ATI cardiovascular notes

beta blocker

A beta blocker will induce bradycardia. The client should take her pulse rate for 1 min before self-administration.

flattened T wave or the development of U waves

A flattened T wave or the development of U waves is indicative of a low potassium level.

Abdominal aortic aneurysm

Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is extending downward and pressing on lumbar spinal nerve roots, causing pain.

right sided heart failure

Blood return from the venous system to the right atrium is impaired by a weakened right heart. The subsequent systemic venous backup leads to development of dependent edema.

hemophilia

Hemophilia is a hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs. It is caused by a deficiency in the most common clotting factor, factor VIII (hemophilia A). Aggressive factor replacement is initiated to prevent hemarthrosis that can result in long-term loss of range of motion in repeatedly affected joints. The affected joint should be elevated to allow the blood to drain away from the joint.

pericarditis

The client who has pericarditis will experience dyspnea, hiccups, and a nonproductive cough. These manifestations can indicate heart failure from pericardial compression due to constrictive pericarditis or cardiac tamponade. Chest discomfort associated with pericarditis will decrease when the client sits upright or leans forward, as this relieves pressure in the pericardial sac. Chest pain associated with pericarditis will increase with deep inspiration due to increased pressure on the pericardial sac. Pericarditis is usually seen on an ECG as an ST-T spiking. This elevation represents ischemic changes caused by the inflammation around the heart. The client who has pericarditis will have tachycardia because of decreased cardiac output and oxygen perfusion.

have a plethoric (dark, flushed) appearance of facial skin

The client who has polycythemia vera will have a plethoric (dark, flushed) manifestation of the facial skin and mucous membranes.

A nurse is assisting in the care of a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mm HG, heart rate 102/min, respiration 22/min, and SpO2 95%. Which of the following actions should the nurse take?

The nurse should administer antihypertensive medication for the elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall. Oliguria can indicate a rupture of the aneurysm, make sure client has urine output of 30ml/hr The nurse should administer pain medication because pain occurs due to pressure from the aneurysm on the lumbar nerves. Pain can also cause hypertension. The nurse should take the client's vital signs at least every 15 min in order to monitor for a sudden drop in blood pressure, which can indicate a rupture of the aneurysm.

A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which of the following actions should the nurse take?

The nurse should elevate the client's legs above his heart to promote venous return by gravity. During discharge teaching, the nurse should reinforce the importance of periodic positioning of the legs above the heart. Position the client supine with his legs elevated when in bed. The nurse should encourage the client to ambulate 5 to 10 min every hour while awake to prevent venous stasis. The nurse should discourage the client from sitting or standing for any duration to prevent venous stasis. no depends t position of the legs. Feet should be elevated above the heart to prevent venous stasis.

P waves occurring at 0.16 seconds before each QRS complex

The nurse should interpret this finding as a normal sinus rhythm.

Ventricular rate of 82/min with an atrial rate of 80/min

The nurse should interpret this finding as ventricular ectopy, such as premature ventricular contractions.

An irregular ventricular rate of 125/min with a wide QRS pattern

The nurse should interpret this finding as ventricular tachycardia.

pacemaker

The nurse should not expect pacer spikes when the client's pulse is greater than the set rate of 72/min, because the client's intrinsic rate overrides the set rate of the pacemaker. The nurse should report when the client has pacer spikes without QRS complexes because this complication can indicate noncapture of the pacemaker. The nurse should report when the client experiences hiccups because this complication can indicate a lead wire is displaced and is stimulating the diaphragm.

percutaneous transluminal coronary angioplasty (PTCA) with stent

The nurse should plan to administer scheduled doses of aspirin postprocedure. This maintains the patency of the client's coronary arteries following the PTCA by preventing platelet aggregation and thrombus formation around the newly placed stent. Bleeding is a post-procedure complication of PTCA because of the administration of heparin during the procedure and the removal of the femoral (or brachial) sheath. Manual pressure or a closure device is used to obtain hemostasis to the site. The client remains on bed rest until hemostasis is assured.

Frozen plasma transfusion

The nurse should review the client's prothrombin time after the administration of FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in the prothrombin time.

epoetin alfa (Epogen, Procrit)

The nurse should teach that a common adverse effect of epoetin alfa is hypertension because of the rise in the production of erythrocytes and other blood cell types. Epoetin alfa is a synthetic version of human erythropoietin. Epoetin alfa is used to treat anemia associated with kidney disease or medication therapy. It increases and maintains the red blood cell level. it is administered to decrease the need for periodic blood transfusions. effects will occur in 2 to 3 months. can be self-administered at home.

Atrial Fibrillation (A-Fib)

an irregular and often very fast heart rate originating from abnormal conduction in the atria example: atria 300 bpm with Wes complex 80bpm The nurse should interpret this finding as atrial flutter, which indicates a lack of conduction between the atria and ventricles. The additional atrial beats are not conducting.

aplastic anemia

characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow The client who has aplastic anemia will have manifestations of petechiae and ecchymosis. Dyspnea on exertion also can be present. In aplastic anemia, all three major blood components (red blood cells, white blood cells, and platelets) are reduced or absent, which is known as pancytopenia. Manifestations usually develop gradually.

O- blood

has no antigens, but both anti-A and anti-B antibodies in the plasma universal donor, remember antibodies are washed out The nurse should administer diphenhydramine IV only if the client manifests an allergic transfusion reaction.

Digoxin

herapeutic range of 0.5 to 0.8 ng/m

PAD

peripheral artery disease A client who has peripheral arterial disease can display dry, scaly, pale, or mottled skin with minimal body hair because of narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities, which can lead to tissue damage. Common manifestations are intermittent claudication (leg pain with exercise), cold or numb feet at rest, loss of hair on the lower legs, and weakened pulses.

Blood tranfusion - complications

which is excess storage of iron in the body. The excessive iron can come from overuse of supplements or from receiving frequent blood transfusions, as in sickle cell anemia. The client who has received several blood transfusions is at risk for hypocalcemia. The citrate in the transfused blood bonds with calcium, causing calcium to be excreted. The client who has received numerous blood transfusions is not at risk for lead poisoning because lead is not found in blood. The client who has received several blood transfusions is at risk for hyperkalemia. Stored blood releases increased amounts of potassium due to red blood cell hemolysis.

hypocalcemia

will have a prolonged S-T interval and a prolonged Q-T interval, but not a flattened T wave.

low hemoglobin

will manifest tachycardia on the ECG rhythm