, inflammation to artery endothelial cell lining
• Smooth muscle cells grow despite damage.
• Collagen and fibrous proteins are secreted.
• Lipids, platelets, clotting factors accumulate.
• Scar tissue replaces some of arterial wall.

 Pathophysiology (continued)
• Early fatty streak
• Plaque build-up
‒ Irregular jagged edges
‒ Blood cells/other material adhere to artery wall
• Reduced blood flow from narrowing artery
• Plaque develops calcium fibrous cap.

• Plaque fibrous cap ruptures or tears.
• Blood clot forms.
• Clot may occlude artery or break loose.
‒ Can lodge in small cardiac artery

 Nonmodifiable risk factors

• Age
• Gender
• Ethnicity
• Genetic predisposition for hyperlipidemia

 Modifiable risk factors
• Blood glucose control • Excessive alcohol intake
• Hypertension • Depression
• Hyperlipidemia • Infection
• Obesity • ↑ Apolipoprotein B
• Smoking • ↑ Serum iron levels
• Sedentary lifestyle • ↑ Serum homocysteine

 Diagnostic tests for CVD

• Cholesterol
‒ Elevation increases risk
• Low-density lipoprotein (LDL)
• High-density lipoprotein (HDL)
‒ Protective, elevation desirable
• Lp(a) cholesterol

 Diagnostic tests for CVD (continued)

• Apolipoprotein B > apolipoprotein A
‒ Increased risk
• Triglycerides
• C-reactive protein (CRP)
‒ Inflammation in coronary arteries

 Therapeutic interventions
• Eating heart-healthy diet
‒ Dietary Approaches to Stop Hypertension (DASH)
• Not smoking
• Exercising
• Taking lipid-lowering agents

Coronary Artery Disease
 Obstruction of coronary artery blood flow

 Usually from atherosclerosis
 Blood flow reduction causes
• Angina
• Myocardial infarction (MI)
• Sudden death

Coronary Artery Disease (continued)
 Prevention
• Modify risk factors
‒ Stop smoking
‒ Low-cholesterol diet
‒ Lipid-lowering agents
‒ Normal blood pressure
‒ Normal blood sugars
• Low-dose aspirin as prescribed
• Million Hearts® 2022: National initiative
‒ Prevent 1 million heart attacks/strokes within 5 years

Angina Pectoris
 “Chest pain“
 Symptom of ischemia
 Causes
• CAD
• Vasospasm
• Valvular heart disease
• Hypertension
• Heart failure

Angina Pectoris (continued)
 Pathophysiology
• Narrowed blood vessels unable to dilate
• Carry less blood/oxygen for heart muscle
• Less oxygen causes myocardial ischemia
• Ischemia causes pain

Types of Angina
 Stable angina
• Occurs with moderate exertion in
familiar pattern
• Usually stops with rest/SL nitroglycerin (NTG)
• Pain is predictable.

Types of Angina (continued_1)
 Unstable angina
• Pain is unpredictable.
• Occurs with less exertion, at rest, during sleep
• Unrelieved with rest/SL NTG
• Cause: Blood clot reducing blood flow
• Can lead to MI

 Variant angina (prinzmetal angina)

• Due to coronary artery spasm
• Longer duration
• Can occur at rest
• Often same time each day
• Often occurs at night
• Serious condition

 Microvascular angina
• Spasms in walls of tiniest arteries of the heart
• Pain more severe and lasts longer

Angina Signs and Symptoms
 Pain
• Heaviness, tightness, viselike, crushing pain in
chest center
• Pain may radiate to arms, shoulder, neck, jaw,
or back
 Pale
 Diaphoretic
 Dyspneic

Angina in Women
 Signs and symptoms

• May differ from traditional signs and symptoms
• Chest pain, jaw pain, heartburn
• Atypical symptoms
‒ Less severe pain
‒ Fatigue
‒ Nausea
‒ Breathlessness

Angina Diagnostic Tests
 Electrocardiogram (ECG)
 Exercise ECG (stress test)
 Echocardiography
 Chemical stress testing
 Cardiac computed tomography (CT) scan
 Cardiac magnetic resonance
imaging/angiogram (MRI/MRA)
 Radioisotope imaging
 Coronary angiography
Goals for Angina
 Identify risk factors.

• Weight reduction
• Heart-healthy diet
• Smoking cessation
• Emotional stress reduction
 Relieve pain.

Anti-Anginal Medications
 Vasodilators
• Nitrates
 Beta blockers
• Metoprolol (Lopressor), atenolol (Tenormin)
• Avoid nonselective types in asthma or chronic
obstructive pulmonary disease (COPD).
• Not effective in variant angina
 Calcium channel blockers
• Amlodipine (Norvasc), diltiazem (Cardizem, Dilacor
XR), felodipine (Plendil), verapamil (Calan SR)

Additional Anti-Anginal Therapy
 Antiplatelets
 Aspirin, clopridogrel (Plavix)
 Statins
 Atorvastatin (Lipitor), fluvastatin (Lescol XL),
lovastatin (Meyacor), pravastatin (Pravachol),
rosuvastin (Crestor) simvastatin (Zocor)

Nursing Diagnoses for CAD and Angina
 Acute Pain
 Deficient Knowledge

Activity: Cue Recognition 24.1
You are caring for Mr. James with unstable

angina who rates his chest pain level at an 8
out of 10.
What action should you take?

Cue Recognition 24.1: Answer
 Monitor vital signs, heart rhythm with

telemetry, oxygen saturation.
 Collect data such as respiratory status, skin
color, diaphoresis, nausea.
 Administer oxygen per orders/agency policy.
 Maintain bedrest.
 Administer prescribed medications such as
nitrates or morphine.
 Inform health-care provider (HCP).
Cue Recognition 24.1: Answer Rationale
 Mr. James is likely experiencing cardiac

ischemia, which is causing a high level of pain.
 You need to collect data to share with the HCP
and guide your actions.
 You should implement any immediate actions
that you can to promote oxygenation, conserve
energy, and relieve pain. Then notify the HCP
for further orders.

Nursing Care for CAD and Angina
 Acute pain
• Ensure IV access for drug administration.
• Rate pain.
• Administer oxygen.
• Administer NTG as prescribed.
‒ Report if unrelieved after three doses.
• Administer aspirin as prescribed.
• Administer analgesic as prescribed.
• Remain with patient.
• Provide emotional support.

Nursing Care for CAD and Angina
(continued)
 Deficient knowledge
• Determine readiness to learn and learning needs.
• Include significant other in teaching.
• Explain CAD pathophysiology, risk factors,
management, medications.
• Identify community resources for lifestyle changes.

Acute Coronary Syndrome
 Includes
• Unstable angina
• MI
‒ Non–ST-segment elevation MI (Non-STEMI)
‒ ST-segment elevation MI (STEMI)

Silent Ischemia
 MI without chest pain

• Occurs in older patients, women
• Often seen with hypertension and diabetes

Sudden Cardiac Death
 Cardiac arrest triggered by lethal ventricular

arrhythmias or asystole from an abrupt
occlusion of a coronary artery
 Prompt treatment required in attempt to
prevent death

Myocardial Infarction
 Death of heart muscle

 Pathophysiology
• Coronary artery blockage reduces blood supply
 Types
• Non-STEMI
‒ Partial blockage
• STEMI
‒ Complete blockage

Myocardial Infarction (continued)

Coronary Arteries
A. Anterior view B. Posterior view

Myocardial Infarction Signs and Symptoms
 Crushing, viselike pain

• Radiates: Arm/shoulder/neck/jaw
 Diaphoresis (sweating)
 Dizziness, fainting
 Dyspnea
 Nausea
 Restlessness

Myocardial Infarction Signs and
Symptoms (continued)
 With heart failure
• Extra heart sound: S3 or S4
• Wheezing or crackles

Timely Treatment of Myocardial Infarction
 Denial common
• Wait to seek care
 “Time is muscle.”
• Call 911.
• Do not drive self or ride with others.
• Reperfusion time critical

Women and Myocardial Infarction
 CAD/MI leading cause of death in women

 Black women at higher risk
 Higher mortality rate than men
 May wait longer than men to seek help
 More complications than men
 Prodromal symptoms the month before MI
• Unusual fatigue, sleep disturbances, dyspnea

Women and Myocardial
Infarction (continued)
 May have atypical symptoms
 Given less aggressive treatment

Myocardial Infarction Atypical Signs
and Symptoms
 For women/older adult
• Absence of classic pain
• Dyspnea
• Fatigue
• Anxiety
• Chest cramping, epigastric or abdominal pain
• Restlessness
• Falling

Older Adults and Myocardial Infarction
 Report to HCP
• Shortness of breath
• Fatigue
• Fast/slow heartbeats
• Chest discomfort
 May have silent MI
 Collateral circulation may offer protection

Myocardial Infarction Diagnosis
 Consideration of patient history

 Diagnostic tests
• Serial ECG
• Highly sensitive cardiac troponin T (cTnT) or I (cTnI)
• Myoglobin
• Creatine kinase (CK)-MB
• CRP
• Magnesium
• Potassium

ECG Changes With STEMI

Myocardial Infarction Pre-Hospital Care
 “Time is muscle.”
 Chew one uncoated adult aspirin.
 Call 911 after 5 minutes for unrelieved
chest pain.

Myocardial Infarction
Therapeutic Interventions
 Goal: Restore cardiac perfusion within 90
minutes of arrival in emergency department.
 Invasive procedures
• Percutaneous coronary intervention (PCI)
‒ Balloon angioplasty
‒ Coronary artery stents
 Thrombolytics
• Time sensitive
‒ Initiate within 1 to 6 hours of symptom onset.

PCI: Balloon Angioplasty

Coronary Artery Stent

Myocardial Infarction Therapeutic
Interventions (continued_1)
 Oxygen
 Antiplatelets
 Nitrates
 Morphine sulfate, carefully considered
 Vasodilators
 Beta blockers
 Antiarrhythmics prn

 Bedrest/bedside commode
 Glucose control
 Daily weight
 Low-sodium clear liquids
 Low-fat, low-cholesterol, low-sodium diet
 No caffeine

 Weight loss
 Smoking cessation
 Statins
 ACE inhibitors
 Beta blockers

Myocardial Revascularization
 Coronary artery bypass graft

• Coronary artery occlusions bypassed with
vein/artery graft(s)
• Increases blood flow/oxygen to myocardium

Coronary Artery Bypass Graft

Types of Bypass Surgery
 Cardiopulmonary bypass
• On pump: Arrested heart surgery
• Off pump: Beating heart surgery
 Minimally invasive surgery
• Minimally invasive coronary artery bypass
grafting (MICS CABG)
• Totally endoscopic coronary artery bypass
surgery (TECAB)

MICS CABG
 Thoracoscope
 No cardiopulmonary bypass
 Small incisions
 Multiple vessels

TECAB
 Three or four chest holes

 Insertion of robotic arms and a camera
 Surgeon controls robotic arms

Myocardial Infarction Nursing Diagnoses
 Acute Pain
 Decreased Cardiac Output
 Decreased Activity Intolerance

Postoperative Cardiac Surgery
Nursing Diagnoses
 Acute Pain
 Decreased Cardiac Output
 Risk for Infection

Nursing Care
 Monitor vital signs.

 Monitor for arrhythmias.
 Report symptoms.
 Provide incisional care.
 Monitor for depression.

Patient Education
 Disease information
 Medications
 Diet
 Activity and exercise
 Rehabilitation
 Stress reduction

Cardiac Rehabilitation
 Optimizes functioning
 Begins in hospital
 Protocols specify activities
 Outpatient program after discharge

Case Study for CUS Communication
You are caring for Mrs. Cade, age 55, who is

reporting chest pain rated at 5/10 that was
treated with nitroglycerin and then reported at
8/10 5 minutes later.
ECG: Sinus tachycardia. Clear lung sounds. Apical
105, respirations 28, BP 126/80.
She is anxious and asking you to stay with her.

Activity: CUS Communication
 You are preparing to communicate with the

patient’s HCP.
 Think about the information you should
include in the communication.
 Now turn to your neighbor and communicate
using CUS.
 Afterwards, review suggested CUS
communication on next slide.

CUS Communication: Suggested Answers
Introduce yourself and the patient.

C: I am concerned about Mrs. Cade’s unrelieved
chest pain.
U: I am uncomfortable with her condition as she
is in distress.
S: I believe her safety is at risk and she requires
additional intervention.

Peripheral Vascular Disease
 Common in older adults and diabetics

 Types
• Arterial
• Venous

Arterial Thrombosis/Embolism
 Arterial blood clot can become embolus.

 Pathophysiology
• Arterial occlusions sudden and dramatic
• Common in lower and upper extremity
• Thrombus adheres to vessel wall
• May occur with an injury to arterial wall

(continued_1)
• Thrombus breaking off and traveling is
an embolism.
• May occlude smaller vessels
• Causes of embolism
‒ Arrhythmias
‒ Prosthetic heart valves
‒ MI
‒ Rheumatic heart disease

(continued_2)
• Abrupt onset with acute arterial occlusion
• Chronic arterial insufficiency symptoms may
develop more slowly if collateral circulation
is present.
• Symptoms depend on artery occluded and tissue
supplied by artery.
• Gangrene may develop rapidly.

(continued_3)
 Clinical signs: Six P’s
• Pain
• Pallor
• Pulselessness
• Paresthesia
• Paralysis
• Poikilothermia

(continued_4)
• Anticoagulants
• Thrombolytics
• Thrombectomy
• Embolectomy

Peripheral Arterial Disease
 Pathophysiology
• Disorder of arterial circulation
• Chronic, progressive arterial narrowing
• Reduces blood supply
• Ischemia develops
• Affects lower extremities

Peripheral Arterial Disease (continued_1)
• Atherosclerosis leading cause
• Organic cause by structural changes from plaque
and inflammation
• Functional cause from vasospasm as noted in
Raynaud disease

 Compensatory mechanisms
• Peripheral vasodilation
• Anaerobic metabolism
• Development of collateral circulation
• Eventually lack of blood supply
produces ischemia.
• Results in ulceration, gangrene, necrosis
of extremity
• Amputation may be necessary.


• May occur late in course of disease
• Women may have no symptoms
• Pain in extremity
• Muscle cramping
• Hair loss on lower calf and ankle
• Dry, flaky, scaly skin
• Thickened toenails

 Signs and symptoms (continued)

• Intermittent claudication
• Cool skin
• Reddish-purple when dependent
• Pale when elevated
• Diminished/absent pulses

• Ankle-brachial index
• Doppler ultrasound
• MRI
• CT scan
• Arteriography
• Plethysmography

• Low-fat, low-cholesterol, low-calorie diet
• Medications
‒ Lipid-lowering agents
‒ Antiplatelets
‒ Thrombolytics

 Therapeutic interventions (continued)

• Invasive therapies
‒ Percutaneous transluminal angioplasty (PTA)
‒ Atherectomy
‒ Stents
‒ Aortofemoral bypass

Aortofemoral Bypass

 Nursing diagnoses
• Ineffective Peripheral Tissue Perfusion
‒ Do not elevate legs because this reduces blood
flow further.
• Readiness for Enhanced Health Literacy

Raynaud Disease
 Local abnormal vasospasms with

cold/emotional stress causing ischemia
 Secondary: Occurs with collagen diseases
 Affects women in colder climates
 Mainly affects digits
 Phases
• Blanching, pain, reddening

Raynaud Disease (continued)
 Therapeutic intervention
• Keep warm, avoid vasoconstriction,
take vasodilators.
 Nursing care/patient teaching
• Protect hands.
• Wear gloves in cold climates.
• Decrease emotional stress level.

Buerger Disease
(Thromboangiitis Obliterans)
 Recurring inflammation and thrombosis of
small and medium arteries and veins of
hands/feet
 Cause unknown, may be autoimmune
 Associated with all types of tobacco use
 Use of tobacco must be avoided.
 Periodontal disease may be factor
in development.

Buerger Disease (continued_1)

• Intermittent claudication
• Vein inflammation
• Numbness and pale digits with cold exposure
 Distal extremity ischemia
• Ulceration
• Gangrene
• Amputation

Buerger Disease (continued_2)
 No cure
• Immediate tobacco use cessation
‒ Using only non-nicotine products
• Less effective: Vasodilators, platelet inhibitors
 Nursing care
• Educate to cease tobacco use.
• Reduce complications.

Aneurysms
 Bulging, ballooning, or dilation of weakened

artery wall
 Abdominal aortic aneurysm (AAA)
most common
 Risk factors
• Atherosclerosis, hypertension, smoking, trauma,
congenital abnormalities
 Incidence increases with age.

Types of Aneurysms
 Fusiform
• Dilation of entire artery circumference
 Saccular
• Bulges on one side of artery wall
 Dissecting
• Caused from tear in artery wall (intimal layer)
• Layers of artery wall separate
• Cavity expands with blood and may rupture

Types of Aneurysms (continued)
A. Fusiform
B. Saccular
C. Dissecting

Abdominal Aortic Aneurysm

• None early
• Symptoms may be vague
• Back/flank pain classic
• Pulsating abdominal mass
• Rupture
‒ Severe, sudden back, flank, or abdominal pain
‒ Shock

Abdominal Aortic Aneurysm (continued_1)
• Abdominal ultrasound
• CT scan
• MRI
• Aortography

• Control hypertension, prevent ruptures.
• Bypass graft
‒ Endovascular stent graft
‒ Open surgical repair

• Acute Pain
• Ineffective Peripheral Tissue Perfusion
 Nursing care
• Patient education
‒ Medication
‒ Avoid lifting.
‒ Reduce stress.
• Postoperative care
‒ Avoid heavy lifting.

Varicose Veins
 Elongated, tortuous, dilated veins

 Cause is unknown
 Hereditary
 Varicosities
• Primary
• Secondary

Varicose Veins (continued_1)
 Pathophysiology
• Primary: Structural defect in vessel wall
• Dilation of vessel leads to incompetent venous
valves that propel blood forward.
• Reflux causes further dilation and blood pooling
in lower extremities.
• Superficial veins are most often involved in
primary varicosities.

• Secondary: Congenital or acquired pathology of
deep venous system
• Dilation of collateral and superficial veins
• Blood stasis in deep venous system
• Pressure increases within the venous system.

 Contributing factors
• Prolonged standing
• Pregnancy
• Obesity


• Telangiectasias (spider veins)
• Dull pain
• Cramping
• Edema
• Heavy feeling in lower extremities
• Ulceration
• Disfigurement of lower extremity

• Reduce contributing factors.
• Relieve pain.
• Elevation and exercise
• Compression stockings
• Injection sclerotherapy
• Radiofrequency ablation
• Laser
• Vein stripping

Venous Insufficiency
 Chronic condition
 Damaged/aging valves cause pooling of blood
in lower extremities.
 Chronic venous insufficiency may lead to
venous stasis ulcers.

Venous Stasis Ulcers
 Result of chronic venous insufficiency

 Dysfunctional valves in venous system
 Veins rupture, causing leaking of red blood
cells into tissue
 Leg/foot: Edema; brownish discoloration;
hardened, leathery skin

Venous Stasis Ulcers (continued)
 Pathophysiology
• Develop at ankle: Medial malleolus
• Difficult to treat
• Patient’s quality of life affected

Venous Disorder
• Goal: Decrease edema/heal ulcerations
• Compression wraps
• Bedrest with elevation of legs
• Avoid prolonged standing/sitting
• Walk
• Skin ulcers: Unna boot, skin grafts

Venous Disorder (continued_1)
• Acute Pain
• Impaired Skin Integrity
• Ineffective Health Self-Maintenance

Venous Disorder (continued_2)
 Nursing interventions
• Wound care
• Emotional support
• Education
‒ Elevate legs.
‒ Protect legs from injury.
‒ Do not cross legs/wear tight clothing.
‒ Avoid heating devices.
‒ Apply compression from foot upward.

Preoperative Vascular Nursing Diagnoses
 Acute or Chronic Pain

 Anxiety

Embolectomy and Thrombectomy
 Can be surgical emergency

 Restores blood flow and oxygenation

Vascular Bypasses and Grafts
 Bypass
• Graft anastomosed to artery above and
below occlusion
 Graft repair
• Diseased area of blood vessel replaced with graft

Endarterectomy
 Arteriosclerotic plaques dissected

 Carotid artery common

Angioplasty
 Open plaque-blocked arteries

 Balloon or laser angioplasty
 Used in smaller occlusions

Stents
 Support to artery walls to keep them open

 May be used with other procedures such
as angioplasty

Complications of Vascular Surgeries
 Bleeding and hemorrhage

 Fluid volume deficit
 Re-occlusion: Surgical emergency
 Hematoma
 Neurological dysfunction

Postoperative Therapeutic Interventions
 Maintain airway.
 Frequent vital signs
 Neurological checks
 Neurovascular checks
 Incision care and drain care
 Fluid status: Hourly intake and output
 Monitor electrolytes.
 Increased girth may indicate bleeding.

Postoperative Vascular Nursing Diagnoses
 Acute Pain
 Ineffective Peripheral Tissue Perfusion
 Ineffective Airway Clearance
 Risk for Infection

Lymphangitis
 Inflammation/infection of lymphatic channels

 May occur in arms/legs
 Serious infection; may cause sepsis
 Pain, red streak, chills, fever
 Antibiotic, heat, elevation, pneumatic
pressure devices
 Monitor site for edema and skin breakdown.
 Nursing diagnoses: Acute Pain, Excess
Fluid Volume
Case Study With Concept Map
Leon: Myocardial infarction

Leon is a 75-year-old male who has had
hypertension for 10 years, a BMI of 40, and a
past fractured hip repair. He is seen in the
emergency department for chest pain rated at
6 out of 10. He takes an ACE inhibitor and
statin medication.

(continued_1)
His vital signs are blood pressure 190/70,
apical pulse 96 and regular, respirations 28,
oxygen saturation 92% on room air. An EKG
shows normal sinus rhythm with an occasional
premature ventricular contraction and an
inferior MI. His troponin is elevated. An IV
angiocath is placed and a nitroglycerin
infusion is started, oxygen 2 liters/minute
is administered.

(continued_2)
The licensed vocational nurse (LVN) reinforces
the explanation about an MI, prescribed
medications, and cardiac rehabilitation that
the registered nurse (RN) provided. The LVN
makes a referral to a dietitian for a nutritional
consult for his elevated BMI and a heart-
healthy diet.

Case Study With Concept Map: Activity
 What nursing concepts would be used for
Leon’s case?
 Can you see how the concepts in Leon’s care
are related?
 Work with your group to create a concept
map showing relationships between
the concepts.
 Continue the map to show patient cues,
nursing interventions, and
collaborative relationships.
Leon: Suggested Relationships
Hypertension
Elevated
troponin
Perfusion
Dietician
Comfort Chest pain

Collaboration
Risk
Leon
factors
Health Oxygenation
Promotion
Medications
Nutrition Oxygenation
saturation
92%
Nutrition Cardiac Heart-
rehab healthy
BMI diet
40

Review Question #1
The nurse evaluates Mr. Agarwal, 53 years old, as
understanding cardiovascular disease teaching if
he lists which of these as modifiable risk factors
for atherosclerosis? Select all that apply.
1. Age
2. Gender
3. Hypertension
4. Obesity
5. Smoking
6. Sedentary lifestyle
Review Question #1 Answer
Correct Answer: 3, 4, 5, 6

Review Question #2
The nurse collects data on Mrs. Field, 72 years old,

who has angina. Which of these signs and
symptoms of angina does the nurse focus on that
are typically seen in women? Select all that apply.
1. Chest pain, jaw pain, heartburn
2. Typical symptoms
3. Describes more severe pain
4. Fatigue
5. Nausea
6. Breathlessness

Review Question #3
What would the nurse include in the patient’s

teaching plan for pre-hospital care for an MI?
Select all that apply.
1. Understand “time is moving.”
2. Swallow two coated baby aspirins.
3. Call 911 after 5 minutes for unrelieved
chest pain.
4. Do not drive self to hospital.
5. Ride with family to hospital.
Correct Answer: 3, 4

Review Question #4
The nurse would evaluate Ms. Evans, 46 years old,
as understanding her education if she lists which
of these in the “Six P’s” of acute arterial
occlusion? Select all that apply.
1. Pain
2. Pulses
3. Paralysis
4. Pallor
5. Paresthesia
6. Poikilothermia
Correct Answer: 1, 3, 4, 5, 6

Review Question #5
The nurse would evaluate Mr. Wayne, 62 years

old, as understanding his education if he states
the classic sign of an abdominal aortic
aneurysm is which of these?
1. Pulsating abdominal mass
2. Abdominal pain
3. Back/flank pain
4. Edema

Correct Answer: 3

Review Question #6
A patient, 65 years old, is admitted with stable
angina. Which of the following symptoms would
the patient be expected to report to the nurse
during data collection? Select all that apply.
1. Chest pain required oxygen for relief.
2. Chest pain occurred with moderate exertion.
3. Chest pain was not relieved with rest.
4. Chest pain occurred in predictable pattern.
5. Chest pain lasted for a few minutes.
6. Nitroglycerin relieved the chest pain.

CH 24

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Book cover for Understanding Medical-Surgical

Nursing, Seventh Edition.

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 Explain the etiologies and signs and

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 Leading cause of disability/death in the

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 Nonmodifiable risk factors

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 Diagnostic tests for CVD

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 Diagnostic tests for CVD (continued)

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 Obstruction of coronary artery blood flow

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 Variant angina (prinzmetal angina)

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 Signs and symptoms

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 Identify risk factors.

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You are caring for Mr. James with unstable

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 Monitor vital signs, heart rhythm with

 Mr. James is likely experiencing cardiac

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 MI without chest pain

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 Cardiac arrest triggered by lethal ventricular

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 Death of heart muscle

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 Crushing, viselike pain

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 CAD/MI leading cause of death in women

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