Cardiovascular Disorders: Assessment, Interventions, and Medications

Cardiovascular Disorders: Assessment, Interventions, and Medications

Cardiovascular disease is one of the leading causes of hospitalization in the United States. As an LPN, you will frequently care for patients with hypertension, heart failure, coronary artery disease (CAD), myocardial infarction (MI), and dysrhythmias. Recognizing assessment findings early and acting within your scope of practice can be life-saving.

Hypertension

Hypertension (HTN) is persistently elevated blood pressure. It is often called the "silent killer" because patients frequently have no symptoms until organ damage occurs. Normal adult blood pressure is less than 120/80 mmHg. Blood pressure consistently at or above 130/80 mmHg meets the threshold for hypertension according to current clinical guidelines.

Assessment findings: Headache (especially in the morning), blurred vision, epistaxis, and dizziness may occur. Many patients are asymptomatic. Always measure blood pressure in both arms at least once; a significant difference between arms may indicate vascular disease.

Nursing priorities: Monitor blood pressure and report values outside the ordered parameters. Reinforce medication adherence, a low-sodium diet, weight management, regular exercise, and avoidance of tobacco. Never abruptly discontinue antihypertensive medications without provider guidance, as rebound hypertension can occur.

Heart Failure

Heart failure (HF) occurs when the heart cannot pump enough blood to meet the body's needs. Left-sided HF causes fluid to back up into the lungs (pulmonary congestion), while right-sided HF causes systemic fluid retention.

Assessment findings (left-sided): Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles in lung bases, S3 heart sound, fatigue, and decreased oxygen saturation.

Assessment findings (right-sided): Peripheral edema (pitting), jugular venous distension, hepatomegaly, and weight gain.

Diagnostic tests: Brain natriuretic peptide (BNP) is elevated in HF and reflects ventricular wall stress. Echocardiogram assesses ejection fraction. Chest X-ray may show cardiomegaly or pulmonary congestion.

Nursing priorities: Position the patient in high Fowler's position to ease breathing. Monitor daily weights (report a gain of more than 2–3 pounds in 24 hours or as ordered). Restrict fluids and sodium as prescribed. Monitor intake and output carefully. Administer diuretics, ACE inhibitors, and beta-blockers as ordered.

Coronary Artery Disease

CAD results from atherosclerotic plaque buildup in the coronary arteries, reducing blood flow to the myocardium. Risk factors include hypertension, hyperlipidemia, diabetes, obesity, smoking, and family history.

Assessment findings: Stable angina produces chest pain or pressure with exertion that is relieved by rest or nitroglycerin. Unstable angina occurs at rest or with increasing frequency and is a medical emergency.

Nursing priorities: Administer nitroglycerin as ordered; keep the patient at rest during an anginal episode. Monitor for hypotension after nitroglycerin administration. Reinforce lifestyle modifications and medication adherence, including antiplatelet therapy and statins.

Myocardial Infarction

MI (heart attack) occurs when coronary artery occlusion causes ischemia and necrosis of myocardial tissue.

Assessment findings: Crushing or pressure-like chest pain radiating to the left arm, jaw, or back; diaphoresis; nausea; shortness of breath; anxiety; and a sense of impending doom. Women, older adults, and patients with diabetes may present atypically with fatigue, nausea, or jaw pain without classic chest pain.

Diagnostic tests: 12-lead EKG (ST elevation in STEMI, changes in NSTEMI), serial troponin levels (troponin rises within hours of MI and is highly specific for myocardial injury), and echocardiogram.

Nursing priorities (MONA mnemonic as a guide): Morphine (per order), Oxygen if saturation is below target, Nitroglycerin (per order), Aspirin. Keep the patient on bedrest, establish IV access, apply continuous cardiac monitoring, and notify the provider immediately. Time is muscle — door-to-balloon time targets exist for STEMI care.

Safety: Never leave a patient with suspected MI alone. Report changes in rhythm, vital signs, or level of consciousness immediately.

Dysrhythmias

Dysrhythmias are abnormal heart rhythms. Common rhythms the LPN must recognize include:

• Normal sinus rhythm (NSR): Regular rate 60–100 bpm, one P wave before each QRS.
• Sinus tachycardia: Rate above 100 bpm; causes include pain, fever, hypovolemia, anxiety.
• Sinus bradycardia: Rate below 60 bpm; may be normal in athletes or caused by medications (beta-blockers).
• Atrial fibrillation (A-fib): Irregularly irregular rhythm, no distinct P waves, wavy baseline. Increases stroke risk; anticoagulation is often prescribed.
• Premature ventricular contractions (PVCs): Wide, bizarre QRS complexes occurring early; frequent PVCs (especially in runs) should be reported.

Nursing priorities: Apply continuous cardiac monitoring. Report new or worsening dysrhythmias promptly. Assess for hemodynamic instability (low blood pressure, altered mental status, chest pain). Have emergency equipment available.

Key Medication Classes

| Class | Example Uses | Key Nursing Points |

|---|---|---|

| Beta-blockers | HTN, HF, dysrhythmias | Monitor HR; hold if HR < 60 bpm (per order); do not stop abruptly |

| ACE inhibitors | HTN, HF | Monitor for dry cough, hyperkalemia, hypotension; hold if angioedema occurs |

| Diuretics (loop) | HF, HTN | Monitor electrolytes, especially potassium; daily weights |

| Antiplatelets | CAD, MI, A-fib | Monitor for bleeding; teach patients to report unusual bruising |

| Statins | CAD, hyperlipidemia | Take at bedtime (many agents); report muscle pain (myopathy) |

Safety reminder: Always check blood pressure before giving antihypertensives and heart rate before giving beta-blockers or digoxin. Hold the medication and notify the provider if values fall outside ordered parameters.