6-Cardiac-11-16-17

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VI. CARDIAC
A.	 Normal	blood	flow	through	the	heart:
The two major veins that bring blood to the right side of the heart are 
the superior and inferior vena cava (This blood is deoxygenated)The 
blood enters the right atrium Then the right ventricle From the 
RV the blood is pumped into the pulmonary artery (this artery carries 
deoxygenated blood)  Then the blood goes to the lungs where it is 
oxygenated Next through the pulmonary veins (they carry oxygenated 
blood) It then goes to the left atrium  to the left ventricle (the 
big bad pump) It is then pumped into the aorta And finally this 
oxygenated blood is delivered throughout the body through the arterial 
system where it eventually ties back into the venous system.
AFTERLOAD
PRELOAD
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B.	 Cardiac	Terms:
1. Preload	is the amount of blood _____________ to the right side 
 of the heart and the muscle _______________ that the volume causes. 
 ______________ is released when we have this stretch. 
2.	 Afterload	is the __________ in the aorta and peripheral arteries that 
 the left ventricle has to pump against to get the blood out.
• This pressure is referred to as resistance.
• With hypertension there’s even more _______________ for the 
 left ventricle to pump against. That’s why ______________ 
 can eventually lead to HF and pulmonary edema, because high 
 afterload ______________ cardiac output and decreases 
 forward flow. Plus, it wears your heart out. 
3.	 Stroke	volume	is the ____________ of blood pumped out of the 
 ventricles with each beat. 
C.	 Cardiac	Output:
• CO = HR x SV
• Tissue ____________ is dependent on an adequate cardiac output.
• Cardiac output changes according to the body’s __________________. 
1.	 Factors	that	affect	cardiac	output:
a. Heart rate and certain arrhythmias
b. Blood ___________
1) Less volume = ___________ CO
2) More volume = ___________ CO
c. ______________ contractility 
• MI, medication, cardiac muscle disease
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2.		Pathophysiology	of	decreased	CO:
• If your CO is decreased, will you perfuse properly? ________
a. Brain: LOC will go_______
b. Heart: Client reports ________ pain
c. Lungs: Lungs sound ____________ Short of breath? ______
d. Skin: ________ and clammy
e.	 Kidneys: UO goes _____
f. Peripheral pulses: ____________
Arrhythmias are no big deal UNTIL they affect your cardiac output.
g.		Three	Arrhythmias	that	are	always	a	big	deal:
1) ________________________________________
2) ________________________________________
3) ________________________________________ 
 
D.	 Coronary	Artery	Disease:
• Coronary artery disease is the most common type of cardiovascular disease.
• Coronary artery disease is a broad term that includes chronic	stable		 	
	 angina and acute	coronary	syndrome. 
1.	 Chronic	Stable	Angina:
a.	 Pathophysiology:
1) Intermittent decreased blood flow to the myocardium leads 
 to ischemia or necrosis? __________________ This ischemia can 
 lead to temporary pain/pressure in chest. 
2) What brings this pain on? Low ____________ usually due to 
 _______________.
3) What relieves the pain? ______________ and/or nitroglycerin SL.
Medication	Effects	on	Cardiac	Output
Preload: Vasodilate 
or diurese to reduce 
(decrease) preload 
1) Diuretics (furosemide)
2) Nitrates (nitroglycerin)
Afterload: Vasodilate to 
reduce (decrease) afterload
1) ACE Inhibitors (enalapril, fosinopril, captopril)
2) ARBS (valsartan, losartan, irbesartan)
3) Hydralazine
4) Nitrates
Improve	Contractility: 1) Inotropes (dopamine, dobutamine, milrinone) 
Rate	Control:	
1) Beta Blockers (propranolol, metoprolol, atenolol, carvedilol)
2) Calcium Channel Blocker (diltiazem, verapamil, amlodipine) 
3) Digoxin
Rhythm	Control: 1) Antiarrhythmics (Amiodarone) 
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b.	 Treatment:
1)	 Medications:
a)	 Nitroglycerin	(Nitrostat®):	Sublingual	
• Causes venous and arterial ___________________
• This dilation will cause ________________ preload and 
 afterload.
• Also causes dilation of the _________________ arteries 
 which will increase blood flow to the actual heart 
 muscle (myocardium)
• Take 1 every ________ min x ________ doses.
• Okay to swallow? __________
• Keep in dark, glass bottle; dry, cool
• May or may not burn or fizz
• The client will get a ________________.
• Renew how often? An average of every 
 _______ months
 Spray? _______ years
• After nitroglycerin (Nitrostat®), what do you expect the 
 BP to do? ______________________
TESTING	STRATEGY
RULE: NEVER LEAVE AN UNSTABLE 
CLIENT.
Algorithm	for	NTG: 
Take one NTG SL, 
after 5 minutes if 
chest pain/discomfort 
is unimproved or 
worsened, activate 
emergency response.
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b) Beta	Blockers (for prevention of angina):
• Examples: propranolol (Inderal®), metoprolol 
 (Lopressor®/Toprol XL®), atenolol (Tenormin®), 
 carvedilol (Coreg®)
• What do beta blockers do to BP, P, and myocardial 
 contractility? _______________
• What does this do to the workload of the heart? 
 _______________
Beta blockers block the beta cells… these are the 
receptor sites for catecholamines - the epi and norepi. 
 
We just decreased the contractility… So what 
happened to my CO? _____________. 
 
We have _____________ the workload on my heart. 
 
This is a good thing to a certain point, because when 
we decrease the work on the heart, the need for 
oxygen is decreased, and that decreases angina. But 
could we decrease the client’s cardiac output (HR and 
BP) too much with these drugs? ________
c)	 Calcium	Channel	Blockers	(prevention of angina):
• Examples: nifedipine (Procardia XL®), verapamil 
 (Calan®), amlodipine (Norvasc®), diltiazem(Cardizem®)
• What do these do to the BP? ____________
• Calcium channel blockers cause vasodilation 
 of the arterial system.
• They dilate ____________________ arteries.
• Two benefits of calcium channel blockers are they 
 ____________ afterload and ________________ oxygen 
 to the heart muscle.
d)	 Acetylsalicylic	acid	(Aspirin®):
• Dose is determined by the primary healthcare provider 
 (81 mg - 325 mg).
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2)	 Client	Education/Teaching	for	Chronic	Stable	Angina:
• Rest frequently
• Avoid overeating
• Avoid excess caffeine or any drugs that increase HR
• Wait 2 hours after eating to exercise
• Dress warmly in cold weather (any temperature extreme 
 can precipitate an attack)
• Take nitroglycerin prophylactically
• Smoking cessation
• Lose weight
• Avoid isometric exercise
• Reduce stress
TESTING	STRATEGY
DO EVERYTHING YOU CAN TO DECREASE THE 
WORKLOAD ON THE HEART.
 
3)	 Cardiac	Catheterization:
a)	 Pre-procedure:
• Ask if they are allergic to ___________________________.
Iodine based dye is used during the procedure.
• Also, we want to check their kidney function because 
 you excrete the dye through the ____________. 
 Many primary healthcare providers prescribe 
 acetylcysteine (Mucomyst®) pre-procedure, especially if 
 the client has kidney problems. Acetylcysteine helps to 
 protect the kidneys.
• Hot shot
• Palpitations normal
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b)	 Post-procedure:
• Monitor VS
• Watch puncture site
What are you watching for? _______________ and 
hematoma formation
• Assess extremity distal to puncture site (5-Ps).
The	5	Ps: 
Pulselessness
Pallor
Pain
Paresthesia 
Paralysis
• Bed rest, flat, extremitystraight X 4-6 hours
• Major complication post cath? _________________________
• Report pain ASAP
• If the client is on metformin (Glucophage®)______________ 
 this medicine for 48 hours post procedure. We are worried 
 about the _______________. 
Unstable	chronic	angina	=	Impending	MI 
2.	 Acute	Coronary	Syndrome:	MI,	Unstable	Angina:
a.	 Pathophysiology:
1) Decreased blood flow to myocardium  ischemia, necrosis 
 or both? ___________
2) Does the client have to be doing anything to bring this pain 
 on? ______________
3) Will rest or nitroglycerin (Nitrostat®) relieve this pain?________
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b.	 Signs/Symptoms:
• Pain
May describe pain as 
______________________, an elephant sitting 
on their chest, pressure radiating to the left 
arm and left jaw, N/V, or pain between their shoulder blades.
_______________ usually present with GI signs and symptoms, 
epigastric discomfort or pain between the shoulders, an aching jaw or 
a choking sensation.
What is the #1 sign of an MI in the elderly? _________________ 
• Cold/clammy/BP drops
• Cardiac output is going ________.
• ECG changes 
• Vomiting
You may see the following terms in a test question:
***WORRY	ABOUT	THE	STEMI	CLIENT***
STEMI: ST-Segment Elevation Myocardial Infarction-this indicates 
that the client is having a heart attack and the goal is to get them 
to the cath lab for PCI in less than 90 minutes.
NSTEMI: Non-ST-Segment Elevation Myocardial Infarction-these 
clients are usually less worrisome.
c.	 Diagnostic	Lab	Work:
1) CPK-MB:
• Cardiac specific _____________________
• _______________ with damage to cardiac cells
• Elevates within __________ hours and peaks in _________ hours
2)	 Troponin:
• Cardiac biomarker with _______ specificity to myocardial damage
• Elevates within ________ hours and remains ___________ 
 for up to 3 weeks
LAB	VALUES	FOR	
TROPONIN	ISOMERS:
Troponin T < 0.10 ng/mL
Troponin I < 0.03 ng/mL
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3)	 Myoglobin:
• Increases within ____ hour and peaks in _____ hours
• _________________ results are a good thing.
4) Which cardiac biomarker is the most sensitive indicator 
 for an MI? _________________
5)	 Which enzymes or biomarkers are most helpful when the client delays 
 seeking care? _________________ 
 
d.	 Complications:	
Major arrhythmias:
• What untreated arrhythmias will put the client at risk for sudden death? 
Pulseless V-Tach
V-Fib
______________________________
• Priority treatment for V-Fib: ___________________
• If the first shock doesn’t work and the client remains in V-Fib, 
 what is the first vasopressor we give? _________________
• Amiodarone (Cordarone®) is an anti-arrhythmic and is used when 
 V-Fib and pulseless VT are resistant to treatment, and also for fast 
 arrhythmias.
• What anti-arrhythmic drugs are commonly given to prevent a second 
 episode of V-Fib? ________________ or ___________________.
• Lidocaine toxicity: any _________ changes
• Amiodarone (Cordarone®) is the first anti-arrhythmic of choice.
Important side effect? ____________________
This hypotension can lead to further arrhythmias.
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e.	 Treatment:
• What medications are used for chest pain when they get to 
 the ED?
_________________________________ (keep O2 sat > 90%)
_________________________________ , (chewable or tablet?)
_________________________________
_________________________________ 
• Head up position. Why? 
Decreases _______________ on the heart and increases 
_________________________. 
1) Thrombolytics:
• Goal:	Dissolve the clot that is blocking blood flow 
 to the heart muscle decreases the size of the infarction.
• Medications: alteplase (t-PA®), tenecteplase (TNKase®, 
 one time push), reteplase (Retavase®) and streptokinase 
 (Streptase®)
• How soon after the onset of myocardial pain should 
these drugs be administered? Within _____________ 
hours 
• Stroke: __________ IS BRAIN.
• Major	complication:	_________________ 
• Obtain a good _______________ history.
• Absolute contraindications:
Intracranial neoplasm, intracranial bleed, suspected 
aortic dissection, or internal bleeding
• During and after administration we take 
__________________ precautions. 
dabigatran (Pradaxa®)
antidote: idarucizumab (Praxbind®) 
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COMMON	MEDICATIONS	REQUIRING	BLEEDING	PRECAUTIONS: 
1. Anti-coagulants and Anti-platelets: Heparin, warfarin (Coumadin®), 
 enoxaparin sodium (Lovenox®), eptifibatide (Integrillin®)
2. Antithrombotics: apixaban (Eliquis®), dabigatran (Pradaxa®), 
 rivaroxaban (Xarelto®)
3. Acetaminophen (Tylenol®)
Bleeding Precautions: Watch for bleeding gums, hematuria and black stools.
Use an electric razor, a soft toothbrush, and No IMs.
• Draw blood when starting IVs, decrease the number 
of ____________ sites.
• What about ABGs? ______________ 
• Follow-Up	Therapy: Antiplatelets are another important 
 component of thrombolytic therapy.
acetylsalicylic acid (Aspirin®), clopidogrel (Plavix®), 
abciximab (ReoPro IV®) (continuous IV infusion to 
inhibit platelet aggregation) 
2)	 Medical	Interventions:
a)	 PCI	(Percutaneous	Coronary	Intervention):
• Includes all interventions such as PTCA (angioplasty) 
 and stents
• Major complication of an angioplasty is a _________.
Don’t forget the client may bleed from heart cath site, 
or they could reocclude.
• If any problems occur  go to ___________________.
Chest pain after procedure: call the primary healthcare 
provider at once  reoccluding!
• Anti-platelet medications:
 Acetylsalicylic acid (Aspirin®)
 Clopidogrel (Plavix®)
 Abciximab (ReoPro IV®)
 Eptifibatide (Integrilin IV®) 
Given to high risk clients who 
have been stented to keep 
artery open and those waiting 
to go to the cath lab
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b)	 Coronary	Artery	Bypass	Graft	(CABG):
• Can be scheduled or emergency procedure
• Used with multiple vessel disease or left main coronary 
 artery occlusion.
• The _____________ main coronary artery supplies 
 the entire left ventricle.
• Left main coronary artery occlusion... 
 Think: __________________ or Widow Maker. 
3) Cardiac	Rehabilitation:
• Smoking cessation
• Stepped-care plan (increase activity gradually)
• Diet changes- _____ fat, _____ salt, _____ cholesterol
• No isometric exercises-___________________ workload 
 of heart
• No Valsalva
• No straining; no suppository; docusate (Colace®)
• When can sex be resumed? For clients without complications: 
 _______________________________________________________ 
 
• What is the safest time of day for sex? 
 _______________________________________________________, 
 when the client is well rested.
• Best exercise for MI client? _____________
• Teach Signs/Symptoms of heart failure:
Weight __________________
Ankle edema
Shortness of ______________
Confusion 
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E.	 Heart	Failure	(HF):
1.	 Causes:
• HF is a complication that can result from problems such as 
 cardiomyopathy, valvular heart disease, endocarditis, 
 acute MI, and _______________.
2.	 Types:
a.	 Left	Sided	Failure:	the blood is not moving forward into the 
 aorta and out to the body … If it does not move forward, then it 
 will go backward into the ________. 
• Signs/Symptoms:
Pulmonary congestion
Dyspnea
Cough
Blood tinged frothy sputum
Restlessness
Tachycardia
S-3
Orthopnea
Nocturnal dyspnea
b.	 Right	Sided	Failure: the blood is not moving forward into the 
 lungs … If it does not move forward then it goes backward 
 intothe ___________ system.
• Signs/Symptoms:
Distended neck veins
Edema
Enlarged organs
Weight gain
Ascites
 Terminology: 
 Systolic	heart	failure: heart can’t contract and eject.
	Diastolic	heart	failure: ventricles can’t relax and fill.
Left	=	Lungs	
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3. Diagnosis:
a.	 B-type	(BNP)	natriuretic	peptide:
• Secreted by ventricular tissues in the heart when 
 ventricular volumes and pressures in the heart are increased
• Sensitive indicator
• Can be _________ for HF when the CXR does not indicate 
 a problem
• If the client is on nesiritide (Natrecor®), turn it off 
 _____________prior to drawing a BNP. 
b.	 CXR:	enlarged ____________________, pulmonary infiltrates 
c.	 Echocardiogram:	looks at the pumping action or ejection 
 fraction of the heart. An ECG can also give you information 
 about backflow and valve disease. 
d.	 New	York	Heart	Association	Functional	Classification 
	 of	Persons	with	HF:
• Classes 1-4 (Class 4 is the worst)
The Swan-Ganz 
(Pulmonary Artery) 
catheter is a balloon 
flotation catheter that 
can be floated into the 
right side of the heart 
and pulmonary artery. 
It provides information 
to rapidly determine 
hemodynamic 
pressures, cardiac 
output and provides 
access to mixed 
venous blood 
sampling.
Arterial lines can be placed in multiple arteries, 
but the most common site is the radial artery. 
It provides continuous intra-arterial blood pressure 
monitoring and allows for repeated ABG samples 
to be collected without injury to the client.
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4. Treatment:
a. Medications:
Standard medication therapy for HF is ACE inhibitors and ARBs.
1)	 ACE	Inhibitors:
• These are the Drug of Choice (DOC) for HF
• They suppress the Renin Angiotensin System (RAS)
• Prevent conversion of Angiotensin I to Angiotensin II
• Results in arterial _____________ and ______________ stroke volume. 
2)	 ARBs:
• Block Angiotensin II receptors, and cause a ________________ in 
 arterial resistance and decreased BP.
Ace inhibitors and ARBs both block aldosterone. When we block 
aldosterone, we lose _____________ and ____________ and retain 
__________________.
It is standard practice (a core measure) that a client with HF will 
be sent home on an ____________________ and/or a beta blocker. 
Why?
Because, these drugs, ____________ the workload on the 
heart by preventing vasoconstriction (decreasing afterload). 
This will increase the cardiac output and keep blood moving 
_______________ out of the heart. That’s what we wantforward 
flow. 
3)	 Digoxin	(Lanoxin®):
Actions:
• Monitor for drug toxicity, especially in the elderly.
• Used when the client is in sinus rhythm or atrial fibrillation and has 
 accompanying chronic HF.
• Often given in combination with an ACE inhibitor, ARBs, Beta Blocker or 
 ________________.
• Contraction? __________________________
• Heart rate? ____________________________
When the heart rate is slowed, this gives the ventricles more time to fill 
with blood.
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• Cardiac output will go ___________.
• Kidney perfusion _______________. 
 
Nursing	Considerations:
• Would diuresis be a good thing or bad thing for this client? 
 _________
• We always want to ____________ heart failure clients…they can’t 
 handle the fluid.
• Digitalizing dose (loading dose)
• How do you know the Digoxin is working? 
 Because the cardiac output goes ___________ 
• Signs/Symptoms of toxicity:
Early: Anorexia, nausea, and vomiting
Late: Arrhythmias and _________________ changes
• Before administering, do what? ________________________
• Monitor electrolytes
All electrolyte levels must remain normal, but potassium is the 
one that causes the most trouble.
(________________+_________________=________________)
TESTING	STRATEGY 
Any electrolyte imbalance can promote Digoxin toxicity.
4)	 Diuretics:
• Examples: furosemide (Lasix®), hydrochlorothiazide 
 (HCTZ®), bumetanide (Bumex®), hydrochlorothiazide/ 
 triamterene (Dyazide®), spironolactone (Aldactone®)
• Action: Decreases ____________________________
• Nursing	Considerations:
When do you give diuretics? ___________________
Normal 
Dig level= 
____to____ 
ng/mL
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b.	 Low	Sodium	Diet:
• Decreases fluid retention and helps decrease____________________________.
• Watch salt substitutes.
Salt substitutes can contain excessive __________________.
• Canned/processed foods & OTC meds can contain a lot of _________________.
c.	 Elevate	head	of	bed.
d.	 Weigh	daily	and	report	a	gain	of	__________________ (1	-	2	kgs).	 
TESTING	STRATEGY 
Fluid retention-think Heart Problems 1st.
e.	 Report	signs	and	symptoms	of	recurring	failure. 
 
f.	 Pacemaker:
• Your “natural” pacemaker is the SA node or sinus node.
 It sends out impulses that make the heart _______________.
• If your heart rate drops to 60 or below, cardiac output can 
 ___________________.
• Pacemakers are used to increase the heart rate with symptomatic	 
 bradycardia. 
 
 
Pacemakers	may	be	temporary	(invasive	or	non-invasive) 
or	permanent.	Most	permanent	pacemakers	are	demand,	but	you	can	also	see	
fixed	pacemakers. 
• Always worry if the heart rate drops below the set rate.
• Any pacemaker will maintain a certain minimal heart rate depending on the 
 settings; in other words the ________________.
• A demand pacemaker kicks in only when the client needs it.
• Fixed rate pacemakers fire at a ______________ rate constantly.
• It’s okay for the rate to increase but never _________________.
• Always worry if the rate ___________ below the set rate. 
 
 
 
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Post-Procedure	Care	(for	permanent	pacemakers):
• Monitor the incision.
• Most common complication post-op? Electrode _____________
• Immobilize arm.
• Assisted passive range of motion to prevent frozen _______________
• Keep the client from raising the arm higher than shoulder height. 
Signs/Symptoms	of	Malfunction:
• It’s possible that no contraction will follow the stimulus. 
 This is called __________________.
• Is it possible for the pacemaker to fire at inappropriate times? 
_______________________________ 
 
 This is called failure to __________________.
• What can cause loss of capture, failure to sense or any malfunction?
The pacemaker may not be ________________ correctly.
Electrodes can _________________.
Battery may be _______________.
• Watch for any sign of decreased CO or decreased_________________. 
Client	Education/Teaching:
• Check __________________ daily.
• ID card or bracelet
• Avoid electromagnetic fields (cell phones, large motors).
• Avoid MRIs.
 
 
 
 
 
 
 
 
 
 
 
 
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F.	 Pulmonary	Edema:	
1. Who	is	at	risk?
Any person:
• receiving IV fluids really ___________________
• the very young and the very old
• any person who has a history of __________ or __________ disease 
2.		Pathophysiology:
• Fluid is backing up into the _______________. The heart is unable to 
 move the volume _________________.
• Pulmonary edema usually occurs at __________, when the client goes to 
 bed. 
3.		Signs/Symptoms:
• Sudden onset
• Breathless
• Restless/anxious
• Severe ___________________________
• Productive cough (pink frothy sputum) 
 
4.		Treatment:
a.	 Oxygen:
• The priority nursing action is to administer high flow oxygen. 
 Monitor oxygen saturation and titrate to keep above ________%. 
b.		Medications:
1)	 Diuretics:
• Furosemide	(Lasix®)
• Causes diuresisand vasodilation which traps more blood 
 out in the arms and legs and reduces _______________.
• 40 mg IV push slowly over 1-2 minutes to prevent __________________ 
 and ototoxicity
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• Bumetanide	(Bumex®)
• Can be given IV push or as a continuous IV infusion to 
 provide rapid fluid _________
• 1-2 mg IV push given over 1-2 minutes 
2)	 Nitroglycerin	(Nitro-Bid®	IV):
• Vasodilation: ____________ afterload
• Decreased afterload = increased CO because the heart is 
 pumping against less pressure, and more blood can be moved 
 _____________. 
3)	 Morphine	(Morphine	Sulfate®):
• 2 mg IV push for vasodilation to decrease preload and afterload 
4)	 Nesiritide	(Natrecor®):
• IV infusion; short term therapy; not to 
 be given more than 48 hours
• Vasodilates veins and arteries and has 
 a diuretic effect 
c.	 Positioning:
• _________________ position; legs down
Improves ______________________________
Promotes ______________________ of blood in lower 
extremities 
d.	 Prevention:
• Prevention when possible:
Check ________________________, and
Avoid fluid volume __________________.
Remember to 
turn the nesiritide 
infusion off 2 hours 
before drawing a 
BNP level.
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G.	 Cardiac	Tamponade:
1. Pathophysiology:
• _____________________, fluid, or exudates have leaked 
 into the pericardial sac resulting in compression of the heart.
• This can happen if the client has had a motor vehicle collision, 
 right ventricular biopsy, an ___________, pericarditis, 
 or hemorrhage post CABG. 
2.	 Signs/Symptoms:
• Decreased cardiac output 
• CVP will be _______________.
• BP will be dropping.
• Hallmark signs for cardiac tamponade
• ________________ CVP
• ________________ BP
• Heart sounds will be muffled or distant
• Neck veins _________________
• Pressures in all 4 chambers are the same
• Shock
• Narrowed pulse pressure (from the baseline)
What is the pulse pressure? It’s the difference 
between the ________________ and the 
______________________ pressure. 
3.	 Treatment:
• Pericardiocentesis to remove _________________________ 
 from around the heart 
• Surgery
Narrowed	
pulse	pressure	
think: Cardiac 
Tamponade
 
Widened	pulse	
pressure 
think: Increased 
Intracranial 
Pressure
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H.	 Arterial	Disorders:
1.	 General	Information:
a.	 Pathophysiology:
• If you have atherosclerosis in one place, you have it everywhere.
• It is a medical emergency if you have an acute arterial 
 _______________.
• Client will report numbness and pain 
• The extremity will be cold
• No palpable pulse
• More symptomatic in ______________________ extremities
• Intermittent	claudication-	hallmark	_________________.
• Arterial blood isn’t getting to the ____________________  
 coldness, numbness, decreased peripheral pulses, atrophy, 
 bruit, skin/nail changes, and ulcerations.
• Pain at rest means _________________ obstruction. 
b.	Treatment: 
• Since arterial blood is having problems getting to the 
tissue, if you elevate the extremity, would the pain 
increase or decrease? ___________________ 
• Arterial disorders of the lower extremities are usually 
treated with either angioplasty or endarterectomy.
	
   We ELEVATE veins 
We DANGLE arteries 
 
 
 
	
  
	We	ELEVATE	veins	
We	DANGLE	arteries
85CRITICAL THINKING AND APPLICATION | STUDENT MANUAL
C
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IA
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CHRONIC	ARTERIAL	vs	CHRONIC	VENOUS
Symptom Chronic	Arterial	Insufficiency
Chronic	Venous 
Insufficiency
Pain
Intermittent claudication 
(progresses to pain at 
rest)
None to aching pain, 
depending on dependency 
of area
Pulses Decreased or may be absent
Normal (may be difficult to 
palpate due to edema)
Color Pale when elevated, red with lowering of leg
Normal (may see petechiae 
or brown pigmentation with 
chronic condition)
Temperature Cool Normal
Edema Absent or mild Present
Skin Changes
Thin, shiny, loss of hair 
over foot/toes, nail 
thickening
Brown pigmentation around 
ankles, possible thickening of 
skin, scarring may develop
Ulceration
If present, will involve 
toes or areas of trauma 
on feet (painful)
If present, will be on sides of 
ankles
Gangrene May develop Does not develop
Compression Not used Used