NCLEX RN GUIDE                                                                                   the best of NCLEX

Cardiovascular 10

Deep venous thrombosis
      1. Definition: clotting in a deep vein
      2. Etiology and risk
        1. immobilization
        2. sepsis
        3. hematological disorders and clotting disorders
        4. malignancies
        5. congestive heart failure
        6. myocardial infarction
        7. obesity
        8. pregnancy
        9. fractures
        10. venipuncture
        11. surgeries: orthopedic, neurologic, urologic and gynecologic
        12. risk of pulmonary embolus
      3. Findingsunilateraledema of extremity
      4. Management
        1. objective: to eliminate the clot and prevent complications
        2. bed rest
        3. anticoagulant therapy - to prevent new clots
        4. thrombolytictherapy - to dissolve thrombus
        5. compression stockings
        6. surgery - thrombectomy
      5. Nursing interventions
        1. monitor for findings of pulmonary embolus
        2. maintain bed rest
        3. administer medications as ordered
        4. teach client
          1. medications and side effects
          2. to avoid prolonged immobility
          3. to maintain adequate fluid intake


  1. Venous stasis ulcers
      1. Definition: chronic skin and subcutaneous ulcers usually found on legs, ankles or feet.
      2. Etiology
        1. chronic venous insufficiency
        2. incompetent valves (vavular, incompetence) in perforating veins or deep veins cause venous stasis
        3. pressure of blood pooling causes capillaries to leak
        4. ulcer begins as small, inflamed, tender area
        5. any trauma causes tissue to break or it may break spontaneously
        6. site: pretibialand medialsupramalleolarareas of ankle
      3. Findings
        1. open skin lesion with irregular border
        2. skin around ulcer usually brown and leathery
        3. pain in affected area


    1. Management
        1. objective: to correct venous hypertension and both prevent and correct ulceration
        2. local wound care
        3. antibiotics and analgesics as indicated
        4. surgery
          1. debridement
          2. skin grafting
          3. removal of veins with incompetent valves
      1. Nursing interventions
        1. keep legs elevated, with feet above level of heart at all times
        2. apply elastic bandages as ordered
        3. cleanse and dress ulcer as ordered
        4. administer drugs as ordered
        5. teach client
          1. to report any signs of inflammation immediately
          2. to avoid trauma to affected limb
          3. to provide skin care
          4. to apply elastic bandages
  • Cardiovascular disease is the leading cause of death among Americans.
  • Take blood pressures correctly
    • give client 5 minutes rest.
    • take blood pressure while client is lying, sitting, and standing.
    • ask client if he/she has recently smoked, drank a beverage containing caffeine or was emotionally upset. If so, repeat blood pressure in 30 minutes.
  • Rarely, the heart may lie on the right side instead of the left, this is called Dextrocardia.
  • Valves control the direction of the blood flow through the heart. Flow is unidirectional.
  • When the atria contract, the atrioventricular valves swing open, allowing the blood to flow down into the ventricles.
  • When the ventricles contract the valves snap shut preventing blood from flowing back up into the atria. Semilunar valves open allowing blood to eject during ventricular contraction.
  • If the SA node fails to generate an impulse, the AV node takes over, generating a slower rate. If the AV node fails to generate an impulse, the Bundle of His takes over, generating an even slower rate. If the Bundle of His fails to generate an impulse, the Purkinje fibers take over and generate an even slower rate.

  • Damaged areas of the heart may also stimulate contractions and produce arrhythmias.
  • Rapid, short-term control of blood pressure is achieved by cardiac and vascular reflexes that are initiated by stretch receptors (baroreceptors) in the walls of the carotid sinus and the aortic arch.
  • Many clients with angina or MIs benefit from involvement in a structured cardiac rehabilitation program to assist clients to increase their activity level in a monitored environment.
  • Current research suggests that life style and personal habits are closely related to cardiac changes once attributed to aging.
  • The elderly are less able to physically adapt to stressful physical and emotional conditions, because their hearts do three things less quickly: the myocardium contracts less easily, the left ventricle ejects blood less quickly, and the heart is slower to conduct the impulse for a heartbeat.
  • Because different enzymes are released into the blood at varying periods after a myocardial infarction, it is important to evaluate enzyme levels in relation to the onset of the physical symptoms such as chest pain.
  • Clients who are in postoperative recovery, on bed rest, obese, taking hormonal contraceptives or had knee or hip surgery should be monitored closely for thrombophlebitis.

Adrenergic neuron-blocking agents
Angiotensin-converting enzyme (ACE) inhibitors
Arterial line
Auscultatory gap
Bounding pulse
Calcium channel blockers
Cardiac catheterization
Cardiac output
Coronary Artery Bypass
Stress test
Stroke volume
Tamponade, cardiac