MED SURG NURS120L Week 6 Exam Review- West Coast University

3/1/202




1 Perfusion
• Cardiovascular System
• Hypertension
• Coronary Artery Disease
• Acute Coronary Syndrome
• Vascular Disorders
2 Week 6 Objectives
Perfusion
Summarize the nursing process in care of patients with alterations in perfusion.
Classify priorities in the care of patients with alterations in perfusion using the following
applicable concepts: health promotion, oxygenation, infection/inflammation, mobility, pain,
mobility, fluid regulation, tissue integrity, safety, nutrition, and culture.
Identify interprofessional collaboration/team management for needs of the patient with
alterations in perfusion.
Examine the pharmacologic, nutritional, developmental, and teaching needs of the patient with
alterations in perfusion.

3 Topics Covered
Lewis Ch. 31: Assessment: Cardiovascular System
Lewis Ch. 32: Hypertension
Lewis Ch. 33: Coronary Artery Disease and Acute Coronary Syndrome
ATI Ch. 27: Cardiovascular Diagnostic and Therapeutic Procedures
ATI Ch. 28: Electrocardiography and Dysrhythmia Monitoring
ATI Ch. 35: Peripheral Vascular Diseases
ATI Ch. 36: Hypertension
4 Assessment of the Cardiovascular System
Subjective Data
History of Present Illness
Fully explore all symptoms
Past Health History
Chest pain, SOB, fatigue, anemia, palpitations, dizziness, syncope, hypertension, edema,
throat infections
Medications
Many non-cardiac drugs can adversely affect the cardiovascular system
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6 Assessment of the Cardiovascular System
Subjective Data (cont.)
Presence of major cardiovascular risk factors?
Abnormal serum lipids, HTN, sedentary lifestyle, diabetes, obesity, tobacco use
Family history of cardiovascular disease?
CAD, HTN, diabetes, atherosclerosis can run in families
Problems with sleep?

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SOB or Cheyne-Stokes respirations can mean heart failure
Orthopnea
Sleep apnea can lead to life-threatening dysrhythmias
7 Assessment of the Cardiovascular System
Objective Data
Vital Signs
Orthostatic BP and HR: SBP should not decrease more than 20mmHg and HR should not
increase more than 20 beats
Jugular Venous Distension (JVD)
 right sided heart failure
Edema
 1+ (mild pitting, slight indent) to 4+ (deep pitting, indentation lasts a long time)
Palpate pulses
0 = Absent, 1+ = Weak, 2+ = Normal, 3+ = Increased, full, bounding
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9 Assessment of the Cardiovascular System
Aortic Area
2nd ICS to right of sternum
Pulmonic Area
2nd ICS to left of sternum
Tricuspid Area
5th left ICS close to the sternum*
Mitral Area
5th ICS at left mid-clavicular line
Erb’s Point
3rd left ICS near the sternum
10 Diagnostic Studies of the Cardiovascular System
Cardiac Biomarkers
Troponin: heart muscle protein released after injury or infarction
Increase is diagnostic of myocardial infarction (MI) or injury
Detectable within 4 – 6 hours, peaks at 10 – 24 hours, detectable for 10 – 14 days
Creatine Kinase (CK) enzymes: CK-MB is specific to heart
Rise in CK-MB is specific for MI or injury
Detectable 3 – 6 hours, peak at 12 – 24 hours, return to baseline in 12 – 48 hours
C-Reactive Protein (CRP)
Produced by liver during periods of acute inflammation
Increase may indicate atherosclerosis and initial cardiac event
11 Diagnostic Studies of the Cardiovascular System
Cardiac Natriuretic Peptide Markers
BNP (b-type natriuretic peptide) is used as a diagnostic marker for heart failure
Serum Lipids
Elevations in triglycerides and LDL (low-density lipoprotein) are strongly associated with

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coronary artery disease (CAD)
Increased HDL (high-density lipoprotein) level is associated with a decreased risk of CAD
Increased level in the total cholesterol to HDL ratio indicates increased risk of CAD
12 Diagnostic Studies of the Cardiovascular System
Chest X-Ray
Shows:
 heart shape and size
anatomic changes in individual chambers
any displacement or enlargement of the heart
pericardial effusion (extra fluid around the heart)
pulmonary congestion
13 Diagnostic Studies of the Cardiovascular System
Electrocardiogram (ECG/EKG)
Assess P, QRS, and T waveforms to analyze heart activity and rhythm
Deviations from normal sinus rhythm (NSR) can indicate problems with heart function
Exercise or Stress Testing
Symptoms occur with activity due to increased demand on the coronary arteries to provide
more O2
Exercise testing is used to evaluate the heart’s response to physical stress
14 Hypertension
Hypertension
Systolic BP (SBP) 140 mmHg or higher OR
Diastolic BP (DBP) 90 mmHg or higher
Pre-Hypertension
SBP 120 – 139 mmHg OR
DBP 80 – 89 mmHg
Normal BP
SBP < 120 mmHg AND
DBP < 80 mmHg
15 Hypertension
Primary Hypertension (Essential/Idiopathic)
Elevated BP without an identifiable cause
Accounts for 90 – 95% of all cases
Contributing factors are increased sodium intake, overweight, diabetes, tobacco use, excessive
alcohol intake
Secondary Hypertension
Elevated BP with a specific cause that can be identified and corrected
Possible causes:
Cirrhosis
Estrogen-replacement therapy
Oral contraceptives
Endocrine disorders
Neurologic disorders