Okay. Now, let's delve into the cardiovascular.
I know that was a lot
in neurological, but that's predominantly
Mr. Johnson's biggest problem
since he had a stroke. So these
are not going to be as
long as we just did with neuro.
But you learned some really
key information on how nursing
addresses the neurological system
from start to finish.
Now, we'll look at the heart. So, our goal
here is just to maintain homeostasis and
adequate tissue perfusion. Now,
so we're going to monitor his
vital signs and his cardiac rhythm. Good news,
he's on the telemetry unit, so we can
easily do that. We're going to watch
his intravascular fluid volume.
We don't want him to have too much or
too little. So we don't want hypervolemia,
extra volume, or hypovolemia,
too low a volume. Now, you're going to
listen to his lung sounds for signs of
pulmonary edema. That's a sign of hypovolemia.
So you're going to auscultate lung
sounds with your stethoscope.
And you want to make sure
that you do it in the front
and the back, and you want to do it
from the bottom and the top, because
we're most likely to develop the lung
sounds of pulmonary edema,
which we call crackles. They won't clear
with coughing. But if he has crackles,
it's normally going to start first
in the back and in the bases.
So don't just settle for doing
a halfway assessment
by listening to his lungs when he's
laying down. Have him sit up,
because remember, we're in telemetry. He
should be able to do that. Have him sit up
and listen to his lungs on both
sides with deep breaths.
If you're starting to hear sounds of
crackles in the base of his lungs,
they don't clear with coughing, we're
starting to get into trouble with
hypervolemia. So make sure
you listen closely for that.
Now, here's a cool one. Lung sounds
are little bit easier to process
Heart sounds take more practice,
but you're listening for a murmur
or an S3 or S4 sound. That's
another sign of heart
failure. So we're watching him for any signs
of heart problems. We want to listen for
pulmonary edema and listen for
a S3 or an S4, a murmur,
that's an additional sign of heart failure.
Now, watching his blood pressure,
keeping it within the orders that the
healthcare provider has written.
They'll give you a range on where you
should maintain his blood pressure,
particular to Mr. Johnson. And you're
going to want to give anti-hypertensive
medications as ordered. Now, remember,
patients who've experienced strokes may
also have cardiovascular disease.
They're kind of common things that go
together. So, we really want to watch them
for risk of fluid volume overload
because they have a higher risk
for fluid volume overload than
the average patient
and also with their blood pressure. So,
let's practice with Mr. Johnson.
What do you know about him that you're
going to be keeping an eye on?
We've just discussed some challenges.
I want you to pause the video
without looking at your notes. Think about
the things that you're going to watch
for Mr. Johnson's cardiovascular system
and special assessments that you'll do.
Okay. So, you know that one of our goals
is to maintain homeostasis and
adequate tissue perfusion. Now, our
goal is to prevent another
clot from forming. Thrombus is
another word for clot,
or a venous thrombus. That's what
a venothromboembolism --
that's why we shorten it sometimes
to VTE. So, if the limbs are
paralyzed or not moving as well, they
present the highest risk
for a VTE. So I'm going to be watching
his right side very closely
because we know he had a left-sided stroke,
we're going to have right-sided problems.
I'm going to encourage him to be
as mobile and active as possible.
That's the best for any patient. Keeps their
lungs breathing, keeps their body parts
moving. We regain strength. So every
patient needs to be as mobile
and independent as possible. Now, we'll likely
use some compression type of sock
and these will be ordered by the healthcare
provider, but that's going to help make
sure that we don't have that venous pooling.
We don't want blood just hanging out
down there because it's more likely to
make a clot. So I'm going to make
sure that if he's starting to look a little
swollen in his extremities, that I elevate
some of those to decrease that
edema. So you want to position
each joint higher than the
joint proximal to it.
So if I don't want dependent edema,
if a patient was laying down,
I could simply put their arms on some
pillows. My wrist is higher
than my elbow, and my elbow is higher
than my joint. So when I say you want
each joint, you want the position
higher than the joint proximal to it,
that's what you're going to do. So, wrist,
higher than elbow, elbow higher than
shoulder. I forgot there for my joint
for a minute. Same thing with legs.
You can tuck a pillow underneath the leg
and the feet, and have them elevated if
you start to notice some swelling
in your patient's legs.
So, now's your chance to
practice with Mr. Johnson.
Think through what we just talked about on
the previous slide. What are some specific
things you would do to assess him, to plan,
implement, and evaluate his care
dealing with cardiovascular?
Okay. Welcome back. Now, let's see
if you can answer this question.
Why is a stroke patient at increased
risk for a venothromboembolism?
Okay. Hopefully, you remembered
that a VTE is when a
blood clot forms. Most often, it's in the deep
veins of the leg. So, sometimes, you'll hear
it called a DVT. So it's usually in the deep
veins of the leg, but it can also
be in the groin or the arm.
So it can travel through the circulation
and it lodges somewhere real important.
Sometimes, it lodges in the
lungs. So, if a deep
vein thrombosis from my leg, or
from my groin, or another
part of my body travels around to
the blood supply in my lungs,
I can end up with a pulmonary embolism.
Now these can be life-threatening.
I've actually experienced a pulmonary
embolus and I would not
recommend it to anyone. So that's
the biggest risk with a DVT
or a VTE, those letters that we use.
Things and parts of that or the
whole clot can break off,
travel around the rest of the body
and block off a very important part
of your circulation. So now
that we've refreshed
your memory on what a VTE is,
let's answer the question.
hy are stroke patients at a higher risk?
Well, that's for lots of reasons.
They're not as mobile as they
used to be in normal life.
They may have some paralysis or weakness
on one side, so those are particularly
going to be the areas where they're
at risk to develop a DVT.
So, why patients are at an increased
risk for developing a clot
is because they have increased
immobility and weakness or
paralysis in these legs. So, they're
not moving as much
and that gives the blood more time
to hook together and make a clot.