7 Integrated Cardiovascular Nursing Practice
Recognize urgent cardiovascular changes, prioritize nursing responses, and apply safety principles across heart failure, coronary emergencies, dysrhythmias, and severe hypertension.
Recognizing time-sensitive emergencies
New or worsening chest discomfort at rest may indicate , including Myocardial infarction (MI). Nausea, sweating, dizziness, and shortness of breath may also accompany these emergencies. Do not delay escalation to see whether symptoms resolve.
Activate the appropriate emergency response, assess airway, breathing, circulation, and vital signs, and facilitate prompt cardiac monitoring, a 12-lead ECG, and ordered testing. Do not ask a patient with new chest pressure to walk, give food and wait, or dismiss symptoms as indigestion.
Responding to worsening heart failure
Orthopnea, crackles, increased ankle swelling, and rapid weight gain can indicate fluid accumulation and worsening . For a patient whose breathing is harder when lying flat, assess respiratory effort and oxygenation, position the patient upright, and promptly report worsening congestion.
Administer oxygen or prescribed treatment as indicated by the assessment and orders. When diuretics are used, monitor the response, urine output, renal function, and electrolytes. Teach patients to track daily weights and report gains according to their care plan; a commonly used warning threshold is about 2 to 3 lb in a day or 5 lb in a week. Do not encourage oral fluids or walking as a response to worsening congestion, and do not hold all prescribed medications without direction.
Responding to unstable dysrhythmias
Assess perfusion and the patient’s condition, not just the rhythm shown on the monitor. A rapid rhythm accompanied by hypotension, altered mental status, chest discomfort, shock, or acute heart failure indicates .
For instability attributable to or flutter with a rapid ventricular rate, activate emergency support and prepare for immediate under the emergency protocol. Continue close monitoring and follow the resuscitation protocol; do not wait for spontaneous conversion or rely on an oral rate-control medication followed by delayed reassessment.
with no pulse is cardiac arrest. Rapidly recognize the emergency, activate the response, begin high-quality , and apply a defibrillator or AED as soon as available. Follow protocol and resume CPR promptly as directed; do not delay treatment to obtain a 12-lead ECG or wait for a provider to arrive.
Recognizing severe hypertension
Very high blood pressure accompanied by concerning neurologic symptoms may indicate acute target-organ injury and a . For example, a blood pressure of with severe headache, blurred vision, and new weakness in one arm requires urgent evaluation.
Activate the appropriate response, assess and document the patient’s condition, and promptly report the findings. Do not independently give an extra medication dose or attempt to lower the pressure rapidly without an order and clinical direction. Severe hypertension without signs of acute target-organ injury is managed differently from a .
Prioritizing among patients
Prioritize patients with new signs of an immediate threat. A patient with coronary artery disease who develops chest pressure, sweating, and shortness of breath needs immediate assessment and escalation because the symptoms may signal ACS or MI.
A patient with stable hypertension requesting help reviewing a home blood-pressure log, a patient with heart failure who has gained 1 lb over a week but has no new symptoms, and a patient with a known, unchanged irregular pulse and no symptoms still need appropriate follow-up. The described findings do not indicate the same immediate threat as new chest pressure with sweating and shortness of breath.
Maintaining safety and supporting self-management
Across cardiovascular emergencies, support airway, breathing, and circulation, activate the appropriate response, and follow emergency protocols and scope-of-practice requirements. Continue monitoring the patient and response to prescribed treatment, and follow current orders.
For prevention and ongoing self-management, reinforce medication adherence, risk-factor management, symptom reporting, and follow-up care. Teach daily weights when prescribed and explain that patients should report changes according to their individual care plan.