Cardiac/Vascular Nurse Exam Secrets Study Guide (20 page)

Lifestyle modifications and pharmacologic management prevent the onset of arteriosclerosis, peripheral arterial disease, and intermittent claudication. Patients should maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

Patients with peripheral arterial disease and intermittent claudication should maintain their feet to prevent the onset of complications such as infections and gangrene. Patients should wash their feet daily and moisturize them, wear thick socks and comfortable shoes, promptly treat fungal infections, trim toe nails, avoid walking barefoot, and immediately have sores and open wounds treated.

Treatment and prevention of hypotension

If blood pressure drop is acute and life threatening, pressors (norepinephrine) may be necessary. Treatment of the underlying cause is of primary concern, such as antibiotics for infection or defibrillation for arrhythmia. Lifestyle modifications and pharmacologic management are used to treat chronic hypotension. The type of treatment depends on the degree and extent of hypotension as well as the underlying cause of the condition. Treatment varies by the symptoms that the patient presents.

Lifestyle modifications include dietary changes like increased salt intake if no other comorbid cardiovascular conditions are present and increased fluid intake, and use of graduated compression stockings. Other modifications include avoiding alcohol and illicit drug use, avoid smoking, avoid prolonged heat exposure, maintain a healthy diet, and eating small meals every few hours.

Pharmacologic agents used to treat hypotension include fludrocortisone, pyridostigmine, nonsteroidal anti-inflammatory drugs, erythropoietin, and/or caffeine.

Lifestyle modifications and pharmacologic management prevent the onset of hypotension. Patients should maintain a diet high in sodium if they do not have any other cardiovascular comorbidities, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, lose excess weight, avoid alcohol and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

The following lifestyle modifications may prevent serious complications associated with hypotension: getting up slowly after sitting in patients with orthostatic hypotension, avoid standing for long periods of time in patients with neurally mediated hypotension, eat small low carbohydrate meals, drink plenty of fluids, avoid alcohol and tobacco use, increase salt intake if no other cardiovascular comorbid conditions exist, use graduated compression stockings, and maintain daily physical activity.

Treatment and prevention of compartment syndrome

Although lifestyle modifications and pharmacologic management may be effective for compartment syndrome, surgical intervention is the most effective approach to management of acute and chronic disease. The pressure and swelling in the compartment can be relieved by a long incision in the fascia of the compartment. The incision is typically left open for 48 to 72 hours post–initial surgery and then a second surgery is performed to close the incision. With larger incisions, skin grafts may be used to close the incision.

If a tight cast or bandage causes the problem, then the bandage and/or cast will be loosened to relieve the syndrome.

Although little can be done to prevent the onset of compartment syndrome, patient education and increased awareness in individuals with a history of the condition or who exert themselves physically on a regular basis are important for prompt diagnosis and treatment.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

Treatment and prevention of pulmonary edema

Lifestyle modifications, pharmacologic management, and, in more severe cases, ventilatory support, are used to treat pulmonary edema. In acute pulmonary edema, oxygen is immediately administered to prevent tissue damage.

Pharmacologic management depends on the underlying cause of pulmonary edema and the presence of other cardiovascular comorbid conditions. Pharmacologic agents used to treat pulmonary edema include preload reducers such as nitroglycerin, diuretics such as furosemide, morphine, afterload reducers such as nitroprusside, enalapril, and captopril, aspirin, and blood-pressure agents.

In treating patients with high altitude–induced pulmonary edema, patients should decrease a few thousand feet and carry oxygen with them. Pharmacologic management with acetazolamide may be beneficial.

Although little can be done to prevent the onset of pulmonary edema, patient education and increased awareness in individuals with a history of the condition or have other comorbid cardiovascular or respiratory risk factors is important for prompt diagnosis and treatment.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, get enough folic acid, manage stress, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

If traveling or climbing at high altitudes, individuals should acclimate themselves slowly but ascending no more than 1,000 to 2,000 feet per day once an individual has reached 8,000 feet. Patients at risk for high altitude induced pulmonary edema should also make sure to drink plenty of fluids and bring oxygen with them.

Treatment and prevention of 1
^st
degree atrioventricular block

Lifestyle modifications and pharmacologic management may be used to treat first-degree atrioventricular block, but most patients diagnosed with the condition do not require treatment. Patients with asymptomatic first-degree atrioventricular block do not require treatment. However, patients who present with symptoms should discontinue medication that could be contributing to the atrioventricular block or seek electrophysiological consultation.

Pharmacologic agents that may be used to treat first-degree atrioventricular block include parasympathetic blockers such as atropine and sympathomimetics such as isoproterenol. Patients undergoing pharmacologic management should be monitored to make sure their condition does not progress to a higher degree of atrioventricular block.

For patients who present with severe bradycardia, syncope, and left ventricular systolic dysfunction, a pacemaker may be required.

Typically, first-degree atrioventricular blocks are not preventable unless induced by pharmacologic drugs; then the drug can be stopped or titrated down. However, it remains unclear if a particular drug will induce a first-degree atrioventricular block, as it depends on the patient. Yet, certain drugs have been known to cause the condition.

In order to prevent progression to higher degrees of atrioventricular block, patients should be monitored by their practicing clinician, especially patients with concomitant bundle-brachial blocks.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, get enough folic acid, manage stress, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

Treatment and prevention of second-degree atrioventricular block type I

The treatment of second-degree atrioventricular block type I depends on the presence or absence of symptoms. Treatment also varies on the extent and degree of the condition and the presence of other comorbid cardiovascular conditions. In patients diagnosed with second-degree atrioventricular block type I with few or no symptoms, treatment may not be necessary. However, asymptomatic patients that present with intra-or infra bundle blocks may require a pacemaker. Also, patients that present with bradycardia, heart failure, myocardial infarction, and asystole greater than or equal to 3 seconds, a pacemaker may be required. Additionally, patients that present with comorbid Lyme disease, drug toxicity, and hypoxia associated with sleep apnea may require treatment and modifications of drug dosing and/or lifestyle changes.

Anticholinergic agents such as atropine sulfate may be used to treat the condition but pacemaker placement is considered standard of care when necessary.

Typically, second-degree atrioventricular blocks type I are not preventable unless induced by pharmacologic drugs and then the drug can be stopped or titrated down.

In order to prevent progression to higher degrees of atrioventricular block, patients should be monitored by their practicing clinician, especially patients with concomitant bundle-branch blocks.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, get enough folic acid, manage stress, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

Treatment and prevention of second-degree atrioventricular block type II

Treatment of second-degree atrioventricular block type II varies on the extent and degree of the condition and the presence of other comorbid cardiovascular conditions. The goal of treatment is to restore sinus rhythm or maintain cardiac output.

Patients that present with bradycardia, heart failure, myocardial infarction, wide QRS complexes, and asystole greater than or equal to 3 seconds, a pacemaker may be required. Additionally, patients that present with comorbid Lyme disease, drug toxicity, and hypoxia associated with sleep apnea may require treatment and modifications of drug dosing and/or lifestyle.

Anticholinergic agents such as atropine sulfate may be used to treat the condition but pacemaker placement is considered standard of care. Also, in patients with extensive symptoms, isoproterenol and dopamine may be used to achieve hemodynamic stability until a pacemaker can be placed.

Typically, second-degree atrioventricular type II blocks are not preventable unless induced by pharmacologic drugs and then the drug can be stopped or titrated down. In order to prevent progression to higher degrees of atrioventricular block, patients should be monitored by their practicing clinician, especially patients with concomitant bundle-branch blocks.

Furthermore, family members and/or caregivers should be taught cardiopulmonary resuscitation (CPR) and how to contact emergency medical services in the event of cardiac arrest. Pacemaker education is necessary to make sure that patients do not have a problem with the battery or the device.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, get enough folic acid, manage stress, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.

Treatment and prevention of third-degree atrioventricular block

Lifestyle modifications, pharmacologic management, and pacemaker implantation are the key treatment approaches for third-degree atrioventricular block. New-onset third-degree atrioventricular block is a medical emergency and treatment is dependent on the extent and degree of the block.

Patients undergoing treatment with pharmacologic agents that target the atrioventricular node should stop or titrate down the medication to help resolve the complete atrioventricular block.

Complete heart block associated with repeated abnormal pulse, inadequate escape rhythm or block below the atrioventricular node should be treated immediately with a pacemaker or pacing agents. Patients with third-degree atrioventricular block and bradycardia, other arrhythmias, and neuromuscular diseases should receive a permanent pacemaker. Individuals who undergo catheter ablation or with documented periods of asystole greater than or equal to 3 seconds should be considered for a pacemaker.

Individuals diagnosed with third-degree atrioventricular block should be on bed rest to avoid further complications. Sympathomimetic agents such as atropine and isoproterenol hydrochloride can be used to treat third-degree atrioventricular block, but pacemaker placement is standard of care in most cases.

Typically, third-degree atrioventricular blocks are not preventable unless induced by pharmacologic drugs and then the drug can be stopped or titrated down. Furthermore, family members and/or caregivers should learn cardiopulmonary resuscitation (CPR) and how to contact emergency medical services (EMS) in the event of cardiac arrest. Pacemaker education is necessary to make sure that patients do not have a problem with the battery or the device.

Patients should also maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, get enough folic acid, manage stress, lose excess weight, avoid beta-blockers and illicit drug use, maintain proper lipid levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels.