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NCLEX-PN Exam Cram: Caring for the Client with Disorders of the Cardiovascular System

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In this chapter, you will discover diseases that affect the cardiovascular system, the treatment of these diseases, and the effects on the client's general health status.
This chapter is from the book

This chapter is from the book

Terms you'll need to understand:

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Aneurysms

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Angina pectoris

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Angioplasty

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Arterosclerosis

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Blood pressure

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Buerger's disease

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Cardiac catheterization

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Cardiac tamponade

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Cardiopulmonary resuscitation

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Cholesterol

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Conduction system of the heart

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Congestive heart failure

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Coronary artery bypass graft

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Defribulation

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Diastole

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Electrocardiogram

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Heart block

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Hypertension

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Implantable cardioverter

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Myocardial infarction

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Pacemaker

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Raynaud's

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Systole

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Thrombophlebitis

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Varicose veins

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Ventricular fibrillation

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Ventricular tachycardia

Nursing skills you'll need to master:

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Performing cardiopulmonary resuscitation (CPR)

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Monitoring central venous pressure

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Monitoring blood pressure

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Interpreting electrocardiography (ECG)

The cardiovascular system is comprised of the heart and blood vessels and is responsible for the transport of oxygen and nutrients to organ systems of the body. The heart is a cone-shaped organ made up of four chambers. The right side of the heart receives deoxygenated venous blood from the periphery by way of the superior and inferior venae cavae. The left side of the heart receives blood from the lungs and pumps the oxygenated blood to the body. The blood vessels are divided into arteries and veins. Arteries transport oxygenated blood and veins transport deoxygenated blood. In this chapter, you will discover diseases that affect the cardiovascular system, the treatment of these diseases, and the effects on the client's general health status.

Hypertension

Blood pressure is the force of blood exerted on the vessel walls. Systolic pressure is the pressure during the contraction phase of the heart and is evaluated as the top number of the blood pressure reading. Diastolic pressure is the pressure during the relaxation phase of the heart and is evaluated as the lower number of the blood pressure reading. A diagnosis of hypertension is made by a blood pressure value greater than 140/90 obtained on two separate occasions with the client sitting, standing, and lying. In clients with diabetes, a reading of 130/85 or higher is considered to be hypertension.

Accuracy of the BP reading depends on the correct selection of cuff size. The bladder of the blood pressure cuff size should be sufficient to encircle the arm or thigh. According to the American Heart Association, the bladder width should be approximately 40% of the circumference or 20% wider than the diameter of the midpoint of the extremity. A blood pressure cuff that's too small yields a false high reading, whereas a blood pressure cuff that's too large yields a false low reading.

Hypertension is classified as either primary or secondary. Primary hypertension, or essential hypertension, develops without apparent cause; secondary hypertension develops as a result of another illness or condition. Symptoms associated with secondary hypertension are improved by appropriate treatment of the contributing illness. Blood pressure fluctuates with exercise, stress, changes in position, and changes in blood volume. Medications such as oral contraceptives and bronchodilators can also cause elevations in blood pressure. Often the client with hypertension will have no symptoms at all or might complain of an early morning headache and fatigue. This silent killer, if left untreated, can lead to coronary disease, renal disease, strokes, and other life-threatening illnesses.

Management of hypertension includes a program of diet and exercise. If the client's cholesterol level is elevated, a low-fat, low-cholesterol diet is ordered. The total serum cholesterol levels should be less than 200 mg/dl.

Medications Used to Treat Hypertension

Should diet and exercise prove unsuccessful in lowering the blood pressure, the doctor might decide to prescribe medications such as diuretics or antihypertensives. Table 13.1 includes drugs used to treat hypertension.

Table 13.1. Hypertension Drugs

Drug Category

Drug Types

Diuretics

Thiazide: Chlorothiazide (Diuril), hydrochlorothiazide (Esidrix, HydroDiuril) Loop diuretics: Furosemide (Lasix), ethacrynic acid (Edecrin) Potassium-sparing diuretics: Spironolactone (Aldactone), triamterone (Dyrenium)

Beta blockers

Propanolol (Inderal), atenolol (Tenormin), nadolol (Corgard), Carvedilol (Coreg)

Calcium channel blockers

Nifedipine (Procardia), verapamil (Calan), diltiazem hydrochloride (Cardizem)

Angiotensin converting enzyme inhibitors

Captopril (Capoten), enalpril (Vasotec), lisinopril (Zestril, Prinivil)

Angiotensin receptor blockers

Candesartan (Altacand), losartan (Cozaar), telmisartan (Micardis)

These drugs can be used alone or in conjunction with one another. Diuretics and vasodilators are often given in combination to lower blood pressure through diuresis and vasodilation. Hypertensive crisis exists when the diastolic blood pressure reaches 140. Malignant hypertension is managed with administration of IV Nitropress, nitroglycerine, Nipride, Lasix, and other potent vasodilators such as Procardia.

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