115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

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 sepa-rate 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.

THROMBOPHLEBITISKey signs and symptomsDeep vein thrombophlebitis Cramping calf pain (may be painless) Edema Tenderness to touchSuperficial 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 DISEASEKey signs and symptomsAortic insufficiency Angina Cough Dyspnea Fatigue PalpitationsMitral insufficiency Angina Dyspnea Fatigue Orthopnea Peripheral edemaMitral stenosis Dyspnea on exertion Fatigue Orthopnea Palpitations Peripheral edema WeaknessMitral valve prolapse Possibly asymptomatic PalpitationsTricuspid insufficiency Dyspnea Fatigue

Key test resultsAortic insufficiency Echocardiography shows left ventricular enlargement. X-ray shows left ventricular enlargement and pulmonary vein congestion.Mitral insufficiency Cardiac catheterization shows mitral insufficiency and ele-vated 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)

313419NCLEX-RN_Chap03.indd 31313419NCLEX-RN_Chap03.indd 31 4/8/2010 7:01:37 PM4/8/2010 7:01:37 PM

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115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

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