Cardiovascular Care Nursing Mnemonics and Tips

You will manage cardiac patients in every setting, so the patterns below need to be automatic. More than 80 million Americans carry some form of cardiovascular disease, including hypertension, coronary artery disease, heart failure, and congenital defects. Here are the mnemonics that hold up at the bedside.

1. Heart Blocks: "The Heart Block Poem"

A heart block is too slow a rhythm because the electrical signal between the atria and ventricles is partially or completely blocked.

2. Right-Sided Heart Failure Manifestations: "AW HEAD"

When the right ventricle fails, it cannot move the blood returning from the venous circulation, so congestion backs up into the peripheral tissues and viscera. Right-sided failure shows up as systemic signs.

• A: Anorexia and nausea from venous engorgement and stasis in the abdominal organs.
• W: Weight gain from fluid retention.
• H: Hepatomegaly from venous engorgement of the liver, which can impair liver function.
• E: Edema (bipedal) in the feet and ankles, worse after prolonged standing or sitting.
• A: Ascites as portal pressure forces fluid into the peritoneal cavity.
• D: Distended neck veins from increased venous pressure.

3. Left-Sided Heart Failure: "DO CHAP"

Left-sided failure backs up into the lungs. When the left ventricle cannot pump blood into the aorta, pressure rises in the left atrium and pulmonary vessels, forcing fluid into lung tissue and alveoli. The result is pulmonary congestion and impaired gas exchange.

• D: Dyspnea with minimal activity and at rest.
• O: Orthopnea, dyspnea lying flat, relieved by sitting up on pillows.
• C: Cough, dry at first, then frothy sputum that may be pink with severe congestion.
• H: Hemoptysis, pink or blood-tinged sputum.
• A: Adventitious breath sounds, crackles that spread through the lung fields as failure worsens.
• P: Pulmonary congestion (crackles/rales) as sustained pressure pushes fluid into the alveoli.

4. Management of Heart Failure: "DAD BOND CLASH"

Treatment aims to relieve symptoms, improve function, and extend survival by reducing preload and afterload and treating contributing factors like hypertension.

• D: Digitalis increases contractile force, slows AV conduction, raises left ventricular output, and enhances diuresis.
• A: ACE inhibitors promote vasodilation and diuresis, dropping afterload and preload.
• D: Dobutamine, IV for significant left ventricular dysfunction and hypoperfusion; stimulates beta-1-adrenergic receptors.
• B: Beta-blockers cut mortality and morbidity by blunting constant sympathetic stimulation.
• O: Oxygen as congestion and hypoxia progress.
• N: Nitrates cause venous dilation, reducing venous return and preload.
• D: Diuretics remove excess extracellular fluid in fluid overload.
• C: Calcium channel blockers cause vasodilation, reducing systemic vascular resistance.
• L: Lifestyle changes, sodium restriction, fluid limits, weight reduction, regular exercise.
• A: Angiotensin II receptor blockers block angiotensin II at its receptor; similar hemodynamics to ACE inhibitors and an alternative for patients who cannot tolerate them.
• S: Sodium restriction, a low-sodium diet (2 to 3 g/day) with limited fluid intake.
• H: Hydralazine lowers systemic vascular resistance and left ventricular afterload.

5. Hypertension Complications: "5 C's of Hypertension Complications"

The higher the pressure and the longer it runs uncontrolled, the more damage to vessels and organs, raising the risk of heart disease, kidney disease, and stroke.

• C: Coronary artery disease as vessels narrow and walls weaken, making clots and plaque rupture more likely.
• C: Chronic renal failure as constant pressure damages the small vessels in the kidneys.
• C: Congestive heart failure as the heart thickens pumping against high pressure and eventually cannot meet the body's demand.
• C: Cardiac arrest when damaged coronary arteries cannot deliver enough oxygen, driving a heart attack.
• C: Cerebrovascular accident as atherosclerosis blocks or weakens cerebral vessels, causing them to clot or rupture.

6. Immediate Treatment of a Myocardial Infarction Client: "MONA TASS"

MONA stands for Morphine, Oxygen, Nitrates, and Aspirin, the four primary MI interventions. It is not the order of administration, just a memory aid for the components.

• M: Morphine reduces pain and anxiety and, as a vasodilator, lowers preload and afterload.
• O: Oxygen improves oxygenation of ischemic myocardium; paired with bedrest to cut myocardial oxygen demand. Give via nasal cannula at 2 to 4 L/min.
• N: Nitroglycerine, first-line for angina and acute MI; causes vasodilation and increases coronary blood flow.
• A: Aspirin blocks thromboxane A2, which aggregates platelets and constricts arteries. The earlier it is given after symptom onset, the greater the benefit.
• T: Thrombolytics dissolve the coronary thrombus, restoring flow and limiting infarct size.
• A: Anticoagulants keep existing clots from enlarging and blocking coronary arteries.
• S: Stool softeners prevent straining that can trigger arrhythmias or arrest.
• S: Sedatives limit infarct size and provide rest. Valium or an equivalent is typical.

7. Myocardial Infarction Management: "INFARCTIONS"

The goals during an MI are to minimize myocardial damage, preserve function, and prevent complications through reperfusion, reduced oxygen demand, and increased oxygen supply.

• I: IV access, two lines for emergency medications.
• N: Narcotic analgesics, morphine in IV boluses to reduce pain and anxiety, lower preload and afterload, and relax bronchioles.
• F: Facilities for defibrillation, crash cart available and ready.
• A: Aspirin inhibits platelet aggregation; start immediately and continue long term.
• R: Rest, bedrest for comfort and healing.
• C: Converting enzyme inhibitor, ACE inhibitors lower blood pressure and promote sodium and fluid excretion.
• T: Thrombolytics, IV to dissolve the coronary thrombus and restore reperfusion.
• I: IV beta-blocker, longterm therapy lowers future cardiac events.
• O: Oxygen at a modest flow rate of 2 to 3 LPM.
• N: Nitrates increase cardiac output, reduce workload, and relieve pain by redistributing blood to ischemic myocardium.
• S: Stool softeners prevent straining, which causes vagal stimulation and slows the heart rate.

8. Myocardial Infarction Nursing Management: "BEE CAB SCORE"

Nursing care targets detecting complications, preventing further damage, and promoting comfort, rest, and emotional wellbeing.

• B: Bedrest reduces myocardial oxygen consumption.
• E: ECG monitoring to catch rate changes or arrhythmias; file rhythm strips in the chart.
• E: Emotional support to reduce stress and anxiety; give tranquilizers as needed.
• C: Cluster/organize patient care to protect uninterrupted rest.
• A: Antiembolism stockings to prevent venostasis and thrombophlebitis.
• B: Bedside commode with privacy.
• S: Stool softener to prevent straining and vagal slowing of the heart.
• C: Cardiac rehabilitation program covering heart disease education, exercise, and family support.
• O: Oxygen therapy at 2 to 3 LPM.
• R: Range-of-motion exercises; turn an immobilized patient often.
• E: Educate and inform, explain procedures and answer questions.

9. Cardiopulmonary Bypass Complications: "4 H's of CPB"

Cardiopulmonary bypass circulates and oxygenates blood while bypassing the heart and lungs, giving the surgeon a still, bloodless field. It is not benign, and use is limited to a few hours.

• H: Hypothermia because blood is cooled to slow the basal metabolic rate.
• H: Hemodilution from isotonic crystalloid given during the procedure.
• H: Heparinization to prevent clotting in the bypass circuit.
• H: Head, or "Pumphead", postperfusion syndrome affecting attention, concentration, short-term memory, fine motor function, and processing speed.

10. Cardiac Tamponade: "The 3 D's" (Beck's Triad)

In tamponade, blood or fluid collects in the pericardium. A slow effusion may stay silent, but a rapid one stretches the pericardium, raises pressure, drops venous return, and cuts cardiac output. The classic exam findings are Beck's triad.

• D: Distant or muffled heart sounds
• D: Distended jugular veins
• D: Decreased pulse pressure