CARDIOGENIC SHOCK • Assess cardiovascular status, vital signs, and

Key signs and symptoms hemodynamic

• Cold, clammy skin variables.
• Hypotension (systolic pressure below 90 mm Hg) • Administer oxygen and medications, as prescribed.
• Narrow pulse pressure CORONARY ARTERY DISEASE
• Oliguria (urine output of less than 30 ml/hour) Key signs and symptoms
• Tachycardia or other arrhythmias • Angina (chest pain) that may be substernal,
Key test results crushing, or compressing;
• ECG shows myocardial infarction (MI) (enlarged Q may radiate to the arms, jaw, or back; usually lasts 3
wave, elevated to
ST segment). 5 minutes; and usually occurs after exertion,
Key treatments emotional excitement,
• Intra-aortic balloon pump or exposure to cold but can also develop when the
• Adrenergic agent: epinephrine client is
• Cardiac glycoside: digoxin (Lanoxin) at rest
• Cardiac inotropes: dopamine, dobutamine, Key test results
inamrinone • Blood chemistry tests show increased cholesterol
(Amrinone), milrinone (decreased
• Diuretics: furosemide (Lasix), bumetanide (Bumex), high-density lipoproteins, increased low-density
metolazone lipoproteins).
(Zaroxolyn) • ECG or Holter monitoring shows ST-segment
• Vasodilators: nitroprusside (Nitropress), nitroglycerin depression and
• Vasopressor: norepinephrine (Levophed) T-wave inversion during an anginal episode.
Key interventions Key treatments
• Assess cardiovascular status, including • Activity changes, including weight loss, if necessary
hemodynamic variables, • Dietary changes, including establishing a low-
vital signs, heart sounds, capillary refill, skin sodium, lowcholesterol,
temperature, low-fat diet with increased dietary fiber (low-calorie
and peripheral pulses. only if appropriate)
• Assess respiratory status, including breath sounds • Antilipemic agents: cholestyramine (Questran),
and arterial lovastatin
blood gas levels. (Mevacor), simvastatin (Zocor), nicotinic acid (Niacor),
• Administer I.V. fluids, oxygen, and medications, as gemfibrozil
prescribed. (Lopid), colestipol (Colestid)
CARDIOMYOPATHY • Low-dose aspirin therapy
Key signs and symptoms Key interventions
• Murmur, third (S3) and fourth (S4) heart sounds • Obtain ECG during anginal episodes.
Key test results • Assess cardiovascular status, including vital signs
• ECG shows left ventricular hypertrophy and and hemodynamic
nonspecific variables.
changes. • Administer nitroglycerin for anginal episodes.
Key treatments • Administer oxygen therapy during anginal episodes.
• Dual-chamber pacing (for hypertrophic • Monitor intake and output.
cardiomyopathy) • Monitor laboratory studies.
• Beta-adrenergic blockers: propranolol (Inderal), ENDOCARDITIS
nadolol Key signs and symptoms
(Corgard), metoprolol (Lopressor) for hypertrophic • Chills
cardiomyopathy • Fatigue
• Calcium channel blockers: verapamil (Calan), • Loud, regurgitant murmur
diltiazem Key test results
(Cardizem) for hypertrophic cardiomyopathy • Echocardiography may identify valvular damage.
• Diuretics: furosemide (Lasix), bumetanide (Bumex), • ECG may show atrial fibrillation and other
metolazone arrhythmias that
(Zaroxolyn) for dilated cardiomyopathy accompany valvular disease.
• Inotropic agents: dobutamine, milrinone, digoxin • Three or more blood cultures in a 24- to 48-hour
(Lanoxin) for period identify
dilated cardiomyopathy the causative organism in up to 90% of clients.
• Oral anticoagulant: warfarin (Coumadin) for dilated
and hypertrophic
cardiomyopathy
Key interventions
• Monitor ECG.