Brush up on key concepts

31

Cardiovascular refresher (continued)

THORACIC AORTIC ANEURYSM (CONTINUED)
Review laboratory test results, which must include a complete
blood count, differential, electrolytes, typing and crossmatching
for whole blood, ABG studies, and urinalysis.
Insert an indwelling urinary catheter and monitor intake and
output.
Carefully monitor nitroprusside I.V. infusion rate; use a separate I.V. line for infusion. Adjust the dose by slowly increasing
the infusion rate. Meanwhile, check blood pressure every
5 minutes until it stabilizes.
With suspected bleeding from an aneurysm, prepare to give a
blood transfusion.
After repair of thoracic aneurysm
Evaluate the clients level of consciousness. Monitor vital
signs, PAP, PAWP, CVP, pulse rate, urine output, and pain.
Check respiratory function. Carefully observe and record the
type and amount of chest tube drainage, and frequently assess
heart and breath sounds.
Monitor I.V. therapy to prevent fluid excess, which may occur
with rapid fluid replacement.
Give medications as appropriate to help improve the clients
condition.
THROMBOPHLEBITIS
Key signs and symptoms
Deep vein thrombophlebitis
Cramping calf pain (may be painless)
Edema
Tenderness to touch
Superficial vein thrombophlebitis
Redness along the vein
Warmth and tenderness along the vein
Key test results
Photoplethysmography shows venous-filling defects.
Ultrasound reveals decreased blood flow.
Key treatments
Activity changes: maintaining bed rest and elevating the
affected extremity
Anticoagulants: warfarin (Coumadin), heparin, enoxaparin
(Lovenox)
Anti-inflammatory agents: aspirin, dalteparin (Fragmin)
Fibrinolytic agent: streptokinase (Streptase)
Key interventions
Assess pulmonary status.
Maintain bed rest, and elevate the affected extremity.
Perform neurovascular checks.
Monitor laboratory values.
Apply warm, moist compresses to improve circulation.

VALVULAR HEART DISEASE

Key signs and symptoms
Aortic insufficiency
Angina
Cough
Dyspnea
Fatigue
Palpitations
Mitral insufficiency
Angina
Dyspnea
Fatigue
Orthopnea
Peripheral edema
Mitral stenosis
Dyspnea on exertion
Fatigue
Orthopnea
Palpitations
Peripheral edema
Weakness
Mitral valve prolapse
Possibly asymptomatic
Palpitations
Tricuspid insufficiency
Dyspnea
Fatigue
Key test results
Aortic insufficiency
Echocardiography shows left ventricular enlargement.
X-ray shows left ventricular enlargement and pulmonary vein
congestion.
Mitral insufficiency
Cardiac catheterization shows mitral insufficiency and elevated atrial pressure and PAWP.
Mitral stenosis
Cardiac catheterization shows diastolic pressure gradient
across valve and elevated left atrial and PAWP.
Echocardiography shows thickened mitral valve leaflets.
ECG shows left atrial hypertrophy.
X-ray shows left atrial and ventricular enlargement.
Mitral valve prolapse
ECG shows prolapse of the mitral valve into the left atrium.
Tricuspid insufficiency
Echocardiography shows systolic prolapse of the tricuspid valve.
ECG shows right atrial or right ventricular hypertrophy.
X-ray shows right atrial dilation and right ventricular
enlargement.
(continued)

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4/8/2010 7:01:37 PM