Page 111 - Critical Care Nursing Demystified

96 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

If a pericardial friction rub is suddenly discovered by the critical care nurse, the health
care provider should be notified immediately and the medication record should be

scanned for the use of anticoagulants.

Other Vascular Sounds—Bruit
A bruit is an extracardiac vascular sound that is high pitched and swishing in its
characteristics. It is caused by either increased blood flow through a normal ves-
sel or blood flow through a partially occluded or torturous vessel. Assess for bruits
over the carotid, renal, and femoral arteries. They can indicate stenosis of these
vessels or aneurysm. Bruits can also be heard over a patent AV shunt for dialysis
where turbulence of blood flow is created by anastomoses of an artery and vein.

Recounting a True Story

The critical care nurse can often have life experiences outside of work that tax his
or her assessment skills. The following is one example, based on a true story.
You are attending the preceremony preparation for your daughter’s wedding. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The wedding is a destination wedding and all of your nearest, dearest relatives
and friends are staying with you at a college inn. As you enter the car to drive
your daughter to get her hair and makeup done, a call comes from your son that
your father is having chest pains. Throwing the keys to your daughter, you meet your
husband, mother-in-law, and father walking slowly back to the inn. You send your
son for a wheelchair and start assessing your father. He is clutching his left chest,
is very diaphoretic, and is reporting sudden chest pain of 5 on a 1 to 10 scale that
started while walking slowly with family after breakfast. The pain has not increased
in intensity with slowly walking back to the inn with his escorts. In your mind you
want to call 911 and get oxygen from the hotel, but you also know your father has
poorly controlled gastroesophageal reflux disease (GERD) and is not consistent in
taking his medications while traveling.
Once settled back in his room, you get him to chew a baby aspirin and assess his
pulse, which has been around 66 and regular since you initially assessed him. After
5 minutes of rest, he no longer has chest pain and informs you he has had epi-
sodes like this and did not take his “purple pill” this morning. He tells you not to
call your daughter and does not want to spoil the wedding. He rests in the after-
noon, meets you at the wedding, and dances the first dance with you. Later, you
teach him about the importance of taking his pills, especially during stressful
events.