Brush up on key concepts

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Cardiovascular refresher (continued)

PERICARDITIS
Key signs and symptoms
Acute pericarditis
Pericardial friction rub (grating sound heard as the heart
moves)
Sharp and usually sudden pain that usually starts over the sternum and radiates to the neck, shoulders, back, and arms (unlike
the pain of MI, pericardial pain is commonly pleuritic, increasing
with deep inspiration and decreasing when the client sits up and
leans forward, pulling the heart away from the diaphragmatic
pleurae of the lungs)
Chronic pericarditis
Pericardial friction rub
Symptoms similar to those of chronic right-sided heart failure
(fluid retention, ascites, hepatomegaly)
Key test results
Echocardiography confirms the diagnosis when it shows an
echo-free space between the ventricular wall and the pericardium (in cases of pleural effusion).
ECG shows the following changes in acute pericarditis:
elevation of ST segments in the standard limb leads and most
precordial leads without significant changes in QRS morphology
that occur with MI, atrial ectopic rhythms such as atrial fibrillation, and diminished QRS voltage in pericardial effusion.
Key treatments
Bed rest
Surgery: pericardiocentesis (in cases of cardiac tamponade),
partial pericardectomy (for recurrent pericarditis), total pericardectomy (for constrictive pericarditis)
Antibiotics: according to sensitivity of infecting organism
Key interventions
Provide complete bed rest.
Assess pain in relation to respiration and body position.
Place the client in an upright position.
Provide analgesics and oxygen, and reassure the client
with acute pericarditis that his condition is temporary and
treatable.
PERIPHERAL ARTERY DISEASE
Key signs and symptoms
Femoral, popliteal, or innominate arteries
Mottling of the extremity
Pallor
Paralysis and paresthesia in the affected arm or leg
Pulselessness distal to the occlusion
Sudden and localized pain in the affected arm or leg (most
common symptom)
Temperature change that occurs distal to the occlusion

Internal and external carotid arteries

Transient ischemic attacks (TIAs), which produce transient
monocular blindness, dysarthria, hemiparesis, possible aphasia,
confusion, decreased mentation, headache
Subclavian artery
Subclavian steel syndrome (characterized by the backflow
of blood from the brain through the vertebral artery on the
same side as the occlusion into the subclavian artery distal to
the occlusion; clinical effects of vertebrobasilar occlusion and
exercise-induced arm claudication)
Vertebral and basilar arteries
TIAs, which produce binocular vision disturbances, vertigo,
dysarthria, and falling down without loss of consciousness
Key test results
Arteriography demonstrates the type (thrombus or embolus),
location, and degree of obstruction and collateral circulation.
Doppler ultrasonography shows decreased blood flow distal to
the occlusion.
Key treatments
Surgery (for acute arterial occlusion): atherectomy, balloon
angioplasty, bypass graft, embolectomy, laser angioplasty,
patch grafting, stent placement, thromboendarterectomy, or
amputation
Thrombolytic agents: alteplase (Activase), streptokinase
(Streptase)
Key interventions
Preoperatively (during an acute episode)
Assess the clients circulatory status by checking for the most
distal pulses and by inspecting his skin color and temperature.
Provide pain relief as needed.
Administer I.V. heparin, as needed, using an infusion pump.
Watch for signs of fluid and electrolyte imbalance, and monitor
intake and output for signs of renal failure (urine output less than
30 ml/hour).
Postoperatively
Monitor the clients vital signs. Continuously assess his
circulatory function by inspecting skin color and temperature
and by checking for distal pulses. In charting, compare earlier
assessments and observations. Watch closely for signs of hemorrhage (tachycardia, hypotension), and check dressings for
excessive bleeding.
In carotid, innominate, vertebral, or subclavian artery occlusion, assess neurologic status frequently for changes in level of
consciousness or muscle strength and pupil size.
In mesenteric artery occlusion, connect a nasogastric tube to
low intermittent suction. Monitor intake and output. (Low urine
output may indicate damage to renal arteries during surgery.)
Assess abdominal status.
(continued)

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4/8/2010 7:01:36 PM