CARDIOVASCULAR NURSING NOTES

Cardiovascular System
 Tissue Perfusion:
o Blood: 5 – 6L circulating in the body
 Decreased blood volume -> decrease tissue perfusion -> hypovolemic shock
o Heart: Pump blood into the body -> decreased pumping ability -> decrease tissue perfusion ->
cardiogenic shock
 Causes:
 Coronary Causes: MI
 Non-coronary causes
 Obstructive Shock
o Blood Vessels: Distribute blood.
 Arteries: Resistance Vessels (Aorta)
 Pulses: When pulses are good, blood flow is good
o 0 Absent, +1 Weak, +2 Normal, +3 Increase, and +4 Bounding = maybe
abnormal
 Veins: Capacitance Vessels (Inferior Vena Cava)
 Capillaries: Exchange Vessels (Largest Surface Area)
 When smooth muscles contract – vasoconstrict.
 When smooth muscles relax – vasodilate.
 Circulatory Shock:
 Cause:
o Infection – inflammation – vasodilation = septic shock
o Allergy – inflammation – vasodilation = anaphylactic shock
o Spinal cord injury – inflammation/loss of SNS – vasodilation = neurogenic
shock
 Vascular Disorders
o Aneurysm: Abnormal Dilation of the wall of an artery.
 Classification:
 Congenital – Cerebral Vessels (Unknown)
 Acquired – Aorta
o Risk Factors:
 Age
 Family History
 Sedentary Lifestyle
 Diet – High Fat, High Cholesterol
 Smoking
 Stress – Adrenal Gland
 Alcohol
 Caffeine
 Obesity
 Hypertension
 DM
 Ascending Aortic Aneurysm (Life Threatening)
o No Symptom
 Thoracic Aortic Aneurysm
o No Symptom
  Abdominal Aortic Aneurysm (At the level of the umbilicus)
o Pulsating mass in the abdomen examined by examiner.
 Management:
o Angiography
 Dissecting Aortic Aneurysm:
o Ascending Aortic Aneurysm – Severe Chest Pain
o Thoracic Aortic Aneurysm – Severe Epigastric Pain
o Abdominal Aortic Aneurysm – Back Pain
 Management:
 Type A – Surgery ASAP
 Type B – Monitor BP – Control the BP before Surgery
 Live a Healthy Lifestyle
 Manage Risk Factors
Peripheral Vascular Disease:
 Peripheral Arterial Insufficiency (Lower Extremity)
o Ischemia
 Leg Pain and Claudication
 Skin – Pale, Thinning of Hair, Cool to Touch
 Pulses – May be abnormal.
 No Edema
 Arterial Ulcer (Small but deep, Circumscribed edges with no granulation tissues)
 Dependent Nursing Intervention: Position Reverse Trendelenburg
 Venous Insufficiency (Lower Extremity)
o Venous Congestion and Phlebitis
 Leg Pain without Claudication
 Skin – Dark, Cyanotic, Pigmented
 Pulses – Normal but difficult to palpate.
 With Edema
 Venous Ulcer (Larger lesions with irregular borders with several granulation tissues)
 Dependent Nursing Intervention: Elevate legs.
o Diagnostic Tests:
 Angiography
 Ultrasound (Best for non-invasive DT)
 Peripheral Arterial Disease:
o Arteriosclerosis Obliterans: Plaque buildup within the artery walls.
 Etiology: Idiopathic
 Risk Factors:
 Age
 Family History
 Smoking
 Hypertension
 Stress
 Obesity
 DM
 Gender: Male
 Extremities: Lower Extremities
 Signs and Symptoms
 Leg Pain and Claudication
  Skin – Pale, Thinning of Hair, Cool to Touch
 Pulses – May be abnormal.
 No Edema
 Arterial Ulcer
 Nursing Diagnosis:
 Acute Pain
 Ineffective peripheral tissue perfusion
 Risk for infection
 Management:
 Position: R. Trendelenburg
 Pain Reliever – NSAIDs
 Avoid Trauma
 Manage Risk Factors
 Skin Care
 Wound Care
 Vasodilators are rarely given
 Amputation
 Rehabilitation
 Live a healthy lifestyle
o Raynaud’s Disease (Blue – White – Red Disease): Numb and cold feeling in response to cold
temperatures or stress/Vasospasm.
 Etiology: Idiopathic
 Risk Factors:
 Exposure to cold temperature
 Smoking
 Stress
 Hypertension
 Gender: Female
 Extremities: Upper Extremities
 Signs and Symptoms:
 Blue in color
 Severe Vasospasm
o White
o Tingling and Numbness
o Pain
 Reversible – Autoregulation – Vasodilation - Red
 Nursing Diagnosis:
 Acute Pain
 Ineffective peripheral tissue perfusion
 Risk for infection
 Management:
 Avoid exposure to cold temperature.
 Wear gloves/boots (Always if patient lives in Alaska)
 Increase Temperature (Heater)
 Avoid Trauma
 Avoid Stress
 Control BP
  Vasodilators are given as ordered – Diltiazem.
 Pain Reliever (If in pain) – NSAIDs

Side Notes:
Reynaud’s Phenomenon
 Etiology:
o Rheumatoid Arthritis
o Systemic Lupus Erythematosus
o Scleroderma: Skin Hardening
 CREST Syndrome: Collection of S/Sx
 Calcinosis – Deposition of calcium in soft tissues
 Raynaud’s Phenomenon
 Esophageal dysmotility
 Syndactyly – Fusion of fingers
 Telangiectasia – Abnormal vessel formation

 Venous Insufficiency Disease

o Varicose Veins: Abnormal dilation and tortious formation in the superficial veins of the lower
extremities.
 Etiology: Incompetent Valves
 Risk Factors:
 Prolonged standing/sitting/crossing of legs
 Pregnancy
 Obesity
 Signs and Symptoms:
 Leg Pain without Claudication
 Skin – Dark, Cyanotic, Pigmented
 Pulses – Normal but difficult to palpate.
 With Edema
 Venous Ulcer
 Nursing Diagnosis:
 Acute Pain
 Ineffective venous circulation
 Risk for infection
 Intervention
 Prevention:
o Avoid prolonged standing/sitting/crossing of legs
o Avoid Obesity
o Wear compression stocking
o Elevate legs
 Medical Management:
o Sclerotherapy
 Vein stripping and ligation
o Deep Vein Thrombosis (DVT) = Venous Thromboembolism (VTE)
 Virchow’s Triad – Thrombus Formation
 Stasis – Hypercoagulable – (+) Endothelial Injury
 Etiology: Idiopathic
 Sign and Symptoms according to manifestation:
  Thrombophlebitis – S/Sx of inflammation – pain, redness, swelling, tenderness
 Phlebothrombosis – Asymptomatic – sudden onset of pain
o Homan’s Sign (Not reliable) – Dorsiflexion of foot will cause pain on calf
muscle. If (+) DO NOT REPEAT THE TEST it might cause “Embolus” due to
dislodgement – Pulmonary Embolism (Dyspnea, Chest Pain, Tachypnea) –
Elevate the HOB – Administer O2 and Refer.
 Risk Factors:
 Immobilization (Bed ridden, paralyzed, comatose)
 Post-op (Advise early ambulation)
 Smoking
 Use of OCP – Increase viscosity of blood
 Intervention:
 Prevention:
o Mobilize (Exercise, Elevate legs, Compression stocking (TED –
Thromboembolic Deterrent Hose)
 Management DVT (case application): This is a case of a 70-year-old female who
had femoral hernia, she underwent herniorrhaphy under spinal anesthesia, she
was paralyzed from waist below. The surgery was successful, and she is already in
the recovery room she experiences sudden onset of leg pain, an emergency
doppler ultrasound was done. She was diagnosed to have DVT both right and left
leg.
o Immobilize – CBR without bathroom privilege.
o Heparin – Anticoagulant – prevent further thrombus formation.
o Pain Reliever – NSAIDs
o Thrombolytic Therapy - Dissolve the thrombus.
 Urokinase
 Streptokinase
 Alteplase
o TED Hose
o Anticoagulant – Warfarin
o Surgery
o Buerger’s Disease = Thromboangitis Obliterans – Thrombus Formation and Inflammation
affecting small and medium sized arteries and veins
 Etiology: Idiopathic
 Risk Factors:
 Smoking
 Males
 Stress
 Sign and Symptoms:
 Leg pain and Claudication
 Skin – Dark, Cyanotic, Pigmented
 Pulses – May be abnormal.
 With Edema
 Intervention:
 AVOID smoking and all forms of tobacco products.
 Avoid Trauma
 Avoid Stress
 Skin Care
  Wound Care
 Vasodilators are rarely given.
 Pain Reliever – NSAIDs
 Amputation
 Rehabilitation

Heart: Hollow muscular organ located in the middle mediastinum.

 Cardiac Muscles – Striated and Involuntary
 Muscular Tissue Properties:
o Contractility
o Conductivity
o Rhythmicity
o Automaticity
o Excitability
 Pump Process:
o Right Atrium receives blood from upper portion of body from Superior Vena Cava
o Right Ventricle receives blood from lower portion of body from Inferior Vena Cava
o From the walls of the heart unoxygenated will enter the RA via Coronary Sinus.
o RA will pump blood to RV passing Tricuspid Valve (function: prevent backflow)
o RV will pump blood to the lungs via Pulmonary Artery (only artery carrying unoxygenated
blood) through Semi-Lunar Valve = Oxygenation
o Oxygenated blood will flow back to the Left Atrium via Pulmonary Vein (only vein carrying
oxygenated blood)
o The valve between LA and LV will pass through Mitral Valve/Bicuspid Valve (function: prevent
backflow)
o Left Ventricle will now pump blood to the Aorta into the Systemic Circulation via Aortic Valve
 Pulmonary Circulation: 25/9mmHg Average Pressure
 Systemic Circulation: 110/70mmHg Average Pressure
o AV Valves Closure produce: First Heart Sound S1
o SL Valves Closure produce: Second Heart Sound S2
o Audible Heart Sounds: “Lub-Dub”
o Third Heart Sound S3 – Rapid Ventricular Filling (Inaudible)
 Only becomes audible if patient have cardiomegaly (CHF)
 “Lub-dub-dub” – Ventricular Gallop
o Fourth Heart Sound S4 – Atrial Contraction (Inaudible)
 Only becomes audible if patient have atrial enlargement and increased atrial pressure.
 “Lub-lub-dub” – Atrial Gallop
o Murmur – Increased turbulence in the flow of blood inside the heart (Backflow)
 Assessment of Valves: Auscultation
o Aortic Valve: Using bell auscultate at the 2nd ICS right parasternal area
o Pulmonic Valve: Using bell auscultate at the 2nd ICS left parasternal area
o Tricuspid Valve: Using bell auscultate at the 4th ICS left parasternal area
o Mitral Valve: Using bell auscultate at the 5th ICS left mid clavicular line
 Apex of the heart
 Apical Pulse – Point of maximum impulse
o Most Definitive Diagnostic Test: 2D Echocardiography
 Valvular Diseases
 Valvular Insufficiency: Inability of the valves to close completely.
o Valvular regurgitation.
 Valvular Stenosis: Inability of the valves to open completely
o Narrowing of the valves.
 Etiology:
o Congenital
o Acquired (Rheumatic Heart Disease, Endocarditis, Kawasaki)
 Mitral Valve Prolapse: Bulging or ballooning of the mitral valve onto the atrium.
o (+) Systolic Click/Mitral Click
o Etiology: Idiopathic
o Risk Factors:
 Congenital
 Female
 Stress
 Family History
o Sign and Symptoms:
 Chest Pain
 Palpitation
 Tachycardia
 Easy Fatigability
 Syncope
o Complication:
 Mitral Regurgitation
 Dysrhythmias
 Management for all Valvular Diseases:
o Valvuloplasty – Valvular Repair
o Valvular Replacement
o Support Cardiac Function
 Provide Rest
 Avoid Stress
o Manage Heart Failure
o Prevent Shock: Cardiogenic Shock

Inflammatory Heart Diseases:

 Pericarditis: Inflammation of pericardial sac.
o Cause:
 Infection
 Trauma
 SLE
 Myocardial Infarction
 Malignancy
 Idiopathic
o Common Clinical Manifestation: Chest Pain
 Characteristic of Pain:
 Myocardial Infarction = CONSTANT
 Pericarditis = Pain that worsens with deep inspiration, lying down, turning
and relieved by sitting or leaning forward (Orthopneic).
 o Sign and Symptoms:
 Friction Rub: Heard at the 4th ICS parasternal border.
 Creaky, scratching, leathery, gratin. Heard best at the end of expiration, and
when patient is sitting and leaning forward (Orthopneic position)
o Diagnosis:
 2D Echocardiography: Most definitive diagnostic test.
 Chest X-Ray
 CBC – Increased WBC
 Elevated ESR – Systemic Inflammation
 Culture and Sensitivity – If manifested through infection.
 Coronary Angiography – If manifested through MI.
 ANA Test
 Biopsy
o Management:
 Position the patient in orthopneic position (Priority)
 Pain Reliever – NSAIDs
 Anti-Inflammatory Drug – Steroids
 Manage the cause
 Prevent and Manage Complications
 Pericardial Effusion – Accumulation of fluid in the pericardial sac.
o Management:
 Pericardiocentesis
 As a nurse position the patient via semi fowler’s
position.
 X-Ray and Ultrasound Guided (Before the procedure)
 ECG Guided (During the procedure) to prevent
puncture of the heart.
 Pericardiotomy
 Pericardiectomy
 Cardiac Tamponade – Life threatening condition that the heart cannot pump
– shock (obstructive shock)
o Assessment: Beck’s Triad
 BP – Decreasing
 Venous Pressure – Increasing
 Distended Neck Vein
 Muffled heart sound
 Endocarditis: Inflammation of the endocardium
 Vegetation – Microthrombi + Bacteria + Pus
o Cause: Bacterial Endocarditis/Ineffective Endocarditis
o Etiology: GABHS, Staphylococcus Bacteria
o Risk Factors:
 Has existing cardiac disease
 Immunocompromised
 Invasive procedure or surgery
o Sign and Symptoms:
 Fever – Intermittent
 Asymptomatic
 Headache
  Dizziness
 Fatigue
 Embolism:
 Roth’s Spot – Hemorrhage with pale center (Retina)
 Osler’s Nodes – Painful nodules in finger pads and toes
 Janeway Lesions – Painless macules of palm and soles
 Splinter Hemorrhages – Brownish streaks on fingernails and toenails.
 Anemia
 Changes in murmur
o F.R.O.M.J.A.N.E
 Fever
 Roth’s spots
 Osler’s nodes
 Murmur
 Janeway lesions
 Anemia
 Nail changes
 Ecchymosis/embolization
o Nursing Diagnosis:
 Hyperthermia
 Fatigue
 Risk for fall/injury
 Risk for shock
o Diagnostics:
 Culture and Sensitivity – Most definitive for infection
 CBC – Increased WBC, Decreased RBC, Decreased Hgb
 Elevated ESR
 2D Echo
 ECG
o Management:
 Nursing Management:
 Manage fever
 Assess for changes in murmur
 Monitor VS
 Support cardiac function:
o Provide rest
o Avoid stress
 Monitor for S/Sx of heart failure/shock
 Medical Management:
 Prevention:
o Prophylaxis, antibiotic prior to any invasive procedure or surgery
(Penicillin, if allergic Erythromycin)
 Antipyretic
 Analgesic
 Drugs to support cardiac function
 Manage heart failure
 Prevent shock
 Myocarditis: Most Common in Children and the common cause is Coxsackie Virus
 Cardiomyopathy: Disease of the cardiac muscles
o Etiology: Idiopathic
o Types:
 Dilated CDM – Significant dilation of the myocardium without hypertrophy
 Diffused necrosis
o Risk Factors:
 Alcohol
 Viral Infection
 Pregnancy
 Hypertrophic CDM – Significant thickness of the myocardium especially the
interventricular septum
o Risk Factor: Family History
 Restrictive CDM – Ventricles becomes rigid
o Risk Factor: Family History
 Arrhythmogenic Right Ventricular CDM – Scarring or fibrosis of the right ventricle
o Risk Factor: Family History
o Diagnostic: 2D Echocardiography
o Management: There is no CURE for cardiomyopathy other than HEART TRANSPLANT.
 Hypertension:

o Etiology:
 Primary – Idiopathic
 Risk Factor:
o Family History
o Age
o Obesity
o Diet: High Fat, High Cholesterol
o Stress
o Smoking
o Alcohol
o Caffeine
 Secondary – Known Causes:
 HPN is a sign of disease:
o Renal Disease
o Pheochromocytoma
o DM
 Hypertension is also a risk factor.
  Goal in the management of hypertension is to control blood pressure.
o Clinical Manifestation:
 Asymptomatic
 Headache – Acute pain related to headache
 Dizziness – Risk for injury/fall
 Blurred Vision – Impaired vision/Disturbed sensory perception – Visual
 Epistaxis – Ineffective airway clearance/Risk fo aspiration
o Nursing Diagnosis:
 Knowledge Deficit
 Non Compliance
 Ineffective Health Maintenance
 Risk Diagnosis
o Independent Intervention:
 Diet: Low Fat, Low Cholesterol, Low Salt, and Low Sugar
 Exercise: Increase the use of glucose, low fats, lower cholesterol (30 mins per day)
 Avoid Stress
 Avoid Smoking: Vasoconstriction
 Avoid Alcohol: Increase HR
 Restrict Caffeine: Increase HR
 Relaxation Techniques:
 DBE
 Guided Imagery
 Walking
o Dependent Intervent: Increased BP – to lower BP to normal – Hypotension (adverse effect)
 Drug Therapy – Antihypertensive Drugs
 Pheochromocytoma – Tumor of adrenal medulla produce high amount of
catecholamines (epi and norepi) – increase SNS – increase BP
 Secondary cause:
o Increase SNS = Increased BP
o Block SNS = Decrease BP to normal
o Mimic, Stimulate = Adrenergic Agonist
o Block the receptors = Antagonist or Blockers
 Epinephrine = Adrenalin
 Norepinephrine = Noradernalin
 Adrenergic Receptors:
o Alpha Adrenergic Receptors
 Alpha 1 (BV) – Stimulate/Agonist =
Vasoconstriction// - Block/Antagonist =
Vasodilation “Zosin”
 Alpha 2 (CNS) – Stimulate/Agonist =
Decrease Norepi flow – decrease SNS –
decrease BP “Clonidine (Catapres) and
Methyldopa (Aldomet)”
o Beta Adrenergic Receptors
 Beta 1 (Heart) – Stimulate/Agonist =
Increase HR// - Block/Antagonist =
Decrease HR
  Beta 2 (Lungs) – Stimulate/Agonist =
Bronchodilation// - Block/Antagonist –
Bronchoconstriction
Propanolol: B1 and B2 Blockers –
Decrease HR and
Bronchoconstriction (Pindolol)
Metropolol: B1 Selective blockers –
Decrease HR (Atenolol, Nevibolol)
 RAAS:
o ACE Inhibitors – Vasodilators
 Captopril, Quinapril, Enalapril
 SE: Cough
o Angiotensin II Receptor Blockers – Vasodilators
 Losartan, Candesartan, Telmisartan
 SE: GI Toxicity
o Diuretics – Best Time to give: Morning
 Thiazide Diuretics – Hydrochlorthiazide “Best drug to maintain
blood pressure”
o Vasodilators: Targets the smooth muscles of blood vessels
 Direct Acting Vasodilators: Directly relax the smooth muscle of
the BV
 Hydralazine (Apresoline)
 Nitrates: All nitrates are sensitive to heat, all nitrates
are sensitive to light.
o Nitroglycerine
o Isosorbide Nitra
o Nitroprusside
 Indirect Acting Vasodilators
 Calcium Channel Blockers
o Nifedipine
o Amlodipine
o Felodipine
o Diltiazem
o Verapamil
o SE: Headache
 Coronary Artery Disease: Ischemic Heart Disease
 Blood Supply of the Heart:
 Left Coronary Artery – Anterior and Lateral wall of the heart
o Left Anterior Descending Branch (LAD) – Most common involve in MI
o Circumflex Branch
 Right Coronary Artery – Posterior and Inferior wall of the heart
o Posterior Interventricular Branch
o Marginal Branch
 Venous Drainage:
o Great Cardiac Vein
o Medial Cardiac Vein
o Etiology: Idiopathic
o Risk Factors: Atherosclerosis
  Age
 Elderly – Atypical Symptoms – confusion – shortness of breath – epigastric
pain
 Males
 Family History: Gene for MI = Atherosclerotic Gene = MI 3x
 Past health history
o Types of Angina:
 Stable Angina – Increased cardiac workload
 Unstable Angina – Decreased Oxygen supply due to severe atherosclerosis (pre
infarction angina)
 Prinzmetal/Variant Angina – Reversible – coronary vasospasm
 Intractable Angina – Severe pain of MI
 Silent Ischemia
o Angina Pectoris: Imbalance between oxygen supply (decreased) and cardiac workload
(increased).
 Reversible
 Timing – Less than 15 minutes
 Relieving Factors:
 Rest
 Nitroglycerine
 Nursing Diagnosis:
 Ineffective myocardial tissue perfusion - Priority
 Priority Intervention:
 Stable Angina: Independent
o Rest – Semi Fowler’s
 Unstable Angina: Dependent
o Nitroglycerine First (V-Dilators)
o O2 Admin
 Prinzmetal Angina: Same as unstable angina
 Diagnostic Test:
 Angiography (Coronary Angiography)
 Blood Test
o Elevated Homocysteine Level
o Elevated C Reactive Protein
 ECG = T Wave inversion myocardial ischemia
 Medical Management:
 Nitroglycerin:
o Acute attack – NTG Sublingual (fast onset 2-5mins)
 Monitor BP before and after giving drugs.
 3x every 5 mins interval, call for ambulance if after taking
thrice and chest pain is still present after 5 mins.
 Modified Trendelenburg – Position of SHOCK!
o Chronic Angina – NTG Patch – 24 hours
 Isosorbide Nitrate: Slow onset of action, given for maintenance or stabled
condition.
 Beta Blockers
 Calcium Channel Blockers
 Ranolazine
  Management:
 Percutaneous Transillumination Coronary Angioplasty (PTCA)
o Myocardial Infarction: Ischemia and Necrosis cardiac cells
 Irreversible
 Timing – More than 30 min
 No reliever factors
 Nursing Diagnosis:
 Acute Pain – Priority
 Dependent – Morphine
o O2 Administration – Nursing Management (Independent)
 Diagnostic Test:
 Angiography – Most Definitive Diagnostic Test
 ECG – More than 30 minutes of pain
o Zone of infarction: ST Elevation – early sign of acute MI
o Zone of injury: ST Depression – myocardial injury
o Zone of ischemia – T Wave Inversion – Myocardial Ischemia
o Pathologic Q Wave – Scar late sign of MI (old MI)
 Cardiac Serum Markers (Cardiac enzyme elevation)
o Enzyme Elevation
 CK MB isoenzyme – Most specific enzyme
 Troponin – Most specific blood test//most important/reliable
test
 CPK
 LDH – Suggestive
 Myoglobin – First to elevate
 Management:
 Pain control is priority: Morphine as ordered
o Oxygenation
 Thrombolytic Drugs:
o Urokinase
o Streptokinase
o Alteplase
 Anti-Thrombotic Drugs: To prevent further thrombus.
o Anti-Platelet – Aspirin
o Anti-Coagulant – Heparin and Warfarin
 PTCA
 CABG – Coronary Artery Bypass Graft – General Anesthesia
 Health teaching: Live a healthy lifestyle
o PQRST Pain Assessment
 Position (Location) – Chest pain or substernal pain
 Precipitating Factor/Provocation
 Quality – Constant: Stabbing, heaviness, crushing
 Radiation – Left arm, left shoulder and left neck
 Relieving Factors
 Heart Failure: Inability of the heart to pump effectively
o Cardiac decompensation
o Cause:
 Cardiac Causes
  Non-Cardiac Causes – COPD (Right Sided HF)
 Renal Failure
o Types:
 Left Sided – LV fails (Most Common)
 Right Sided – RV fails
o Left Sided Heart Failure:
 Manifestation:
 Pulmonary Edema
o Paroxysmal Nocturnal Dyspnea (Earliest manifestation of P.E)
 Orthopnea
 Dyspnea
 (+) Crackles (Rales)
o Right Sided Heart Failure: Congestive Heart Failure
 Manifestation:
 Systemic Edema
o Bipedal Edema
o Ascites
o Hepatomegaly
o Splenomegaly
o Weight Gain
o Fluid Volume Excess

 Nursing Diagnosis:
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Impaired Gas Exchange
 Fluid Volume Excess
 Decreased Cardiac Output
 Diagnostic Test:
 2D Echo (Most Definitive)
 Chest X-Ray (Initial)
 BNP (Beta Type Natriuretic Peptide): Protein in the blood – released by the
ventricles in response to congestion
o Normal Value: < 100 pcg/ml
 o CHF: > 400 to > 800 pcg/ml
 Intervention:
 Priority: Airway and Breathing Problems
o Management:
 Position – High Fowler’s
 O2 Administration
 IV Line
 Furosemide 40mg IV stat
 Catheterize patients
 Monitor I and O
 Monitor VS
 Fluid Volume Excess
o Management:
 Restrict Fluid
 Restrict Sodium
 Monitor I and O
 Monitor VS
 Weight Patient Daily
 Diuretics
 Furosemide
 Spironolactone
 Monitor Serum K Level
 Decreased Cardiac Output:
o To Decrease Cardiac Workload
 Management:
 Provide Rest
 Avoid Stress
 Support cardiac function
o ACE Inhibitors (Captopril)
o Angiotensin II Receptors Blockers
o Beta Blockers
o To Increase Cardiac Contractility
 Management:
 Cardiotonic Drugs (+) Inotropic Effect
 Sympathomimetic – Enhances SNS
o (+) Inotropic Effect
o (+) Chronotropic Effect – Increase BP
 Dobutamine: IV thru an infusion pump
 Dopamine: IV thru an infusion pump
 Cardiac Glycosides – Increase calcium release in the
cardiac cells, (-) Chronotropic Effect: Slows down the
heart rate by prolonging cardiac repolarization
o Digoxin
o Digitalis
 Nursing Consideration During Digoxin Administration
o Monitor HR – Do not give if HR is less than 60
o Monitor Serum K Level – Hypokalemia increases
digoxin toxicity
o Monitor ECG
o Maintain therapeutic level 0.5 – 2.0 ng/ml
o Do not combine with CCB
o Do not combine with Amiodarone
(Antiarrhythmic drug) / Beta Blockers
o Monitor for S/Sx of digoxin toxicity
 Bradycardia
 Visual Disturbances – Hallmark adv
effect
 Nausea and Vomiting (refer)
 Lack of appetite
 ECG Changes
o Withhold medication dose and REFER
o Anticipate that the doctor will order for
antidote – Digibind
o Monitor for recurrence of S/Sx of heart failure