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Cardiovascular Nursing

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Learning Objectives

  1. Anatomy and Physiology of the Heart
    1. Describe the role of the right heart in the circulatory process.
    2. Describe the role of the left heart in the circulatory process.
    3. Identify the manner in which the heart is situated in the chest and is held in place.
    4. Define systole and diastole as parts of the cardiac cycle.
    5. Describe the heart’s valves and discuss the activity of the valves.
    6. Name the basic unit of cardiac muscle fiber and describe its parts.
    7. List and explain the properties of cardiac muscle.
    8. Define myocin, actin, myofibril, sarcomere.
    9. Name the coronary arteries.
    10. Differentiate between right and left vessel dominance.
    11. Describe the purpose of the sodium-potassium pump.
    12. Define ECG.
    13. Name the major chemoreceptor and describe its response to stimulation.
    14. Compare baroceptor response to decreased systolic blood pressure and to increased systolic blood pressure.
    15. Differentiate between an adrenergic and a cholinergic response.
  2. Assessment of the Heart
    1. Describe the first step in a nursing assessment of the heart.
    2. Name one chief complaint that is frequently related to heart disease.
    3. Differentiate between present illness and past medical history.
    4. Discuss the significance of the past medical history.
    5. Name the three cardinal parts of the physical examination.
    6. Locate the auscultory sites of the heart.
    7. List the four heart sounds and describe how each is produced.
    8. Define click, snap, and pericardial rub.
    9. Discuss the information gained about right atrium pressure from an examination of the neck veins.
    10. Differentiate between a “thrill” and a “bruit.”
    11. List the amplitude descriptions for arterial pulses.
    12. Classify heart murmurs with respect to loudness.
    13. Give one example of a systolic murmur.
  3. Common Dysfunctions of the Heart
    1. Describe the course of developing atherosclerosis with the plaque formation.
    2. Identify at least five risk factors linked to CAD.
    3. Describe the sequence of events in the pain of angina.
    4. Differentiate between stable and unstable angina.
    5. Differentiate between a subendocardial and a transmural myocardial infarction.
    6. Name the three elements of the diagnosis for acute myocardial infarction.
    7. List the benign complications of myocardial infarction.
    8. Discuss three nursing interventions for the patient experiencing an acute myocardial infarction.
    9. Describe the compensatory mechanisms that come to play in early cardiac failure.
    10. Differentiate between left ventricular failure and right ventricular failure.
    11. Name and describe the current classifications of hypertension.
    12. Identify symptoms associated with hypertension.
    13. Explain the renin-angiotensin system
    14. Differentiate among myocarditis, pericarditis, and endocarditis.
    15. Discuss the etiologies of acute and subacute endocarditis.
    16. Differentiate mitral stenosis from mitral insufficiency.
    17. Name and describe the four classes of shock.
    18. Describe the compensatory mechanisms of the body to delay onset of shock.
    19. Describe the signs and symptoms of shock.
    20. List at least five gram-negative agents responsible for septic shock.
    21. Describe the treatment for anaphylactic shock.
    22. Identify the priorities for care of patients with at least four separate cardiac dysfunctions.
    23. List the components of an education program for a patient with any of the above cardiac dysfunctions.
  4. Hemodynamic Monitoring
    1. Discuss the data obtained from hemodynamic monitoring.
    2. Describe valve activity as pressure rises in the right heart.
    3. Differentiate between hemodynamic measurements obtained from the CVP line and the Swan-Ganz catheter.
    4. List at least three factors that influence CVP.
    5. Describe the waveform change record as the SwanGanz catheter passes from the right atrium to the right ventricle.
    6. Review the mechanical events that occur in the right heart that create the pressures measurable with a PA catheter.
    7. Describe the series of events in the right heart resulting from pressure changes and valve openings and closures.
    8. Correlate the mechanical events in the right atrium with the RA waveforms.
    9. Review the mechanism for measurement of left ventricular pressure with a Swan-Ganz catheter.
    10. Name at least two problems that may precipitate an alteration in PCWP.
    11. List the arteries commonly used for insertion of arterial lines.
    12. Describe the waveform for an arterial line.
    13. Define cardiac output.
    14. List the four factors that influence cardiac output.
    15. Describe the effect of afterload on cardiac output.
    16. Describe the nurse’s role in caring for a patient with a CVP line and a PA catheter.
    17. Design a patient education program for hemodynamic monitoring.
  5. Electrocardiograph Monitoring
    1. List the necessary equipment for a bedside monitoring system.
    2. Review the steps in an orderly analysis of a rhythm strip.
    3. Describe electrode placement for a Lead II in the monitoring system.
    4. Describe the measurement of complexes on graph paper.
    5. List the classifications of arrhythmias.
    6. Distinguish the life-threatening arrhythmias from nonlife-threatening arrhythmias.
    7. List and describe the two life-threatening arrhythmias.
    8. Name the sudden onset-sudden offset atrial arrhythmia.
    9. Describe the “backup” system in the heart when the normal pacemaker fails.
    10. Distinguish among first-degree, second-degree, and third-degree blocks.
    11. Describe two types of second-degree block.
    12. Name the fascicles of the bundle branches.
    13. Describe the complex appearance of a right bundle branch block.
    14. Describe the mechanism of depolarization when a right bundle branch block exists.
    15. Define hemiblock.
    16. Review nursing measures for placing a patient on a monitoring system.
    17. Explain the need for recording frequent rhythm strips.
  6. Anatomy and Physiology of the Peripheral Vascular System

    7. List the subsystems of the peripheral vascular system. Name the three layers of blood vessels. Trace the circulation through one full transit, beginning in the left ventricle. Name the five parts that make up the microcirculation system. Explain the purpose of unidirectional valves. Explain the function of the arterioles. Describe activity in the capillaries. Explain peripheral vascular resistance. Define blood pressure. Identify the three factors that affect systolic pressure. Differentiate between elastic vessels and capacitant vessels. Define pulse pressure. Discuss mean arterial pressure. Trace the response of baroreceptors to stretch and/ or pressure.

  7. Assessment of the Peripheral Vascular System
    1. Identify at least seven areas to be included in a comprehensive history of the peripheral vascular system.
    2. Design questions for assessment of the chief complaint.
    3. List the three symptoms of pain at rest commonly associated with peripheral vascular disease.
    4. Define and describe intermittent claudication.
    5. Describe the clinical picture of Leriche’s syndrome.
    6. Trace the procedure of inspection for peripheral vascular disease.
    7. Explain the significance of a (+) Homans’ sign.
    8. Describe the phenomenon “lobster foot.”
    9. Describe three methods used to determine venous and arterial filling.
    10. List the elements of a complete lower-extremity assessment.
    11. Describe the technique for examination of the hand.
    12. List the symptoms associated with chronic vascular disease.
    13. Review the classification scale for evaluating peripheral pulses.
    14. Describe Alien’s test and state its purpose.
    15. List the pulses of the upper and lower extremities.
  8. Common Dysfunctions of the Peripheral Vascular System
    1. List the etiologic risk factors related to arterial occlusive dysfunction.
    2. Identify the origins of arterial emboli.
    3. Describe the pattern of occlusive extremity dysfunction.
    4. Name the five P’s of reduced arterial flow.
    5. Distinguish between Raynaud’s disease and Raynaud’s phenomenon.
    6. Define “rainbow phenomenon.”
    7. Identify at least two factors related to the etiology of Buerger’s disease.
    8. Differentiate between true and false aneurysm.
    9. Name three types of aneurysms.
    10. List symptoms of a thoracic aortic aneurysm.
    11. Describe the symptoms of a dissecting aortic aneurysm.
    12. Identify the three major etiologic factors that put a patient at risk for venous occlusive disease.
    13. Differentiate between thrombophlebitis and phlebothrombosis.
    14. Describe the four signs and symptoms of an inflammatory process.
    15. Identify the priorities for care of patients with three different peripheral vascular dysfunctions.
    16. List the components of an education program for a patient with any of the above peripheral vascular dysfunctions.
  9. Venous Surgery
    1. 1. Describe the surgical treatment for venous ligation.
    2. 2. Discuss the purpose of the vena cava interruption procedure.
    3. 3. Describe complications leading to the abandonment of the early vena caval ligation procedure.
    4. 4. List three advantages of the Greenfleld filter.
    5. 5. Give examples of the three types of portosystemic shunting available.
    6. 6. Identify priorities in nursing care for a patient undergoing venous surgery.
    7. 7. Prepare a nursing care plan for the patient experiencing venous surgery.
  10. Arterial Surgery
    1. Discuss the two lesions most frequently related to the mitral valve surgery.
    2. List the classic symptoms of aortic stenosis.
    3. List characteristics of the “ideal” prosthetic valve.
    4. List the types of biological valves in use today.
    5. Name the preferred surgical treatment for mitral regurgitation.
    6. List the symptoms of tricuspid valve stenosis.
    7. Discuss the indications for permanent pacemaker insertion.
    8. Describe the electrode placement for pacing.
    9. Explain the letter code for pacemakers.
    10. Identify two differences between the external pacemaker and the temporary transvenous pacemaker.
    11. Explain the primary use of a ventricular assist device.
    12. Explain the use of an implantable cardioverterdefibrillator.
    13. List criteria for the use of a temporary artificial heart.
    14. Describe the technique for coronary artery bypass graft surgery.
    15. Trace the steps in achieving cardiac standstill for coronary surgery.
    16. Define sequential graft and Y graft.
    17. Describe the technique for percutaneous transluminal coronary angioplasly.
    18. Differentiate between the criteria for selection of patients for percutaneous transluminal coronary angioplasty and coronary artery bypass grafting.
    19. Trace the steps in the procedure for cardiopulmonary bypass.
    20. Name the coagulation test used in the operating room to evaluate the use of heparin.
    21. State several causes of terminal (end) stage cardiac disease.
    22. State the two major problems that can occur following cardiac transplantation.
    23. State three adverse effects of the drug cyclosporin.
    24. Review the elements of the preoperative nursing assessment.
    25. Develop a nursing education teaching plan for the patient who will be experiencing cardiac surgery.
  11. Cardiac Surgery
    1. Discuss the two lesions most frequently related to the mitral valve surgery.
    2. List the classic symptoms of aortic stenosis.
    3. List characteristics of the “ideal” prosthetic valve.
    4. List the types of biological valves in use today.
    5. Name the preferred surgical treatment for mitral regurgitation.
    6. List the symptoms of tricuspid valve stenosis.
    7. Discuss the indications for permanent pacemaker insertion.
    8. Describe the electrode placement for pacing.
    9. Explain the letter code for pacemakers.
    10. Identify two differences between the external pacemaker and the temporary transvenous pacemaker.
    11. Explain the primary use of a ventricular assist device.
    12. Explain the use of an implantable cardioverterdefibrillator.
    13. List criteria for the use of a temporary artificial heart.
    14. Describe the technique for coronary artery bypass graft surgery.
    15. Trace the steps in achieving cardiac standstill for coronary surgery.
    16. Define sequential graft and Y graft.
    17. Describe the technique for percutaneous transluminal coronary angioplasly.
    18. Differentiate between the criteria for selection of patients for percutaneous transluminal coronary angioplasty and coronary artery bypass grafting.
    19. Trace the steps in the procedure for cardiopulmonary bypass.
    20. Name the coagulation test used in the operating room to evaluate the use of heparin.
    21. State several causes of terminal (end) stage cardiac disease.
    22. State the two major problems that can occur following cardiac transplantation.
    23. State three adverse effects of the drug cyclosporin.
    24. Review the elements of the preoperative nursing assessment.
    25. Develop a nursing education teaching plan for the patient who will be experiencing cardiac surgery.
  12. Nursing Diagnoses Care Plans for the Patient with a Cardiovascular Problem
  13. Vasodilators, Diuretic Agents, Positive Inotropic Agents, and Central Acting Antihypertensive Agents
    1. Name the two uses for vasodilator agents in the treatment of cardiovascular disease.
    2. Describe the action of nitroglycerin.
    3. Differentiate the various routes of NTG administration.
    4. Name the unique feature of sodium nitroprusside.
    5. Identify the drug of choice for hypertensive crisis.
    6. List the adverse reactions to minoxidil.
    7. Name the newer additions to vasodilator therapy.
    8. Describe the action of alpha adrenoreceptor blocking agents.
    9. Discuss the effects on blood pressure of the renin-angiotensin blocking agent captopril.
    10. Explain the judicious use of diuretics in treating the congestive failure cardiovascular patient.
    11. Name the three main classes of diuretics.
    12. List five adverse effects of thiazide diuretic therapy.
    13. Describe the action of the thiazide diuretics.
    14. Differentiate loop diuretics from potassium sparing agents.
    15. Construct a patient education program for patients receiving diuretic therapy.
    16. Describe the action of positive inotropic agents on myocardial cells.
    17. Give two examples of these agents.
    18. Discuss the activity of dopamine.
    19. Develop a patient education program for administering digitalis.
    20. Provide a question-and-answer period for patient and family.
    21. Compare the activity of dopamine and dobutamine.
    22. Discuss the two therapeutic activities of digitalis therapy.
    23. three early symptoms of digitalis toxicity.
    24. Name one example of a drug that stimulates the alpha adrenoreceptors in the central nervous system.
    25. Describe the antihypertensive activity of quanethidine.
    26. List the symptoms of sudden withdrawal of quanabenz.
    27. Devise a teaching plan for instruction of antihypertensive drug regimens.
    28. Identity priorities when administering an agent from any of the above drug groups.
  14. Antiarrhythmic Agents, Beta Adrenergic Receptor Blocking Agents, and Calcium Channel Blocking Agents
    1. Define automaticity, excitability, and conductivity.
    2. Recognize the phases of a cardiac cell’s action potential.
    3. Describe the basis for the Vaughn-Williams antiarrhy-thmia classification for drugs.
    4. Describe the action of Class I drugs.
    5. Name the prototype of Class IA drugs.
    6. Describe the activity of Class II drugs.
    7. Give 1wo examples of Class II drugs.
    8. Contrast the action of Class I agents with Class II agents.
    9. Define and describe torsade de pointes.
    10. Define the meaning of cardioselectivity.
    11. List two beta odrenergic blocking agents that are cardioselective.
    12. Describe the danger involved with sudden withdrawal of beta blocking agents.
    13. Name at least two cardiac problems in which beta blockers make up a part of the drug regimen.
    14. List and describe the properties of beta adrenore-ceptor antagonists.
    15. Name the phase of a cardiac cell’s action potential in which calcium channel blockers have an effect.
    16. Name the five classes of calcium channel blocking agents.
    17. Give one example of a drug in each class.
    18. Name the prototype of three of the calcium channel blocking agent classes.
    19. List the items to be included in a patient education program.
    20. Review nursing priorities for the patient medicated with calcium channel blocking agents.
    21. Identify priorities when administering an agent from any of the previously mentioned drug groups.
  15. Miscellaneous Cardiovascular Drugs
    1. List the antilipemics in current use.
    2. Differentiate between the two groups of hypolipemic drugs.
    3. Name the drug in use to reverse the effects of hepa-rin.
    4. Review the protocol for the use of streptokinase in the treatment of acute thromboembolic disease.
    5. Name the specific antidote for streptokinase overdose.
    6. Explain the lysing properties of TPA.
    7. Describe the action of pentoxifylline in the treatment of intermittent claudication.
    8. Identify nursing priorities for a patient receiving anti-coagulant therapy.
    9. Name the emergency medication used to reverse acidosis.
  16. Diagnostic Procedures in Cardiovascular Disease
    1. List and explain the blood tests for a cardiac enzyme panel.
    2. Discuss the relationship of HDL and LDL to risk factors in the development of CAD.
    3. State the normal values for the electrolytes.
    4. Describe the information available from an arterial blood gas result.
    5. Identify the various elements included in a CBC.
    6. Describe an exercise electrocardiogram.
    7. Define ambulatory ECG.
    8. Describe M-mode scanning.
    9. Discuss nuclear imaging as a diagnostic tool.
    10. Contrast a Thallium-201 study with a PYP study.
    11. 1Explain a MUGA scan.
    12. Describe a cardiac catheterization.
    13. Define EP studies.
    14. State the purposes for EP studies.
    15. Describe a Doppler echocardiogram.
    16. Identify priorities when preparing a patient for any diagnostic test or procedure.

Table of Contents

Learning Objectives
1. Anatomy and Physiology of the Heart
2. Assessment of the Heart
3. Common Dysfunctions of the Heart
References: Chapters 1 to 3
4. Hemodynamic Monitoring
5. Electrocardiograph Monitoring
References: Chapters 4 & 5
6. Anatomy and Physiology of the Peripheral Vascular System
7. Assessment of the Peripheral Vascular System
8. Common Dysfunctions of the Peripheral Vascular System
References: Chapters 6 to 8
9. Venous Surgery
10. Arterial Surgery
11. Cardiac Surgery
References: Chapters 9 to 11
12. Nursing Diagnoses Care Plans for the Patient with a Cardiovascular Problem
References: Chapter 12
13. Vasodilators, Diuretic Agents, Positive Inotropic Agents, and Central Acting Antihypertensive Agents
14. Antiarrhythmic Agents, Beta Adrenergic Receptor Blocking Agents, and Calcium Channel Blocking Agents
15. Miscellaneous Cardiovascular Drugs
References: Chapters 13 to 15
16. Diagnostic Procedures in Cardiovascular Disease
References: Chapter 16
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