Cardiovascular System NCLEX Review
Welcome back to the Brain Nurses weekly NCLEX blog providing a needed tips from our comprehensive Cardiovascular System NCLEX review to help you prepare for your examination! Thank you for taking the time to read this and far sharing this with your friends. We have seen our traffic increase lately and assume that our great readers are spreading this blog around!
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The topic for this week is the cardiovascular system. Vital signs are always a major consideration especially orthostatic hypotension in the elderly and those on medications. The nurse must learn to look, listen, and feel in the assessment of their patients.
The areas covered during this weeks blog are Cardiovascular Pharmacology Classifications, General Cardiovascular Principles, Acute Myocardial Infarction, and Pericardial Effusion.
Cardiovascular Pharmacology Classifications
Pharmacology is always a needed topic by our students and we are happy to provide this overview of the pharmacology classifications that are important for a successful attempt at the NCLEX. Considerations when discussing the cardiovascular system are as follows:
- Inotropic agent: Increases the force of contraction and perfusion to the organs. An increase in urine output would indicate an increased perfusion to the kidneys.
- Antidysrhythmics: Treat abnormal heart rhythms which can begin the atria or the ventricles.
- Nitrates and vasodilators: Relax the smooth muscles in the coronary arteries to increase blood supply to the heart muscle for better perfusion and to relieve chest pain. These drugs can also relax the blood vessels in the peripheral circulation to lower blood pressure and decrease preload and afterload to improve heart function.
- Beta blockers: Block the effects of the sympathetic nervous system and can be used to treat abnormal rhythms, chest pain, and can protect the heart after an acute myocardial infarction
- Calcium channel blockers: Relax the blood vessels reducing blood pressure and improving blood flow. They also slow down the electrical conduction in the heart and can be used to control rapid dysrhythmias.
- Angiotensin-converting enzyme (ACE) inhibitors: Used to control high blood pressure and help the heart function better in those with heart failure and after a heart attack.
- Angiotensin II receptor blockers (ARBs): These agents work like the ACE inhibitors except they allow for an additional step in the drug’s conversion which decreases the incidence of the side effect of a dry, annoying cough.
- Central acting alpha-blockers: Used to treat hypertension.
- Coagulation modifiers: Antiplatelet and anticoagulants interfere with the formation of blood clots to prevent heart attacks, strokes, and deep vein thrombosis. Thrombolytics dissolve blood clots.
- Antilipemic agents: Decrease the amount of LDL cholesterol in the blood stream and reduce the amount of plague deposits. Some agents can increase the amount of HDL cholesterol.
- Colony stimulating factors used for numerous conditions affecting production of cells from the bone marrow
General Cardiovascular Principles
Heart sounds reflect the function of the valves, and can be difficult for the nursing student to master. In order to make this easier to remember for the NCLEX and for use in clinical practice. Several audio hints and can be studied:
- “Swish” sound: Murmur
- Extra Heart Sounds: Gallop
- Grating Sound: Friction rub. Heard on inspiration and exhalation
- Irregular Rhythm: Atrial fibrillation or atrial flutter
- Skipped beat: Premature ventricular contraction
Acute Myocardial Infarction
Acute myocardial infarction is damage to the myocardium resulting from an interruption of blood flow. The main cause of AMI is coronary heart disease.
There are many symptoms of AMI that the nurse must be able to identify for the NCLEX and during their clinical work. To asses acute myocardial infarction, look for the following symptoms, which are also all sign of tissue hypoxia:
- Chest pain
- Cool, clammy
- Increased BP
- Heart failure
- Nausea and vomiting
- Decreased level of consciousness
- Temperature elevation
To manage acute myocardial infarction, conduct:
- Frequent Assessments
- Repeat ECG with new pain or change in condition
- Follow up diagnostics to evaluate for blockage
- Echocardiogram to evaluate function
Pericardial effusion and tamponade is the accumulation of fluid or blood in the pericardial sac. If blunt or penetrating trauma to the pericardium or heart, blood will accumulate rapidly and be life threatening. The larger the effusion, and the faster it develops, the more symptomatic the patient will be.
To conduct the assessment of pericardial effusion, look for:
- Clear lung sounds
- Pulsus paradoxus
- Elevated CVP
- Narrowing pulse pressure
- Jugular vein distention
- Muffled heart tones
Use an echocardiogram to diagnose and pericardiocentesis to drain the pericardial cavity.
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