CARDIO-VASCULAR

1
Major Diagnostic Tests Nursing Skills Common
Disorders / Assessment & Medications
Common Intervention
diseases
❑ ❑ Complete blood ❑ Cardiovascular ❑ Vasodilator
Hypertension count (CBC) Assessment Nitroglycerin
❑ ❑ Electrocardiogram ❑Heart sounds ❑ Anti-hypertensive
CAD/Occlusive ❑ Oximetry ❑ Interventions for BETA BLOCKER
❑ Heart failure ❑ (ABGs) Ineffective ACEI
❑ Cardiac ❑ Chest x-ray Tissue Perfusion
CCB
Tamponade ❑ CT scan Impaired Gas
❑ Glycoside
❑ Vascular ❑ Echocardiogram Exchange
Digoxin
diseases ❑ Coagulation Test Positioning
❑ Cardiac enzymes Oxygen therapy ❑ Diuretics
troponin Cardioversion/ ❑ Anticoagulants
❑ Lipids defibrillation ❑ Opiod Analgesic
❑ Angiography / Pacemaker MORHINE
Cardiac Angioplasty
2
catheterization CPR
3
 The Cardiovascular System
The vascular system consists of the arteries,
veins and capillaries
The arteries are vessels that carry blood away
from the heart to the periphery
The veins are the vessels that carry blood to the
heart
The capillaries are lined with squamos cells,
they connect the veins and arteries
Heart Chambers = 2 sup. atria (thin receiving
chambers) and 2 inf. ventricles (muscular
pumping chambers)
 Basic Blood Vessel Types
a. Arteries = carry blood away from the heart
b. Veins = carry blood towards the heart
c. Capillaries = link arteries and veins. Sites of
exchange between blood and tissues.
 Heart wall =
 Pericardium = Encloses the heart.
 Epicardium = Most superficial and is a.k.a. visceral
serous pericardium
 Myocardium = Middle layer
 Endocardium = Inner layer

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 REP

5/22/2023 6
External Heart Anatomy
 TERMINOLOGY
 Bradycardia- pulse rate below 60 beats/min
 Tachycardia – pulse rate of above 100 beats/min
 Mean Arterial Pressure (MAP) An approximation of the
average pressure in the systemic circulation throughout the
cardiac cycle; used in hemodynamic monitoring. Mean arterial
pressure must be at least 60 mm Hg for adequate organ
perfusion.
 Postural (orthostatic) hypotension A blood pressure
decrease of more than 10 to 15 mm Hg of the systolic pressure
or a decrease of more than 10 mm Hg of the diastolic pressure
and a 10% to 20% increase in heart rate. Postural hypotension
occurs when the client’s blood pressure is not maintained
adequately when moving from a lying to a sitting or standing
position.

8
 Apex: The bottom of the heart.
 Base: Top of the heart.
 Automaticity: Property that enables the heart to generate its own
impulses.
 Bruit: Swooshing sound similar to the sound of the blood pressure.
 Cardiac output: Amount of blood ejected from the left ventricle each
minute.
 Diastole: Ventricular relaxation.
 Jugular venous distention: A condition associated with heart failure and
fl uid volume overload. The neck veins appear full, and the level of
pulsation may be greater than 3 cm above the sternal angle.
 Nocturia: Urinating during the night.
 Orthopnea: Onset or worsening of dyspnea on assuming the supine
position with improvement upon sitting up, most often seen in CHF.
 Point of maximal intensity: Point where the inferior tip of the heart may
cause a pulsation.


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 Pulse Pressure The difference between the systolic and
diastolic pressure. Normal pulse pressure is 30 to 40 mm Hg.
 Increase Pulse Pressure (Widening) With ICP
 Decrease Pulse Pressure(narrowing) With Cardiac Tamponade
 Pulse Deficit : the difference between radial and apical pulse
 Pulse deficit: Apical pulse minus the number of missed beats.
 Blood Pressure (BP) The force exerted by the blood against
the walls of the blood vessels. If the blood pressure falls too
low, blood flow to the tissues, heart, brain, and other organs
becomes inadequate. If the blood pressure becomes too high,
the risk of vessel rupture and damage increases.
 Preload: Volume in the right atrium at the end of diastole.
 Preload volume overload
 Afterload: Pressure in the great vessels.
 Afterload pressure overload
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 The Cardiovascular System
Heart Rate
 The normal sinus heart rate is 60 to 100
beats/min.
 Sinus tachycardia is a rate > 100
beats/min.
 Sinus bradycardia is a rate < 60
beats/min.
 Sympathetic system INCREASES HR
 Parasympathetic system (Vagus) DECREASES
HR
5/22/2023 11
 Q. The nurse has collected the following
information on a patient:
 Palpated blood pressure—180; auscultated blood
pressure—170/100; apical pulse—60; radial pulse—
70.
 1. What is the patient’s Pulse Pressure?
 A.10 B.70 C.80 D.100
 ANSWER B
 What is the patient’s Pulse Deficit?
 A.10 B.70 C.80 D.100
 ANSWER A

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 Q.Which of the following values reflects a normal
cardiac output?
 A.2.5 L/min B.5.8 L/min
 C.7.3 L/min D.9.6 L/min
 ANS: B The normal cardiac output in the human adult is 4
to 6 L/min.
 CO = SV  HR.
 The normal cardiac output is 4 to 7 L/min
 Stroke Volume The amount of blood ejected from the left
ventricle with each contraction. The normal stroke volume is
70 to 130 mL/heartbeat.
 MAP = SX2D/3= 90

5/22/2023 13
CIRCULATION
The heart also has four
chambers - two atria and two
ventricles
“Right atrium: collecting
chamber for incoming
systemic venous system
“Right ventricle: propels blood
into pulmonary system
“Left atrium: collects blood
from pulmonary venous
system
“Left ventricle: largest thick-
walled muscle that acts as a
high-pressure pump which
propels blood into the
systemic arterial system
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Figure 11.4
Q. The direction of blood flow through the heart is best
described by which of the following?
1. Vena cava right atrium right
ventricle lungs pulmonary artery left atrium left
ventricle
2. Right atrium right ventricle pulmonary artery
lungs pulmonary vein left atrium left ventricle
3. Aorta right atrium right
ventricle lungs pulmonary vein left atrium left
ventricle vena cava
4. Right atrium right ventricle pulmonary
vein lungs pulmonary artery left atrium left
ventricle

Correct answer: 2.

5/22/2023 16
 The Heart Sounds: The heart chambers are guarded
by valves-The a trio-ventricular valves - tricuspid and
bicuspid / MITRAL, The semi-lunar valves - pulmonic
and aortic
1. S1- due to closure of the AV valves
and is heard loudest at the apex of the heart.
2. S2- due to the closure of the semi-lunar valves
and is heard loudest at the base of the heart.
3. S3- due to increased ventricular filling
(eg.CHF, VR) , may be normal in individuals >30 years.
4. S4- due to forceful atrial contraction
eg.cardiac hypertrophy
Abnormal heart sounds S3 and S4 and are referred to as
the galloping of a horse.
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Cardiac Conduction System

5/22/2023 18
The CONDUCTING SYSTEM OF THE HEART
1. SA node- the pacemaker - The SA node-
generates electrical impulses at 60 to 100 times per
minute and is controlled by the sympathetic and
parasympathetic nervous systems.
2. AV node- slowest conduction- If the sinoatrial
node fails, the atrioventricular node can initiate and
sustain a heart rate of 40 to 60 beats/min.
3. Bundle of His – branches into the Right and the
Left bundle branch
4. Purkinje fibers- fastest conduction -Purkinje
fibers can act as the pacemaker with a rate between
20 and 40 beats/min when higher pacemakers (such
as the sinoatrial nerve) fail.
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Q. The electrical stimulus of the cardiac cycle follows which sequence?
1. AV node—SA node—bundle of His
2. bundle of His—AV node—SA node
3. SA node—AV node—bundle of His—bundle branches
4. AV node—SA node—bundle of His—bundle branches
ANSWER 3
Q. The component of the conduction system referred to as the
pacemaker of the heart is the:
1. AV node. 2. SA node. 3. Bundle of His. 4. Bundle branches.
ANSWER 2
Q. A new nurse on the telemetry unit is reviewing information about
how to correctly read ECG. The nurse is expected to know that the PR
interval represents
A. the spread of depolarization in the atria.
B. the time from firing of the sinoatrial (SA) node to the beginning of
depolarization in the ventricle.
C. the spread of depolarization and sodium release in the ventricles to cause
ventricular contraction.
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D. relaxation of the ventricles and repolarization of the cells. ANS B
 10 WIRES
12 LEADS

lub dub
5/22/2023 21
22
• Three formations
– P wave: impulse P WAVE –
across atria Atrial depolarization
– QRS complex: QRS COMPLEX-
spread of impulse Ventricular
down septum, around depolarization
ventricles in Purkinje
fibers
– T wave: end of T WAVE: Ventricular
electrical activity in repolarization
ventricles
C.ST SEGMENT –
Changes represent
myocardial injury/
5/22/2023
ischemia 23
A. P wave 0.06 to 0.12 sec
B. Q
C. R
D. S
E. T wave 0.16 sec
Repolarization of the ventricles
F. U
G. PR Interval;
0.12 to 0.20 sec
Measured from beginning of P wave to beginning of
QRS complex
H. QRS interval
Depolarization from the AV node throughout ventricles
<0.12 sec
I. QT interval
Time of depolarization and repolarization of ventricles24
Q. The P wave represents which of the following?
A.Atrial contraction B.Atrial depolarization
C.Sinus node discharge D.Ventricular contraction
ANS: B The P wave is an electrical event and represents atrial
depolarization. Atrial contraction should accompany the P wave
but does not always.
Q. Patient with chest pain that aggravated by coughing,
there is added sound on left sternal border .in ECG you will
find
a. ST changes b. PR prolongation c. Hyper voltage
Answer A .
Q. ECG finding of acute pericarditis?

 a. ST segment elevation in all leads

Classic ECG findings in pericarditis: Low-voltage, diffuse ST-
segment elevation.

5/22/2023 25
Changes represent myocardial injury/ ischemia
Typical ECG changes seen in myocardial ischemia
include ST-segment depression and/or T wave
inversion.
The typical ECG change seen during myocardial injury
is ST-segment elevation.
An ST-segment elevation and a pathologic Q wave
may be seen on the ECG with myocardial infarction.
. As part of the discharge instructions, the nurse correctly
instructs the client that which symptom is a sign of artificial
pacemaker malfunction?
1. Tingling in the chest area
2. Dizziness during activity
3. Pain radiating to the arm
4. Tenderness beneath the skin
ANSWER 2
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q. What is the most probable type of arrhythmia in the following ECG (lead II)?
A. Atrial fibrillation B. Atrial flutter
C. Ventricular fibrillation D. Supra-ventricular fibrillation

q. What is the most probable type of arrhythmia in the following ECG (lead
VI)?
A. Atrial fibrillation B. Atrial flutter
C. Ventricular tachycardia D. Supra-ventricular fibrillation

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q. What is the most probable type of arrhythmia in the following ECG (lead II):

Atrial fibrillation
a-

b- Atrial flutter
c- Ventricular fibrillation
d- Supra-ventricular fibrillation

a- Atrial fibri llation

b- Atrial flutter
c- Ventricular fibrillation
d- Supra-ventricular fibrillation 28
 a. Angle of Louis;
b. Aortic area;
c. Mitral area (apex)
and PMI;
d. Tricuspid area;
e. Erb's point;
f.Pulmonic area

Auscultation of the chest using the diaphragm

and bell in various positions to include the
following locations
- Aortic area at the right second intercostal space–
S2 is louder than S1
- Pulmonic area at the left second intercostal
space–S2 is louder than S1
- Erb’s point at the left third intercostal space–S1
and S2 are heard equally
- Tricuspid area at the left fourth intercostal space–
S1 is louder than S2
- Apex at the left fifth intercostal space at the
midclavicular line–S1 is louder than S2 29
 Lipid Profile
 measures the serum cholesterol,
triglycerides and lipoprotein levels
 Cholesterol< 200 mg/dL
 Triglycerides- <150 mg/dL
 LDL< 130 mg/Dl bad
 HDL> 50-70- mg/dL good
 NPO post midnight (usually 12 hours)

5/22/2023 30
 Q. A community health nurse is planning a
screening day for blood pressure and
cholesterol. What kind of prevention would
this be?
 A. Primary B. Secondary
 C. Tertiary D. Community
 ANSWER B

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 DIAGNOSTIC STUDIES
 CK- MB ( creatine kinase)
 Elevates in MI within 4 hours, peaks in 18 hours and then
declines till 3 days
 Normal value is 0-7 U/L
Troponin I and T
 Troponin I is usually utilized for MI
 Elevates within 3-4 hours, peaks in 4-24 hours and persists
for 7 days to 3 weeks!
 Normal value for Troponin I is less than 0.6 ng/mL
REMEMBER to AVOID IM injections before obtaining blood
sample
Serum cardiac markers (CK - MB) - rises 4-6 degrees
after acute MI; Returns to normal in three to four
days. Troponin - rises quickly but remains elevated
for5/22/2023
two weeks 32
ECHOCARDIOGRAM
Ultrasound Non-invasive test that
studies the structural and
functional changes of the heart
with the use of ultrasound &
Ejection Fraction >55
No special preparation is needed
Client should remain still, in supine
position slightly turned to the left side,
with HOB elevated 15-20 degrees

QAn echocardiogram reveals an ejection fraction

of 55%. On the basis of this information, Ms. A’s
cardiac function is
A.adequate.
B.mildly decreased.
C.moderately decreased.
D.severely decreased.
ANS: A The normal ejection fraction is at least
greater5/23/2023
than 50%; therefore 55% is adequate. 33
Holter Monitoring
A non-invasive test in which the client wears a Holter monitor
and an ECG tracing recorded continuously over a period of 24
hours
Instruct the client to resume normal activities and maintain a
diary of activities and any symptoms that may develop
Q. Which nursing instruction is most benefi cial for helping the
physician interpret the information collected by the Holter
monitor?
1. “Record the times and types of physical activities you perform.”
2. “Take your radial pulse rate every hour during the next day.”
3. “Try to relax and limit your exercise as much as possible.”
4. “Keep your lower extremities elevated while sitting.”

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Stress Test
A non-invasive test that studies the heart during
activity and detects and evaluates CAD
Exercise test, pharmacologic test and emotional test
Treadmill testing is the most commonly used stress
test
Used to determine CAD, Chest pain causes, drug
effects and dysrhythmias in exercise
Pre-test: consent may be required, adequate rest , eat
a light meal or fast for 4 hours and avoid smoking,
alcohol and caffeine
Post-test: instruct client to notify the physician if any
chest pain, dizziness or shortness of breath . Instruct
client to avoid taking a hot shower for 10-12 hours
after the test
CARDIAC catheterization
Insertion of a catheter into the heart and
surrounding vessels
Determines the structure and performance of
the heart valves and surrounding vessels
Used to diagnose CAD, assess coronary atery
patency and determine extent of
atherosclerosis
Pretest: Ensure Consent, assess for allergy to
seafood and iodine, NPO, document weight
and height, baseline VS, blood tests and
document the peripheral pulses
KFT, INR, PT, PTT & STOP glucophage
CARDIAC CATHETERIZATION
Intra-test: inform the patient that a feeling of warmth and
metallic taste may occur when dye is administered lie still
Post-test: Monitor peripheral pulses, color and warmth and
sensation of the extremity distal to insertion site
Maintain sandbag to the insertion site if required to
maintain pressure
Monitor for bleeding and hematoma formation
Maintain strict bed rest for 6-12 hours
Client may turn from side to side but bed should not be
elevated more than 30 degrees and legs always straight
Encourage fluid intake to flush out the dye/contrast media

37
Q. Before the cardiac catheterization and coronary
arteriogram, it is essential for the nurse to ask the client
about any allergy to iodine or which other substance?
1. Penicillin- 2. Morphine
3. Shellfish 4. Eggs-
ANS. 3. People who are allergic to shellfi sh may also be
sensitive to iodine.
Q. The physician recommends that the client undergo percutaneous
transluminal coronary angioplasty (PTCA). The nurse knows that the
client understands the physician’s explanation of the PTCA
procedure when the client makes which statement?
1. “A balloon-tipped catheter will be inserted into my coronary artery.”
Q. When the client returns to the room after the percutaneous
transluminal coronary angioplasty (PTCA) procedure, which
assessment finding should be reported immediately to the HP?
1. Urine output of 100 mL/hour 2. Blood pressure of 108/68 mm Hg
3. Dry mouth 4. Chest pain 38
CVP central venous pressure
 The CVP is the pressure within the SVC
 Reflects the pressure under which blood is
returned to the SVC and right atrium
 A normal right atrial pressure value or CVP is
4 to 12 mm Hg or cm H2O
 Elevated CVP indicates increase in blood
volume, excessive IVF or heart/renal failure
 Low CVP may indicated hypovolemia,
hemorrhage and severe vasodilatation

5/22/2023 39
 Q. The nurse determines that a large amount
of crystalloid fluids administered to a patient
in septic shock is effective when
hemodynamic monitoring reveals what?
 a. CO of 2.6 L/min
 b. CVP of 15 mm Hg
 c. PAWP of 4 mm Hg
 d. Heart rate (HR) of 106 bpm
 ANSWER. b. The endpoint of fluid resuscitation in
septic and hypovolemic shock is a central venous
pressure (CVP) of 15 mm Hg or a PAWP of 10 to
12 mm Hg. This CO is too low and this heart rate
is too high to indicate adequate fluid replacement.
40
 CORONARY ARTERY DISEASE CAD
 Description- fatty deposits in coronary arteries (atheroma or
plaque) narrow the artery (by 75% or more) and cut flow of
blood and oxygen to the heart muscle.
 CAD begins when endothelial cells in the arterial lining are
injured, making them permeable to lipoproteins
 ◗ Clot-forming platelets adhere to the injury site, and
lipoproteins build up around smooth-muscle cells, causing
fatty streaks
 ◗ Fibrofatty plaques form from repeated injury to the
endothelial cells; as the process is repeated, the vessel
progressively narrows
 ◗ Plaques can rupture, causing emboli, or can worsen and
compromise myocardial oxygenation and blood flow, thus
precipitating angina or MI
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CAD - Coronary artery disease
 Description ◆ In CAD, plaques partially or totally occlude
the coronary artery vasculature; it’s the leading cause of
death and disease
 TRADITIONAL RISK FACTORS
 • Nonmodifiable
 • Heredity • Age • Gender
 • Modifiable
 • Elevated lipid level • Hypertension
 • Cigarette smoking • Diabetes
 • Obesity • Sedentary lifestyle
 NONTRADITIONAL RISK FACTORS
 • Metabolic syndrome (Met-S) • C-reactive protein (CRP)
 • Elevated homocysteine level
 ASSESSMENT findings
1. CHEST PAIN-MI:is described as severe, persistent,
crushing substernal discomfort
Radiates to the neck, arm, jaw and back-Occurs
without cause, primarily early morning
NOT relieved by rest or nitroglycerin
Lasts 30 minutes or longer
Chest pain- ANGINA:The most characteristic symptom
PAIN is described as mild to severe retrosternal pain,
squeezing, tightness or burning sensation
Radiates to the jaw and left arm,Precipitated by
Exercise, Eating heavy meals, Emotions like
excitement and anxiety and Extremes of temperature
Relieved by REST and Nitroglycerin
 Myocardial infarction
Signs and symptoms of MI are variable and may
include the following:
• Chest pain; substernal and/or radiating to the left arm, jaw
• Nausea N/V
• Dyspnea Shortness of breath
• Diaphoresis
Assessment findings
4. cold clammy skin
5. restlessness, sense of doom
6. tachycardia or bradycardia
7. hypotension
8. S3 and dysrhythmias
NURSING MANAGEMENT
1. Administer prescribed medications
Nitrates- to dilate the coronary arteries
Aspirin- to prevent thrombus formation
Beta-blockers- to reduce BP and HR
Calcium-channel blockers- to dilate coronary artery
and reduce vasospasm
2. Teach the patient management of anginal attacks
Advise patient to stop all activities
Put one nitroglycerin tablet under the tongue
Wait for 5 minutes, If not relieved, take another
tablet and wait for 5 minutes, Another tablet can be
taken (third tablet),If unrelieved after THREE
tablets seek medical attention
Medical Management
1. ANALGESIC
The choice is MORPHINE
It reduces pain and anxiety
Relaxes bronchioles
To enhance oxygenation DECREASE O2
DEMAND
2. ACE- PRIL
Prevents formation of angiotensin II
Limits the area of infarction
3. Thrombolytics
Streptokinase, Ateleplase
Dissolve clots in the coronary artery allowing blood
 ◆ Treatment aims to modify risk factors for CAD to prevent
acute myocardial events (smoking cessation, decreased intake of
dietary fat, and increased activity level); pharmacologic agents -
to stabilize client MONA
 ● Oxygen to increase oxygenation of the blood
 ● Non entericcoated aspirin for antiplatelet effect
 ● Fibrinolytic therapy for eligible patients
 ● Betaadrenergic blockers to reduce the workload and oxygen
demand
 ● ACE inhibitor to reduce afterload and preload
 Coronary angioplasty with percutaneous coronary intervention
 ◆ Surgical treatment, stent placement, percutaneous
transluminal coronary angioplasty PTCA, or coronary artery
bypass grafting (CABG),
 Saphenous vein /mamo artey
47
 1.Complication of MI is:
 Cardiac arrhythmia, cardiogenic shock
 2. the most dangerous arrhythmia?
– V-tach (Ventricular tachycardia) & VF (Ventricular fibrillation) - D/C
shock (defibrillator) is used with:200j
 – V-tach (Ventricular tachycardia) & VF (Ventricular fibrillation)
 Q A new-onset MI can be recognized by which of the
following ECG changes?
a.Q waves b.Smaller R waves
c.Widened QRS d.ST-segment elevation
 ANSWER D
 Q. When to give aspirin and clopidogrel?
 a) pt with a hx of previous MI
 b) Acute MI
 c) hx of previous ischemic stroke
 d) hx of peripheral artery disease
48
 e) after cardiac cath The correct answer is B
 INR ACTION
 >10 Stop warfarin. Contact patient for examination. MONITOR
INR
 7-10 Stop warfarin for 2 days; decrease weekly dosage by 25%
or by 1 mg/d for next week (7 mg total); monitor INR
 4.5-7 Decrease weekly dosage by 15% or by 1 mg/d for 5 days
of next week (5 mg total); repeat monitor INR
 3-4.5 Decrease weekly dosage by 10% or by 1 mg/d for 3 days
of next week (3 mg total); repeat monitor INR.
 2-3 No change.
 1.5-2 Increase weekly dosage by 10% or by 1 mg/d for 3 days
of next week (3 mg total);
 <1.5 Increase weekly dose by 15% or by 1 mg/d for 5 days of
next week (5 mg total);
 Q. therapeutic range of INR : b. 2.0-3.0
49
 A known case of chronic atrial fibrillation on the
warfarin 5 mg came for follow up you find INR 7 but
no signs of bleeding you advice is:
 a. Decrease dose to 2.5 mg
b. Stop the dose and repeat INR next day
c. Stop warfarin
 d. Continue same and repeat INR
 the correct answer is B
 Patient is a known case of CAD the best exercise:
 a. Isotonic exercise b. Isometric exercise
 c. Anerobic exe d. Yogha
 the correct answer is A Isotonic and aerobic exercises are
good for patients with CAD
 Q.The mechanism of action of Aspirin:
 a. Inhibit cyclooxygenase b. Inhibit phospholipase A2
50
 In assessing a patient’s major risk factors for heart disease,
which would you want to include in your history?
 1. Family history, hypertension, stress, age
 2. Personality type, high cholesterol, diabetes, smoking
 3. Smoking, hypertension, obesity, diabetes, high cholesterol
 4. Alcohol consumption, obesity, diabetes, stress, high cholesterol
 Correct answer: 3 Rationale: For major risk factors for coronary artery
disease, collect data regarding elevated serum cholesterol, elevated blood
pressure, blood sugar levels above 130 or known diabetes mellitus,
obesity, cigarette smoking, low activity level.
 Q. Which laboratory results would the nurse expect to be
elevated if the client had a myocardial infarction (MI)?
 A. Isoenzymes(CK-MB ) and troponin B. Sodium and potassium
 C. Red blood cells and platelets
 Q. Which of the following is the most common symptom of
myocardial infarction?
 A. Chest Pain B. Dyspnea C. Edema D. Palpitation
5/22/2023 51
 ANSWER A DIAPHORESIS
 Q.Whilst recovering from surgery a patient
develops deep vein thrombosis. The sign that
would indicate this complication to the nurse
would be:
A. Intermittent claudication
B. Pitting edema of the area
C. Severe pain when raising the legs
D. Localized warmth and tenderness of the site
Answer: D
 Q. Before administering the digoxin (Lanoxin) to
theclient, what nursing assessment is essential?
A. The client’s heart rate B. The client’s BP
C. The client’s heart sounds D. The client’s breath sounds

5/22/2023 52
 Angina Pectoris - Chest pain resulting from
coronary atherosclerosis or myocardial ischemia
 Three Common Types Of Angina
 1. Stable Angina
 - The typical angina that occurs during exertion,
relieved by rest and drugs and the severity does not
change
 2. Unstable angina
 - Occurs unpredictably during exertion and emotion,
severity increases with time and pain may not be
relieved by rest and drug
 . 3. Variant angina
 - Prinzmetal angina, results from coronary artery
VASOSPASMS, may occur at rest 53
 One differentiating factor between stable angina and
unstable angina is that stable angina
 A.responds predictably well to vasodilators.
 B.is not precipitated by activity.
 C.has a low correlation to CAD.
 D.is a result of coronary artery spasm.
 ANS: A Stable angina usually begins gradually and is
corrected by the administration of vasodilators.
 Hypertensive crises drugs:
 Nitropruside (nepride) & hydralazine (apresoline)
 The drug of choice for Supra ventricular
tachycardia is …SVT
 – Adenosine--Adenosine should be given in seconds
and follws by bolus of IV fluids
5/22/2023 54
Q. Which drugs are most commonly used to treat hypertensive
crises?
a. Labetalol and bumetanide (Bumex)
b. Esmolol (Brevibloc) and captopril (Captopril)
c. Enalaprilat (Vasotec) and minoxidil (Minoxidil)
d. Fenoldopam (Corlopam) and sodium nitroprusside (Nitropress)
Q. d. Hypertensive crises are treated with IV administration of
antihypertensive drugs, including the vasodilators sodium nitroprusside,
fenoldopam, and nicardipine; adrenergic blockers such as labetalol, esmolol,
and phentolamine; the ACE inhibitor enalaprilat; the calcium channel blocker
clevidipine; nitroglycerin for myocardial ischemia; hydralazine with other
medications; and oral captopril. Sodium nitroprusside is the most effective
parenteral drug for hypertensive emergencies.
 Adenosine (Adenocard) is an antidysrhythmic agent given
primarily to Convert Supra Ventricular Tachycardias. SVT
 Adenosine slows AV conduction causing transient AV block. It is used
clinically to convert supraventricular tachycardias
 Given within 1-3 sec accomp.by bolus IVF
55
 Q. Which side effects are most closely associated with
the use of nitroglycerin tablets?
1. Headache &Dizziness 2. Backache
3. Diarrhea 4. Jaundice & Pallor
ANS. 1, Side effects of nitroglycerin include headache, flushing,
hypotension and dizziness. These effects are the direct result of
vasodilation. The other choices are not associated with
nitroglycerin.
Q. If the chest pain is not relieved after taking one
nitroglycerin tablet, the nurse should teach the client to
take what action?
1. Take another tablet in 5 minutes.
2. Drive to the emergency department.
3. Call the physician immediately.
4. Swallow two additional tablets.
ANS. 1. The dose of nitroglycerin may be repeated in 5 minutes, for a total of
three doses. However, the client is told to call the physician if the pain is
56
unrelieved after three successive doses because other treatment may necessary.
Vasodilators
Types: Nitroglycerin paste (Nitro-Bid), nitroglycerin sublingual (Nitrostat),
isosorbide mononitrate (Imdur), isosorbide dinitrate (Isordil), and hydralazine
(Apresoline) are used.
Definition: Vasodilators work by dilating the blood vessels and increasing
oxygen supply, especially in areas where ischemia is present. They are used to
treat patients with angina, MI, or hypertension associated with chest discomfort.
Contraindications: Patients who are hypotensive should not use these
medications.
Pharmacokinetics: They are absorbed by the liver and excreted through the
urine. Patients who take sildenafil (Viagra) should avoid nitrates due to the side
effect of severe hypotension.
Side Effects: Hypotension, headache, reflex tachycardia, syncope, and
dizziness.
Nursing Care: Monitor the patient’s blood pressure and pulse before
administering, paying attention to any parameters. Nitrates given sublingually
should be taken while the patient is sitting down. Nitroglycerin tablets are kept
in a dark bottle in a cool place. Three tablets are given in 5-minute
intervals, and if chest pain is not relieved by the third dose, a more 57
 Thrombolytics
 Types: Alteplase (Activase), tenecteplase (TNKase), and streptokinase
(Strepltase) are commonly given.
 Definition: Thrombolytic medications are also used to dissolve blood
clots by activating plasmin to break up clots. They are used to treat
patients with myocardial infarction, pulmonary embolism,
DVTs, and stroke.
 Contraindications: Patients with bleeding disorders should not use
this medication.
 Pharmacokinetics: Metabolized by the liver and excreted through the
urine.
 Side Effects: Bruising and bleeding.
 Nursing Care: Thrombolytic therapy has to meet the criteria of
administering the medication to patients with MI and stroke
within 3 hours of symptom onset. Monitor clotting factors while
patients are on these medications. Monitor for signs of bleeding. If
medication therapy cannot be administered, surgical interventions may
be needed. Place the patient on bleeding precautions. Closely monitor
patients. 58
 ANTIPLATELETS
 Types: Aspirin (ASA), triofiban (Aggrastat), clopidogrel (Plavix), ticlopidine
(Ticlid), and cilostazol (Pletal).
 Definition: These medications are used to prevent the formation of plaque
build-up and thrombus in the arteries. Blockage of the arteries can cause
serious complications such as stroke or MI.
 Contraindications: Patients with bleeding disorders should stop taking
antiplatelet medications. They are also instructed to stop all antiplatelet
medications before surgeries or invasive procedures.
 Pharmacokinetics: Metabolized and excreted by the liver.
Side Effects: Bruising, GI bleeding, GI upset, anemia, dizziness, and headache.
Nursing Care: Monitor for signs of bleeding. Teach the patient to assess for
side effects. If the patient is experiencing dark stool or frank blood through the
stool, stop all antiplatelet medications. Monitor liver functions. The patient
should take precautions against bleeding while on these medications,
such as shaving with an electric razor, applying pressure to small cuts,
avoiding bruises, and using a soft toothbrush. As these medications can
cause GI upset, they should be taken with food. Patients are instructed to stop these
medications before any procedure. Patients who have cardiac surgery or blood clots are
placed on long-term antiplatelet therapy 59
 Blood Pressure BP
 Baroreceptors (pressoreceptors) in the
carotid and aorta: affected by changes in the
arterial BP
 Stretch receptors, located in the vena cava
and the right atrium, respond to pressure
changes that affect circulatory blood volume.
 Hormones- ADH (vasopressin), aldosterone
promotes water and sodium retention by the
kidneys, epinephrine can increase BP;
 Cardiac output X peripheral resistance

5/22/2023 60
 Hypertension
◆ Hypertension is persistent high blood pressure,
usually defined as a systolic pressure above 140 mm
Hg or a diastolic pressure above 90 mm Hg based on
two or more consecutive readings over a 2-week
Period
◆ Three types of hypertension exist: essential or
idiopathic (elevated blood pressure of unknown
cause); secondary (elevated blood pressure of known
cause, such as renovascular disease, pregnancy,
and coarctation of the aorta); and malignant (severe,
fulminant form with a diastolic pressure
above 140 mm Hg)
61
 ◆ Related signs and symptoms may include
headache (usually in the morning), dizziness,
bruits,fl ushed face, epistaxis, blurred vision,
retinopathy, retinal hemorrhages, restlessness,
crackles, and dyspnea (if the lungs are involved)

5/22/2023 62
5/22/2023 63
Beta-Adrenergic Blockers (Beta-Blockers): All -olol, -ilol, -alol Endings
Definition: Beta-blockers decrease cardiac output by releasing norepinephrine,
epinephrine, and catecholamine to decrease blood pressure. They are used for
patients with hypertension, myocardial infarction, and dysthymias.
Types: Atenolol (Tenormin), nebivolol (Bystolic), metoprolol (Lopressor),
propanolol (Inderal), labetolol (Trandate), carvedilol (Coreg), naldolol
(Corgard), acebutolol (Sectral), and bisoprolol (Zebeta).
Contraindications: Patients with low blood pressure, heart failure,
bradycardia, bronchospasms, and renal disease. Patients with diabetes
mellitus should use beta-blockers with caution because these
medications may mask signs of hypoglycemia.
Pharmacokinetics: Metabolized by the liver and excreted in the urine.
Side Effects: Bradycardia, hypotension, dizziness, dry mouth, hyperglycemia,
fatigue, nausea, bronchospasms, nightmares, and insomnia.
Nursing Care: Before administering these medications, assess vital signs.
Follow parameters before administering dosage. Monitor side effects. Assess for
orthostatic hypotension or signs of decreased blood pressure. Patients who
take beta-blockers should use caution when taking over-the-counter
medications.
64
 Angiotensin-Converting Enzyme Inhibitors: All “-pril” Endings
 Definition: ACE inhibitors are used to prevent the conversion of angiotensin
I to angiotensin II to increase cardiac output and contractility.
 Types: lisinopril (Zestril), captopril (Capoten), benzapril (Lotensin),
enalapril (Vasotec), ramipril (Altace), and quinapril (Accupril).
 Contraindications: Patients with hypotension, MI, renal and heart failure.
 Pharmacokinetics: Metabolized and excreted by the kidneys.
 Side Effects: Persistent dry cough, orthostatic hypotension, loss of
taste, hyperkalemia, renal failure, dizziness, and tachycardia.
 Nursing Care: Obtain a set of vital signs before administering medication.
Follow parameters if ordered by the physician. Monitor for side effects such
as persistent cough; consider changing medication if symptoms persist.
Monitor patients’ renal function while they are on these medications.

65
 Calcium Channel Blockers (CCBs): All -dipine Endings
 Definition: These medications decrease cardiac contractility by inhibiting
calcium ions. CCBs are used to promote dilation of the blood vessels, which
results in a decrease in blood pressure. They are used for patients with
hypertension, dysrhythmias, and angina.
 Types: amlodipine (Norvasc), nifedipine (Procardia), diltiazem (Cardizem),
verapamil (Calan), and clevidipine (Cleviprex).
 Contraindications: Patients with hypotension, congestive heart failure,
and atrioventricular block.
 Pharmacokinetics: Metabolized and excreted by the liver.
 Side Effects: Dizziness, constipation, hypotension, edema, headaches,
bradycardia, and gingival hyperplasia.
 Nursing Care: Obtain a set of vital signs before administering medication.
Follow parameters if ordered by the physician. Monitor for side effects.

66
Calcium Channel Blockers (CCBs): All -dipine Endings
Definition: These medications decrease cardiac contractility by
inhibiting calcium ions. CCBs are used to promote dilation of the
blood vessels, which results in a decrease in blood pressure. They
are used for patients with hypertension, dysrhythmias, and
angina.
Types: amlodipine (Norvasc), nifedipine (Procardia), diltiazem
(Cardizem), verapamil (Calan), and clevidipine (Cleviprex).
Contraindications: Patients with hypotension, congestive heart
failure, and atrioventricular block.
Pharmacokinetics: Metabolized and excreted by the liver.
Side Effects: Dizziness, constipation, hypotension, edema,
headaches, bradycardia, and gingival hyperplasia.
Nursing Care: Obtain a set of vital signs before administering
medication. Follow parameters if ordered by the physician.
Monitor for side effects. 67
 . Angiotensin II Receptor Blockers: All “-sartan” Endings
 Definition: These medications block angiotensin II receptors,
resulting in a decrease in blood pressure. Used to treat
hypertension.
 Types: lorsartan (Cozaar), valsartan (Diovan), olmesartan
(Benicar), irbesartan (Avapro), telmisartan (Micardis),
candesartan (atacand), azilsartan (Edarbi), and eprosartan
(Teveten).
 Contraindications: Patients who are hypotensive.
 Pharmacokinetics: Metabolized and excreted by the kidneys.
 Side Effects: Hypotension, dizziness, tachycardia, nausea, and
hypoglycemia.
 Nursing Care: Obtain vital signs before administering dose.
ARBs and ACE inhibitors are given together for patients who
suffer from severe dry cough. Monitor blood glucose levels.
Report any side effects to the physician. 68
Anticoagulants
Definition: Anticoagulants are used to dissolve blood clots and prevent further
thrombosis by coagulating (thinning) the blood. They are used to treat patients
with atrial fibrillation, and those at risk for or with deep vein thrombosis or
pulmonary embolism (PE).
Types: Heparin (IV, , or subQ), warfarin (Coumadin), enoxaparin
(Lovenox), tinzaparin (Innohep), dalteparin (Fragmin), dabagatran
(Pradaxa), and fondaparinux (Arixtra).
Contraindications: Individuals with bleeding disorders should stop or use
caution when taking these medications.
Pharmacokinetics: Metabolized and excreted by the liver.
Side Effects: Easy bruising, hemorrhage, bleeding in the gums, GI
bleed, and heparin-induced thrombocytopenia.
Nursing Care: Coumadin is often used to treat blood clots, PE, and atrial
fibrillation. Coumadin dosage is controlled and based on the individual’s
prothrombin time (PT) and international normalized ratio (INR) to clotting
factors. The normal PT level is 10 to 12 seconds and INR is 1.2 to 2.0.
An INR less than 3 can mean the patient is at risk for bleeding and the
dose may need to be stopped or decreased. Patients are instructed to
69
have the PT/INR checked frequently.
Anticoagulants
Teach the patient about the side effects and risks of taking Coumadin. The
medication is typically given at the same time every day. The antidote for
Coumadin is vitamin K.
Heparin prevents clots by activating fibrinogen and fibrin. Heparin helps
convert fibrinogen to fibrin to dissolve clots. Heparin is effective and based on
an individual’s partial prothrombin time (PTT). Now, here is a little trick,
because you will be tested on the two main anticoagulants. Heparin goes
with PTT, and Coumadin goes with PT; now if you write out PTT and
cross the two T’s it creates an “H” to represent heparin. Heparin can be
given IV or subcutaneously. If a patient is admitted for a blood
PHARMACOLOGY Cardiovascular Medications 136
clot or a PE, a heparin drip is typically ordered, and the PTT is monitored every
6 hours until levels are therapeutic. Follow the heparin protocol at your facility.
Monitor for signs of bleeding. The antidote for heparin is protamine sulfate.
Lovenox is similar to heparin but not as potent. Lovenox is given
subcutaneously in the abdomen or arm. There are no clotting factors that need
to be monitored with Lovenox. The injection site may cause severe bruising, so
instruct the patient not to rub or apply pressure to the area after administering.
Monitor for signs of bleeding. The antidote for Lovenox is protamine sulfate.
70
 HYPERTENSION
MEDICAL MANAGEMENT /Drug therapy
 Diuretics-Patassium

 Beta Blockers OLOL Atenolol

Tenormin
 ACE inhibitors-PRIL ENAPRIL
RENETIC- DRY COUGH
 Calcium channel blockers- DEPINE

 AMELODIPINE NORVASC

 A2 Receptor blockers-SARTAN
DIOVAN
 Vasodilators -ISOKET
 Q.An 69 year old non diabetic. with mild
hypertension and no hx of Coronary heart disease.
the best drug in treatment is.
a. thiazides b. ACEI c. ARB d. CCB
 Answer A
 which of the following anti hypertensive is
contraindicated for an uncontrolled diabetic patient
 a. hydrochlorothiazide b. Losartan
 c. hydralazine d. spironolactone
 ANSWER A side effect of thiazide : hyperglycemia
 Q.In patients with hypertension and diabetes, which
antihypertensive agent you want to add first?
 a. β-blockers b. ACE inhibitor
 c. α-blocker d. Calcium channel blocker
 ANSWER B 72
 The physician prescribes captopril (Capoten)
25mg po tid for the client with hypertension.
Which of the following adverse reactions can
occur with administration of Capoten?
A. Tinnitus
B. Persistent cough
C. Muscle weakness
D. Diarrhea
 Answer B is correct. A persistent cough might be
related to an adverse reaction to Captoten.

5/22/2023 73
 CHF
 A syndrome of congestion of both pulmonary and
systemic circulation caused by inadequate cardiac
function and inadequate cardiac output to meet the
metabolic demands of tissues
 Inability of the heart to pump sufficiently
 The heart is unable to maintain adequate circulation
to meet the metabolic needs of the body
 Classified according to the major ventricular
dysfunction- Left or Right
75
 Digoxin/ lanoxin – glycoside 0.25MG
 Forcefull contractility
 Check HR
 Monitor K
 DIGOXIN blood level 0.8-2 NANOGRAM
 DIGOXIN TOXICITY
 ABSENT OF P WAVE
 ANTIDOTE DIGIBAND -DIGIFAB

76
 NURSING INTERVENTIONS
 1. Assess patient's cardio-pulmonary status
 2. Assess VS, CVP and PCWP. Weigh patient daily to
monitor fluid retention
 3. Administer medications- usually cardiac
glycosides are given- DIGOXIN or DIGITOXIN,
Diuretics, vasodilators and hypolipidemics are
prescribed
 4. Provide a LOW sodium diet. Limit fluid intake as
necessary
 5. Provide adequate rest periods to prevent fatigue
 6. Position on semi-fowler’s to fowler’s for adequate
chest expansion
 7. Prevent complications of immobility
 Loop Diuretics
 Types of Loop Diuretics: Furosemide (Lasix), torsemide (Demadex), and
bumetanide (Bumex).
 Definition: These are the most effective of the diuretics. Loop diuretics
reduce sodium and water in the loop of Henle to decrease edema, fluid
overload, and hypertension. Typically given to patients who have CHF,
edema, or hypertension.
 Contraindication: Patients who have hypokalemia, hypotension, or renal
failure.
 Pharmacokinetics: Metabolized and excreted by the kidneys.
 Side Effects: Dehydration, hearing loss, hypokalemia, hyponatremia,
hypocalcemia, increase in uric acid, and hypotension.
 Nursing Care: Obtain vital signs before administering. Monitor BP before
and after. Monitor electrolytes. Obtain daily weights. Monitor urine output. If
patient is experiencing shortness of breath or if crackles in lung are
heard on auscultation, Lasix is usually administered IV push. Assess
for output to see if the medication is effective. Can be given IV or orally.
Pay attention to the “–mide” ending (which indicates a loop
diuretic).
78
 Cardiac Glycosides
 Types: Digoxin (Lanoxin).
 Definition: These medications increase contractility and cardiac output.
Cardiac glycosides also decrease sodium and potassium levels. They are
used for patients with cardiac tachycardia and heart failure.
 Contraindicated: Caution should be used when administering to patients
with renal failure or those with electrolyte imbalances
 Side Effects: Visual disturbances, nausea, vomiting, weight loss,
bradycardia, hypokalemia, dizziness, tachycardia, and fatigue.
 Nursing Care: Before administering, take the apical pulse for a full minute.
If the pulse is less than 60 bpm, hold the medication. This medication can
decrease the pulse severely. Complications such as digitalis toxicity
can occur when taking this medication. Labs are obtained to
monitor digoxin levels, which range from 0.5 to 2.0 ng/mL. The
signs of digoxin toxicity are nausea, vomiting, green halos, and cardiac
dysrhythmias. The antidote for digoxin is digoxin immune fab (Digibind). If
an irregular heartbeat or rhythm occurs while a patient is taking this
medication, the drug should be stopped and the physician contacted
immediately. Cardiac monitoring is ordered.
79
Q. When preparing discharge instructions for this
client, the nurse’s instructions should include taking
oral furosemide (Lasix) at what time of day?
[ ] 1. Before bedtime
[ ] 2. When arising in the morning
[ ] 3. With the main meal
[ ] 4. In the late afternoon
ANS. 2. When given once daily, furosemide (Lasix) is
generally administered in the early morning to avoid
disturbing the client’s sleep with the need to urinate. If
the medication is ordered for twice a day, the fi rst dose is
usually given early in the morning at about 6 a.m., and the
other dosage in the early afternoon at about 1 p.m.

5/22/2023 80
Medication for patient with ventricular
tachycardia who is hemodynamically
stable
A. Atenolol
B. Verapamil
C. Amiodarone
D. Lidocaine
 The negative effect of intravenous
nitroglycerin (Tridil) for shock management
is:
 Reduced preload
 Reduced afterload
 Increased
5/22/2023
cardiac output 81
CARDIOGENIC SHOCK
Heart fails to pump adequately
resulting to a decreased cardiac output
and decreased tissue perfusion
ETIOLOGY
1. Massive MI
2. Severe CHF
3. Cardiomyopathy
4. Cardiac trauma
5. Cardiac tamponade
CARDIOGENIC SHOCK
ASSESSMENT FINDINGS
1. HYPOTENSION
2. oliguria (less than 30 ml/hour)
3. tachycardia
4. narrow pulse pressure
5. weak peripheral pulses
6. cold clammy skin
7. changes in sensorium/LOC
8. pulmonary congestion
CARDIOGENIC SHOCK
LABORATORY FINDINGS
Increased CVP
Normal is 5-10 cmH2O
NURSING INTERVENTIONS
1. Place patient in a modified Trendelenburg (shock )
position
2. Administer IVF, vasopressors and inotropics such
as DOPAMINE and DOBUTAMINE
3. Administer O2
4. Morphine is administered to decreased pulmonary
congestion and to relieve pain
5. Assist in intubation, mechanical ventilation, PTCA,
CABG, insertion of Swan-Ganz cath and IABP
6. Monitor urinary output, BP and pulses
7. cautiously administer diuretics and nitrates
Shock decrease low hypo inadequate
perfusion
Early sign shock- increase hr –tachycardia
Late signs- low bp
Rx treatment - dopamine
 CARDIAC TAMPONADE
A condition where the heart is unable to
pump blood due to accumulation of fluid in
the pericardial sac (pericardial effusion)
This condition restricts ventricular filling
resulting to decreased cardiac output
Acute tamponade may happen when there
is a sudden accumulation of more than 50
ml fluid in the pericardial sac
CARDIAC TAMPONADE
Causative factors
1. Cardiac trauma
2. Complication of Myocardial
infarction
3. Pericarditis
4. Cancer metastasis
 CARDIAC TAMPONADE
ASSESSMENT FINDINGS
1. BECK’s Triad- Jugular vein distention,
hypotension and distant/muffled heart sound
2. Pulsus paradoxus
3. Increased CVP
4. decreased cardiac output
5. Syncope
6. anxiety
7. dyspnea
8. Percussion- Flatness across the anterior chest
 CARDIAC TAMPONADE
NURSING INTERVENTIONS
1. Assist in PERICARDIOCENTESIS
2. Administer IVF
3. Monitor ECG, urine output and BP
4. Monitor for recurrence of
tamponade
THORACENTESIS
PARACENTESIS
Q. When obtaining a health history from this client,
which finding strongly suggests that the client is
hypertensive? EXCEPT
[ ] 1. Unexplained nosebleeds
[ ] 2. Dizziness
[ ] 3. blurred vision
[ ] 4. Occasional heart palpitations
ANS. 4. Hypertension is a serious disorder that is associated with
stroke and heart disease. It may be classifi ed as primary (without
a known cause) or secondary (a known pathology). Some of the
earliest signs and symptoms of hypertension include spontaneous
nosebleeds, awakening with a headache, and blurred vision. Other
symptoms include a persistent throbbing or pounding headache,
dizziness, fatigue, and nervousness. Usually clients with
hypertension have flushed rather than pale skin.
5/22/2023 91
Q. A client has an angiotension-converting enzyme (ACE)
inhibitor, enalapril (Vasotec) 10 mg daily added to the medication
regimen.
Which of the following client statements will the nurse recognize
as a potential side effect of the medication?
[ ] 1. “I have noticed that I am urinating more than normal.”
[ ] 2. “I have a dry, hacky cough throughout the day.”
[ ] 3. “I feel weak and lethargic in the afternoon.”
[ ] 4. “I feel that I am having heart palpitations.”
ANS. 2. A dry, hacky cough is a side effect of angiotensinconverting enzyme
(ACE) inhibitors. The cough is attributed to the drug’s increase in bradykinin,
an infl ammatory substance, which causes sensitization of sensory nerves in
the airway and an enhancement of the cough refl ex. If this occurs, the client
should inform the health care provider because the medication may need to
be changed. Switching to an angiotensin II receptor blocker (ARB) such as
losartan (Cozaar) relieves the cough and lowers blood pressure. Angioedema
(swelling of the face) also is a side effect of ACE inhibitors.

5/22/2023 92
 ANEURYSM: Dilation involving an artery
formed at a weak point in the vessel wall
Saccular= when one side of the vessel is
affected
Fusiform= when the entire segment
becomes dilated
RISK FACTORS
1. Atherosclerosis ARTERIOSCLEROSIS
2. Infection= syphilis
3. Connective tissue disorder
4. Genetic disorder= Marfan’s Syndrome
 PATHOPHYSIOLOGY
Damage to the intima and media weakness
outpouching
Dissecting aneurysm tear in the intima and
media with dissection of blood through the
layers
ASSESSMENT
1. Asymptomatic
2. Pulsatile sensation on the abdomen
3. Palpable bruit
ARTERIES
 Blood vessels that
carry blood away from
the heart are called
arteries.
 They are the thickest
blood vessels and they
carry blood high in
oxygen known as
oxygenated blood
(oxygen rich blood).
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Refers to arterial insufficiency of
the extremities usually secondary
to peripheral atherosclerosis.
Usually found in males age 50 and
above
The legs are most often affected
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral
Arterial occlusive disease
Non-Modifiable
1. Age
2. gender
3. family predisposition
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Modifiable
1. Smoking
2. HPN
3. Obesity
4. Sedentary lifestyle
5. DM
6. Stress
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
1. INTERMITTENT CLAUDICATION- the
hallmark of PAOD
This is PAIN described as aching, cramping or
fatiguing discomfort consistently reproduced
with the same degree of exercise or activity
This pain is RELIEVED by REST
This commonly affects the muscle group below
the arterial occlusion
2. Progressive pain on the extremity as the
disease advances
3. Sensation of cold and numbness of the
extremities
 VEINS
Blood vessels that carry
blood back to the heart
are called veins.
They have one-way
valves which prevent
blood from flowing
backwards.
They carry blood that is
high in carbon dioxide
known as deoxygenated
blood (oxygen poor
blood).
 HOMAN’s SIGN
The foot is FLEXED upward
(dorsiflexed) , there is a sharp pain
felt in the calf of the leg% indicative
of venous
inflammation

5/22/2023 101
HOMAN’s SIGN
The foot is FLEXED upward (dorsiflexed) , there is a sharp pain felt in the
calf of the leg% indicative of venous
inflammation

5/22/2023 102
A patient has a positive Homan’s sign. You know that a
positive Homan’s sign:
1. occurs with venous insufficiency.
2. is indicative of possible thrombophlebitis.
3. is seen in the presence of severe edema.
4. indicates problems with arterial circulation.
Correct answer: 2
Rationale: Calf pain on dorsiflexion of the foot is a positive
Homan’s sign, which occurs in about 35% of deep vein
thrombosis. It also occurs with superficial phlebitis, Achilles
tendinitis, and gastrocnemius and plantar muscle injury.

5/22/2023 103
A patient has been diagnosed with Raynaud’s disease and asks
the nurse what occurs with this disease. Which of the
following is the most appropriate response?
1. “Arterial vessel occlusion is caused by many clots that develop
in the heart and are carried to the bloodstream.”
2. “Arteriolar vasoconstriction occurs, most often in the fingertips
with symptoms of coldness, pain, and pale skin.”
3. “Peripheral vasospasm occurs in the lower limbs as a result of
valve damage from long-standing venous stasis.”
4. “Thrombosis related to prolonged vasoconstriction caused by
overexposure to the cold occurs.”
ANSWER 2

5/22/2023 104
 A recommended position for a patient in acute
pulmonary edema is:
Prone, to encourage maximum rest, thus decreasing respiratory
and cardiac rates.
Semi-Fowler’s to facilitate breathing and promote pooling of
blood in the sacral area.
Trendelenburg, to drain the upper airways of congestion.
Upright with the legs down, to decrease venous return.
Which of the following signs and symptoms usually
signifies rapid expansion and impending rupture of an
abdominal aortic aneurysm?
A. Abdominal pain.
B. Absent pedal pulses.
C. Chest pain.
D. Lower back pain.
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31. A client is admitted with suspected abdominal aortic
aneurysm (AAA). A common complaint of the client
with an abdominal aortic aneurysm is:
❍ A. Loss of sensation in the lower extremities
❍ B. Back pain that lessens when standing
❍ C. Decreased urinary output
❍ D. Pulsations in the periumbilical area
Answer D is correct. The client with an abdominal
aortic aneurysm frequently complains of pulsations or
feeling the heart beat in the abdomen. Answers A and C
are incorrect because they are not associated with
abdominal aortic aneurysm. Answer B is incorrect
because back pain is not affected by changes in position.
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Rheumatic heart disease-- ASO titer
Raynaud’s disease is a form of:
Arterial vessel occlusion caused by multiple emboli that
develop in the heart and are transported through the
systemic circulation
Arteriolar vasoconstriction, usually on the fingertips,
that results in coldness, pain and pallor.
Peripheral venospasm in the lower extremities owing to
valve damage resulting from prolonged venous stasis.
Phlebothrombosis related to prolonged vasoconstriction
resulting from overexposure to the cold.

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Tetralogy of Fallot.