NCLEX-RN® Review Made Incredibly Easy! (Incredibly Easy! 5th Edition by Lippincott.

Cardiovascular refresher (continued) THORACIC AORTIC ANEURYSM (CONTINUED) • Review laboratory test results, which must include a complete blood count, differential, electrolytes, typing and crossmatching for whole blood, ABG studies, and urinalysis. • Insert an indwelling urinary catheter and monitor intake and output. • Carefully monitor nitroprusside I.V. infusion rate; use a separate I.V. line for infusion. Adjust the dose by slowly increasing the infusion rate. Meanwhile, check blood pressure every 5 minutes until it stabilizes. • With suspected bleeding from an aneurysm, prepare to give a blood transfusion. After repair of thoracic aneurysm • Evaluate the client’s level of consciousness. Monitor vital signs, PAP, PAWP, CVP, pulse rate, urine output, and pain. • Check respiratory function. Carefully observe and record the type and amount of chest tube drainage, and frequently assess heart and breath sounds. • Monitor I.V. therapy to prevent fluid excess, which may occur with rapid fluid replacement. • Give medications as appropriate to help improve the client’s condition. THROMBOPHLEBITIS Key signs and symptoms Deep vein thrombophlebitis • Cramping calf pain (may be painless) • Edema • Tenderness to touch Superficial vein thrombophlebitis • Redness along the vein • Warmth and tenderness along the vein Key test results • Photoplethysmography shows venous-filling defects. • Ultrasound reveals decreased blood flow. Key treatments • Activity changes: maintaining bed rest and elevating the affected extremity • Anticoagulants: warfarin (Coumadin), heparin, enoxaparin (Lovenox) • Anti-inflammatory agents: aspirin, dalteparin (Fragmin) • Fibrinolytic agent: streptokinase (Streptase) Key interventions • Assess pulmonary status. • Maintain bed rest, and elevate the affected extremity. • Perform neurovascular checks. • Monitor laboratory values. • Apply warm, moist compresses to improve circulation. VALVULAR HEART DISEASE Key signs and symptoms Aortic insufficiency • Angina • Cough • Dyspnea • Fatigue • Palpitations Mitral insufficiency • Angina • Dyspnea • Fatigue • Orthopnea • Peripheral edema Mitral stenosis • Dyspnea on exertion • Fatigue • Orthopnea • Palpitations • Peripheral edema • Weakness Mitral valve prolapse • Possibly asymptomatic • Palpitations Tricuspid insufficiency • Dyspnea • Fatigue Key test results Aortic insufficiency • Echocardiography shows left ventricular enlargement. • X-ray shows left ventricular enlargement and pulmonary vein congestion. Mitral insufficiency • Cardiac catheterization shows mitral insufficiency and elevated atrial pressure and PAWP. Mitral stenosis • Cardiac catheterization shows diastolic pressure gradient across valve and elevated left atrial and PAWP. • Echocardiography shows thickened mitral valve leaflets. • ECG shows left atrial hypertrophy. • X-ray shows left atrial and ventricular enlargement. Mitral valve prolapse • ECG shows prolapse of the mitral valve into the left atrium. Tricuspid insufficiency • Echocardiography shows systolic prolapse of the tricuspid valve. • ECG shows right atrial or right ventricular hypertrophy. • X-ray shows right atrial dilation and right ventricular enlargement.