(^24) Medical-Surgical Nursing Demystified
HALLMARK SIGNS AND SYMPTOMS
- Hypotension, because blood flow decreases below normal.
- Tachycardia, because the heart is trying to pump faster to maintain adequate
blood flow to the body, or occasionally bradycardia, where the heart rate is
less than 60 beats per minute due to myocardial damage. - Arrhythmias—when the heart muscle does not have enough oxygen it
becomes irritable, making arrhythmias more likely. - Clammy skin, because oxygenation to tissues is reduced.
- Drop in skin temperature because of reduced circulation as a result of
hypotension. - Urine output less than 30 ml per hour (oliguria) because the kidneys are not
being perfused. - Crackles heard in the lungs secondary to pulmonary edema, meaning fluidis
building up in lungs. - Confusion due to poor perfusion.
- Distended jugular veins—sign of fluid overload, inability of heart to manage
fluid coming into heart. - Cyanosis of lips, peripheral extremities due to poor perfusion.
INTERPRETING TEST RESULTS
- Chemistry—check electrolytes, kidney function to ascertain kidney perfusion;
calcium level is increased or decreased secondary to muscle contractility. - Echocardiogram—to look for ventricular rupture, pericarditis, or valve dys-
function. - Electrocardiogram:
- Q-wave enlarged due to heart failure.
- Elevation of ST-waves is a sign of ischemia.
TREATMENT
Treatment is based on medical support for the heart until etiology (cause) can be
determined. In cardiogenic stroke, the stroke volume and the heart rate must be in-
creased to keep the organs perfused. The effects of the following medications should
accomplish this.