Nursing Tips: Cardiovascular

A patient who experiences prolonged standing (like nurses!) is at risk for developing varicose veins. Educate patients with this risk factor to wear compression stockings and elevate the legs when possible.

Because hypokalemia increases a patient's risk of digoxin toxicity, be sure to closely monitor the potassium levels for patients taking digoxin!

Atropine is a medication that can be administered to patients with sinus bradycardia or heart block in order to increase heart rate.

Cardiac Enzymes are released in response to cardiac ischemia. They include CK-MB, Myoglobin, Troponin T, and Troponin I. Troponin is the most specific!

Adenosine (Adenocard) is a Class V antiarrhythmic medication used for supraventricular tachycardia.

A client experiencing shock is at risk for Disseminated Intravascular Coagulopathy (DIC). Monitor for signs of clotting/bleeding and report any of these findings promptly.

A child with Sickle Cell Anemia experiencing vaso-occlusive crisis should be treated with scheduled opioid analgesia (non-opioid analgesia will not be sufficient!).

A child with infective endocarditis will require IV antibiotics via PICC line for 2 - 6 weeks, and may require a valve repair or replacement.

A child with Hemophilia A is deficient in Factor VIII. In Hemophilia B the deficiency is with Factor IX. Treatment of these conditions will include replacement of the missing factor, desmopressin, and aminocaproic acid.

KEY symptoms of Coarctation of the Aorta: elevated BP and bounding pulses in the arms, decreased BP and pulses in the legs.

KEY symptoms of a Patent Ductus Arteriosus: machine-hum murmur, bounding pulses, and wide pulse pressure.

The DASH diet (for patients with hypertension) emphasizes low sodium, high potassium, and high calcium foods.

Calcium channel blockers are Very Nice Drugs: Verapamil, Nifedipine, Diltiazem.

Calcium gluconate is used for emergency treatment of hyperkalemia and hypermagnesemia!

Iron supplements can cause dark green/black stools. This is expected and harmless.

A patient is POSITIVE for orthostatic hypotension if: The SBP decreases more than 20mmHg when changing position AND/OR the DBP decreases more than 10mmHg

ACE inhibitors typically end in -pril. Remember the key side effects.

Non-selective beta blockers are used for hypertension, angina, arrhythmias, and MIs. However, they should NEVER be used in patients with asthma, as they can cause bronchospasm.

Please Listen Carefully - these beta blockers are NON-selective: Propranolol, Labetalol, Carvedilol. They will impact the lungs too!

Amy owes me one hundred dollars, but she is in the hospital with VFIB on an amiodarone drip... so I guess it's not a good time to collect.

The key side effect to remember with ALL anticoagulants (ex: heparin, warfarin, rivaroxaban) is BLEEDING!

Taking epoetin alfa will fix your anemia so you can grow up to be a strong alpha male.

Filgrastim is a medication used to stimulate the growth of neutrophils in patients with neutropenia.

Niacin (Vitamin B3) can be used to treat hypercholesterolemia. Key side effect is flushing of the face.

My face doesn't look very nice after taking niacin (because it is flushed!)

Ferrous Sulfate is an iron supplement that can stain the teeth. 

I'm furious that my teeth got stained from ferrous sulfate!

Too much magnesium (magnesium toxicity) brought Maggie to her knees (due to cardiac and respiratory depression).

Calcium (Ca) expected range: 9 - 10.5 mEq/L HINT: California (CA) is due for a big earthquake that may measure 9 - 10.5 on the Richter scale.

Potassium (K) expected range: 3.5 - 5.0 mEq/L HINT #1: There are ~3.1 miles in a 5K HINT #2: Bananas (high in Potassium!) come in bunches of 3-5.

Magnesium (Mg) expected range: 1.3 - 2.1 mEq/L HINT: MGs are very small British cars - you can only fit 1-2 people in them.

The MOST important side effect to know for BOTH hyperkalemia and hypokalemia is DYSRHYTHMIAS.

Troponin T and I are key cardiac enzymes that become elevated when there is damage to the heart.

One sign of hypocalcemia is a positive Chvostek's sign. HINT: You check for the Chovostek's sign by tapping the patient's cheek (over the area of the facial nerve).

When administering iron dextran via IM injection, use the Z-track method!

Warfarin is an important oral anticoagulant. The mode of action of warfarin is the antagonize vitamin K, which prevents formation of several clotting factors. HINT: Warfarin declares WAR on vitamin K.

Blood pressure cuffs: If the cuff is too large, you will get a falsely low reading. If the cuff is too small, you will get a falsely high reading.

Thrombolytic meds include: alteplase, reteplase (many end in -plase). If you are trying to break up a clot, you have come to the right PLACE!

Apical pulse is taken at the fifth intercostal space at the left midclavicular line.

Rivaroxaban is an anticoagulant. HINT: If you take Rivaroxaban, your blood will flow like a river. RivaroXaban works by inhibiting factor Xa in the coagulation cascade.

Know what types each blood type can receive:

Type O: Can receive O

Type A: Can receive A and O

Type B: Can receive B and O

Type AB: Can receive  A, B, AB, & O

Know your antidotes for anticoagulants: Vitamin K for warfarin, Protamine for Heparin.

Therapeutic INR is 2-3 for patients receiving warfarin.

Therapeutic aPTT is 1.5-2 times baseline (baseline = 30-40 sec) for patients receiving Heparin.

Major risk factor for rheumatic fever: untreated or partially treated upper respiratory infection with Group A beta-hemolytic streptococcus (GABHS).

If a patient has a blood transfusion reaction: stop the transfusion, infuse 0.9% NACL through a separate line, and be sure to send the blood bag back to the lab.