EXAM 3 N129

Which of these are nursing diagnoses that apply to heart failure? Select all that apply. Impaired Gas Exchange Decreased Cardiac Output Chronic Pain Anxiety Fluid Volume Deficit

Anxiety Decreased Cardiac output Impaired Gas Exchange

The nurse is reinforcing discharge instructions to a client who has a mitral valve prolapse. Which of the following should be included?

"You may have a possible need for prophylactic antibiotics."

List the six steps used for dysrhythmia interpretation

1. Regularity of Rhythm-R-R spacing on ECG. NORMAL RHYTHM -NO GREATER THAN 2 SMALL boxes 2. Heart Rate Count 6 seconds: each "big" box is 0.2 sec, x 15= 3 sec., 30 = 6 sec. 3. P Wave 4. P-R Interval 5. QRS Complex 6. QT Interval

While conducting community health screening, the nurse recognizes that which of the following individuals is at highest risk for atrial fibrillation?

A 62-year-old male smoker with a history of rheumatic heart disease

AORTIC STENOSIS

AORTIC STENOSIS patho: aortic valve NARROWED/STENOSIS Left Ventricle Contracts More Forcefully Left Ventricle Hypertrophies Decreased Cardiac Output Eventual Left sided Heart Failure (last place the blood goes to before going out) Etiology: Congenital defects, rheumatic heart disease, calcification with aging s/s-NONE EARLY, Angina (Ischemia-PAIN), murmur, syncope, orthopnea, dyspnea on exertion, fatigue, pulmonary edema Complications-heart failure, dysrhythmias, endocarditis Therapeutic Interventions-Surgery Aortic Valve Replacement-treatment of choice Valvotomy Treat Heart Failure Symptoms Prophylactic Antibiotics per Criteria

Thrombolytic medications

AlteplASE, StreptokinASE, UrokinASE antidote: aminocaproic acid Stroke patients-right away CLOT BUSTERS-DISSOLVES CLOTS-enzyme side effects: BLEEDING avoid injections, monitor labs, implements bleeding precautions

AORTIC REGURGITATION

Aortic Valve Does Not Close Left Ventricle's Volume Increases Left Ventricle Dilates Left Ventricle Fails Decreased Cardiac Output Pulmonary Edema -blood flow backwards etiology:Rheumatic Heart Disease (Most) Congenital Defects Syphilis Severe Hypertension Rheumatoid Arthritis ACUTE CAUSES: aortic dissection, endocarditis S/S-NONE EARLY, exertional dyspnea, fatigue, widened pulse pressure, angina at night (LATE SYMPTOM) Complications Endocarditis, Heart Failure Therapeutic Interventions-Vasodilator (decrease afterload, decrease workload, pump easier and decreases resistence) Surgical Valve Replacement (treatment of choice prior to heart failure for chronic aortic regurgitation. before congestive heart failure begins) -Prophylactic Antibiotic Therapy per Criteria

An automatic external defibrillator (AED) is available to treat the client who goes into cardiac arrest and is receiving cardiopulmonary resuscitation (CPR). With this device, the nurse checks the cardiac rhythm by:

Applying the adhesive patch electrodes to the skin and moving away from the client

Plan nursing care for a patient with a valvular disorder MULTIPLE ANSWER

Assessment: History, infections, congentital defects?, meds, clubbing, skin, stressors, issues with activity, fatigue, DIAGNOSTIC TESTS FOR VALVULAR DISORDERS: ECG (enlargement of chambers can affect electrical conduction) Chest X-Ray (shows enlarged chambers) 2-D and Doppler Echocardiography (shows size, motion, vegetations, valve function and flow with Doppler) Coronary Angiogram (shows blood flow and blockages of vessels) Cardiac catheterization (shows structure, motion, blood flow, size, blockages and PRESSURES in the heart) Nursing Interventions Pain Relief Normal Cardiac Function Improve Quality of Life Medications Anticoagulants-signs of bleeding, taking at same time, getting labs checked, Monthly INR/PT Tests-warfarin 2-3 Medic alert identification Include caregivers for elderly Revised Endocarditis Prevention-Prophylactic antibiotics

BNP

B-type natriuretic peptide; used to diagnose CHF, secreted by ventricles of heart due to excessive stretching higher pressure in ventricles-higher lab result

Antilipemics

BAS-cholestyramine(Questran) cholestipol(Colestid)Statins-atorvastatin(Lipitor) simvistatin(Zocor) rosuvastatin(Crestor) lowers cholesterol statins-muscle cramps, headaches, fatigue DON'T DRINK GRAPEFRUIT JUICE

What is the screening test for heart failure? Creatine kinase BNP Myoglobin Troponin

BNP

What occurs in left heart failure to blood flow? Blood Backs Up from Left Atrium Blood Backs Up from Right Atrium Blood Backs Up from Right Ventricle Blood Backs Up from Left Ventricle

Blood backs up from left ventricle-short of breath

Plan nursing care for patients with an implanted device MULTIPLE ANSWER

CARDIAC PACEMAKERS temporary-epicardial, transvenous, transcutaneous permanent- surgically implanted OVERRIDE DYSRHYTHMIAS GENERATE AN IMPULSE CAN BE PLACED IN ATRIA, VENTRICLE O BOTH Problems: failure to sense, pace, and/or capture nursing care for pacemakers-monitor ecg, monitor apical pulse, vital signs, symptoms of chest pain, monitor for signs of bleeding and infection, sling on operative side for several days to prevent dislodgement of wires, no lifting or raising arms over head Educate:Incision Care How to Take Radial Pulse Symptoms to Report Pacemaker ID Card Things to Avoid -magnetic fields Trigger Metal Detectors Grounded Appliances Safe Periodic Pacemaker Checks SYNCHRONIZED CARDIOVERSION allows R wave to be sensed for appropriately timed delivery Used In Dysrhythmias when R Wave Present Ventricular Tachycardia with Pulse Atrial Fibrillation, Atrial Flutter, Supraventricular Tachycardia painful procedure-conscious sedation IMPLANTABLE CARDIOVERTER FIBRILLATOR automatically defibrillates when lethal rhythm detects cardioverts when VT detected

A nurse is caring for a client on telemetry who is alone in a room at the end of the hall. The client's heart rhythm goes from a sinus rhythm into ventricular fibrillation and the client loses consciousness. The nurse would immediately:

Call for help and initiate cardiopulmonary resuscitation (CPR) Dfib

heart failure (CHF, congested heart failure) causes

Coronary Artery Disease Cardiomyopathy Hypertension Heart Valve Disorders Myocardial Infarction What goes into the heart-it has to go out Whatever goes into the right has to come out of the left Left ventricle TYPICALLY weakens first

A nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse would expect to note which specific characteristic of this condition?

Dependent edema

Explain the pathophysiology, etilogy, s/s, diagnostic tets, therapetuic measures, and nursing care for dilated, hypertrophic, and restrictive cardiomyopathy MULTIPLE ANSWER

Dilated Cardiomyopathy -VENTRICULAR CAVITY ENLARGES, CONTRACTILITY DECREASES, MOST COMMON Exertional Dyspnea, Orthopnea, Fatigue Hypertrophic Cardiomyopathy -LEFT VENTRICLE MUSCLE WALL ENLARGEMENT, DECREASES VENTRICULAR FILLING, DEATH IN ATHLETES Athletes that suddenly die) 1 out of 500 ppl-don't know it Exertional Dyspnea, Angina at Rest Restrictive Cardiomyopathy -CARDIAC MUSCLE STIFFNESS-IMPAIRS VENTRICLE STRETCH, LIMITS FILL, RAREST FORM Exertional Dyspnea, Syncope, Arrhythmias

Antihypertensives

Diuretics: ThiazideChlorothiazide (Diuril)Hydrochlorothiazide (Microzide)Metolazone (Zaroxolyn) NOT POTASSIUM SPARING , LoopBumetanide (Bumex) Furosemide (Lasix)Torsemide (Demadex) NOT POTASSIUM SPARING-POTENT , Osmotic, Potassium sparingAmiloride (used with HCTZ)Spironolactone (Aldactone) NO SALT SUBSTITUTES Alpha blockers (peripherally acting-DECREASES sympathetic -blocks fight or flight and centrally acting- ACE inhibitors lisinopril (Zestril) enalapril (Vasotec) ramipril (Altace)benazepril (Lotensin) ARBs irbesartan(Avapro) losartan(Cozaar) valsartan(Diovan) Anti-anginals- nitrates (NTG)- help with angina, chest pain Beta blockers (BB)- lolololol-don't stop abruptly!!!-inhibit fight or flight response Calcium Channel blockers (CCB) diltiazem(Cardizem) verapamil(Calan) nicardipine(Cardene) nifedipine(Procardia) amlodipine(Norvasc)

CHAPTER 25 Describe how electrical activity flows through the heart

ECG-electrocardiogram Shows cardiac electrical activity 12-lead ECG=12 Different views Waveforms change appearance in different leads Horizontal axis-amount of time going by 1 small square-0.04 sec 1 large square- 0.2 sec 5 large squares-1 sec deflections-positve or negative PWAVE-first wave of the cardiac cycle and represents atrial depolarization PR INTERVAL-space between the P Wave and the peak of the R segment. Typically 0.12 to 0.20 seconds. time it takes to to travelf rom the SA node to the AV node QRS COMPLEX-after the P wave, ventricular depolarization is composed of three waves. W wave first downward deflection R Wave first upward deflection S Wave second negative deflection of Q Wave or First negative deflection after R wave T WAVE-Ventricular Repolariation-Follows QRS complex QT INTERVAL-beginning of Q wave to end of T wave U WAVE-low potassium levels in blood RARE-after T wave Isoelectric Line-no electrical activity; straight line POSITIVE DEFLECTION-wave goes up from the isoelectric line NEGATIVE DEFLECTION-wave goes down from the isoelectric line ST SEGMENT- end of QRS to beginning of T wave; depressed with ischemia; elevated with cardiac injury (infarction, heart attack)

Defibrillation

Electrical shock delivered to reset lethal ventricular dysrhythmias Pulseless Ventricular Tachycardia Ventricular Fibrillation Paddles Pressed (or place patches) Firmly Against Chest Second Intercostal Space, Right of Sternum Anterior Axillary Line, Fifth Intercostal Space Announce "Clear" Increasing Energy: 200, 300, 360 Joules Joules are device specific AED-automatic external defibrillator external device automattically analyzes rhythms-V FIB OR VT Don't shock Asystole s/s-unconscious, no heart sounds, peripheral pulses, BP, respiratory arrest, cyanosis, pupil dilation interventions-CPR, ACLS protocols-endotracheal intubation, epinephrine, vasopressin

Anticoagulants

Heparin & enoxaparin antidote: protamine sulfate prevent the blood from clotting DOES NOT DISSOLVE CLOTS side effects-BLEEDING Labs: aPTT,, PLTS monitor intake of Vitamin K-reduces effectiveness WARFARIN antidote: phytonadione inhibits four dependent clotting factors DOES NOT DISSOLVE CLOTS Labs: PT/INR monitor intake of vitamin K-reduces effectiveness

Explain the pathophysiology, etilogy, s/s, diagnostic tets, therapetuic measures, and nursing care for inefective endocarditis, pericarditis, and myocarditis INFLAMMATORY AND INFECTIOUS CARDIAC DISORDERS: INFECTIVE ENDOCARDITIS

INFLAMMATORY AND INFECTIOUS CARDIAC DISORDERS: INFECTIVE ENDOCARDITIS: infection of endocardium patho: invading organism attaches to endocardium, vegetative lesion forms (collection of platelets and fibrin that stick together and then break off that can cause emboli), damages valve leaflets, emboli/heart failure possible MEN/OLDER ADULTS etiology: immunocompromised, artificial heart valve, congenital/valvular heart disease, IV drug use, gingival disease (prophylactic antibiotic before dental may prevent) s/s-fever, murmur, immune response is slow and unpredictable (immunsennosence), splinter hemorrhages (blood blister on nail), petechiae, Janeway Lesions (small, painless red-blue lesions on palms and soles), Osler's Nodes( small, painful nodes on fingers and toes), Roth's spots (hemorrhages on eye), petechia Complications: vegetative Emboli (stroke, seizure, find way to kidneys (hemoturia, renal failure)), pulmonary emboli when found into the lung, heart valve stenosis regurgitation, heart failure Diagnostic Tests Blood Cultures Echocardiography Therapeutic Interventions IV Antimicrobial Drug Rest/Supportive Care Home IV Antimicrobial Therapy Surgical Valve Replacement/Repair Nursing Management Vital Signs/Cardiac Function Report Heart Failure/Emboli Signs Teach Good Hygiene, Oral/Dental Care Report Symptoms: Fever, Chills, Sweats

The nurse is caring for a client who is on digoxin. With myocarditis, the nurse is aware that which of these effects occurs with digoxin administration?

Increased risk of toxicity .8-2.0

MITRAL REGURGITATION

MITRAL REGURGITATION patho: mitral valve has incomplete closure, backflow of blood to left atrium, left atrium dilates, extra volume to left ventricle, left ventricle dilates from extra volume, EVENTUALLY MAY FAIL LEFT HEART FAILURE Etiology:Rheumatic Heart Disease (Most) Endocarditis Congenital Defects Chordae Tendinae Dysfunction Mitral Valve Prolapse s/s- NONE EARLY, murmur, dyspnea, cough, hemoptysis, fatigue with activity, palpitations, atrial fibrillation, chest pain compliccations: afib, pulmonary hypertension, heart failure, endocarditis risk Interventions: None, Unless Symptoms Prophylactic Antibiotics per Criteria ACE Inhibitors -takes off the workload of the heart, decreases the active load (rejection of the blood,) Anticoagulants: Atrial Fibrillation Mitral Valve Repair/Replacement

MITRAL STENOSIS

MITRAL STENOSIS Mitral Valve THICKENING /Chordae Tendineae SHORTENING Narrows Valve Opening-stenosis Blood Flow Obstructed from Left Atrium Left Atrium Enlarges-blood flow out of the left atrium is impaired Backward Pressure Occurs Until Right Ventricle Dilates/Fails (goes so far back) Cardiac Output Reduced Increased pressure in the heart ( in each individual chamber is heightened) etiology: Common - Prior Rheumatic Fever (can take 2-3 decades to show valvular damage) Congenital Defects Tumors Rheumatoid Arthritis Systemic Lupus Erythematosus Calcium Deposits s/s-NONE EARLY, shortness of breath, fatigue, exertional dyspnea, murmur, cough (hemoptysis productive, bloody cough), palpitations ,edema, atrial fibrillation (flutter) (give anticoagulants like warfarin, decrease risk for emboli), chest pain Complicatons: stroke (blood pooling from emboli that starts to clot) and seizures Interventions: Prophylactic Antibiotics per Criteria Anticoagulants: Atrial Fibrillation Percutaneous Balloon Valvuloplasty Surgery Mitral Valve Repair Commissurotomy (separate the thickened adherent leaves of the stenosed mitral valve.) Annuloplasty (repair or reconstruction of the valve flaps or annulus.) Mitral Valve Replacement

CHAPTER 23 Explain the pathophysiology, etiology, signs and symptoms, and diagnostic tests for each of the valvular disorders MULTIPLE ANSWER MITRAL VALVE PROLAPSE MVP----

MITRAL VALVE PROLAPSE MVP patho: During Ventricular Systole, Mitral Valve Flaps Normally Closed In Mitral Valve Prolapse One/Both Flaps Bulge Into Left Atrium If Bulging Flaps Do Not Fit Together, Mitral Regurgitation Occurs (Blood regurgitates back into the left atrium like a parachute). etiology: unknown (infections, ischemic heart ds. enlargement of heart cardiomyopathy) , women 15-30 yrs of age, men older than 50 have more severe effects, MOST COMMON s/s-murmur of apex (bottom, lower border of left ventricle) of heart (clicking), anxiety, atypical chest pain, dysrhythmias, dyspnea, fatigue, palpitations, OFTEN NONE complications:Dilation of left side of heart, heart failure, infective endocarditis, emboli Interventions:None, Unless Symptoms Healthy Lifestyle Avoid Stimulants/Caffeine Prophylactic antibiotics to prevent bacterial infections Stress Management Beta Blockers for Tachycardia Valve Surgery for Severe MVP

INFLAMMATORY AND INFECTIOUS CARDIAC DISORDERS: myocarditis

MYOCARDITIS patho & etiology: inflammation of myocardium, RARE, often follows virus S/S-NONE, possible viral infection signs, chest pain, tachycardia Diagnostic Tests Endomyocardial Biopsy-preferred or the first 6 weeks MRI Echocardiogram ECG Therapeutic Interventions Reduce Heart's Workload Oxygen Treat Cause Antimicrobial Treat Heart Failure Nursing Care Vital Signs/Cardiac Status Diversional Activities Energy Conservation Education

Q-T interval

Normal ranges-0.34-0.43 Prolonged or shortened length can lead to ventricular dysrhythmias

INFLAMMATORY AND INFECTIOUS CARDIAC DISORDERS: pericarditis

PERICARDITIS inflammation of pericardium Acute-resolves in less than 6 weeks Chronic-results in fibrous scarring of the pericardium. Thickened pericardial sac limits stretch ability of the heart. (doesn't pump effectively, RIGID because of sack inhibiting movement) May be attributed to neoplastic disease, mets, radiation or TB. patho: Ventricular Filling Reduced Decreased Cardiac Output and BP etiology: infections, lyme disease, drug reactions, connective tissue disorders, neoplastic disease, postmyocardial infarction, Dressler's syndrome, renal disease, trauma s/s-Chest Pain; Substernal, Radiates, Grating -Increases with Deep Inspiration -Relieved by Sitting Up/Forward Pericardial Friction Rub Dyspnea Low-grade Fever Cough Diagnostic:ECG Echocardiogram WBC Pericardial Fluid CT Scan MRI Interventions: Pericardiocentsis Bed rest NSAIDs, corticosteroids Treat Cause Antibiotics Hemodialysis Pericardial Window Pericardiectomy Complications Pericardial Effusion Cardiac Tamponade (lots of flulid in percotic sack, pressure on heart, difficult to pump) INCREASED HEART RATE Immediate Pericardiocentesis (narrowing of the pulse pressure) Management:Vital Signs Cardiac Function/Tamponade Signs Pain Relief NSAIDs, Corticosteroids Position of Comfort-sitting up, leaning forward position (probably) Education

Identify s/s of acute and chronic heart failure

PULMONARY EDEMA-ACUTE HEART FAILURE fluid in lungs-pressure s/s-classic: pink, frothy sputum, rapid respirations with accessory muscles, severe dyspnea, orthopnea, crackles, wheezes, anxiety, restlessness, clammy, cold skin CHRONIC HEART FAILURE s/s-fatigue, weakness, exertional dyspnea (orthopnea, paroxysmal nocturnal dyspnea), cough, crackle and wheezes, tachycardia, chest pain-angina, cheyne stokes respiration, edema, anemia, nocturia, cyanosis, altered mental status, malnutrition complications-Liver and Spleen Enlargement Pleural Effusion Thrombosis and Emboli Cardiogenic Shock

The nurse is collecting data for a client 3 days after an automobile accident in which the patient hit the steering wheel. The data reveal symptoms of pericarditis. Which of these findings are indicative of pericarditis?

Pericardial friction rub

What is the classic symptom of acute heart failure? Pink, Frothy Sputum Rapid Respirations Orthopnea Wheezes

Pink frothy sputum

Antiplatelet Agents

Plavix-clopidogrel, ASA, aspriin Inhibits platelet aggregation-ability to stick together can give anticoagulants with side effects: GI bleeding, bruising, tarry stools, hematuria interventions: monitor for bleeding, take with food to reduce GI upset --------------------------------------- Inotrope-impacts contractility or squeeze of the heart. Chronotrope-pertains to the rate of the heart Dromotrope-pertains to the speed with which the impulse travels thru the AV node Each of these can either be a positive (help heart squeeze) or negative effect. (brings down)

Cardiac glycosides

Positive inotropes-negative chronotropes-negative dromotropes DIGOXIN, DOBUTAMINE-gtt for icu side effects: GI-n/v, vision changes: diplopia, blurred, photophobia, green or yellow halos around lights/objects, bradycardia Considerations: Dig levels 0.8-2.0 ng/mL Monitor apical pulse for one full minute

The nurse is contributing to a plan of care for a client who has acute pericarditis. The patient has a nursing diagnosis of Pain related to the inflammatory process. What nursing action should the nurse recommend?

Provide anti-inflammatory medication as ordered.

Explain medical treatments used for acute and chronic heart failure MULTIPLE ANSWER

Pulmonary edema-acute heart failure Interventions- Immediate treatment Reduce workload of left vetricle Treat Underlying Cause Fowler's Position Oxygen/Mechanical Ventilation Diuretics IV Morphine IV-calm, decreases heart rate which decreases respiratory efforts/dyspnea, decrease BP Inotropic Agents IV-strengthen contraction of heart-make beat stronger Vasodilators IV-decrease afterload CHRONIC HEART FAILURE drug therapy-table 26.5 Oxygen Therapy ACE Inhibitors or ARBs Beta Blockers Diuretics Inotropic Agents Vasodilators diagnostic tests-BNP, SERUM BUN, creatinine, liver and thyroid function tests, ferritin, chest x ray, Echo, ECG, exercise stress testing, cardiac Magnetic imagine, Cardiac cath/angiography, sleep studies (issues at night, apnea)

Valvular damage

Rheumatic Fever (ages 5-15) reaction to strep throat. Fever occurs 2-3 weeks after the onset of infection. autoimmune Diagnostic test- Throat culture to detect streptococcal infection Treatment-Treat streptococcal infection promptly with penicillin Rheumatic fever leads to rheumatic heart defects and subsequent valvular damage. Damage CAN BE PREVENTED...if detect and treat strep infection promptly Risk for if repeated strep and doesn't get treated Mainly seen in adults because of delay

normal sinus rhythm Rules

Rhythm: Regular Heart Rate: 60 to 100 bpm P Wave: Rounded, Before each QRS PR Interval: 0.12 to 0.20 Seconds QRS Interval: < 0.10 Seconds

Explain current medical treatments for each type of cardiac dysrhythmias MULTIPLE ANSWER

SINOATRIAL NODE DYSRHYTHMIAS SINUS BRADYCARDIA rate slower than 60 bpm that can be asymptomatic or symptomatic Rhythm: Regular Heart Rate: < 60 bpm P Waves: Rounded, Before Each QRS PR Interval: 0.12 to 0.20 Seconds QRS Interval: < 0.10 Seconds s/s-fatigue, fainting TREATMENT-no symptoms-nothing Oxygen, atropine, Dopamine, Epinephrine, Pacemaker SINUS TACHYCARDIA rate from 101 to 180 bpm s/s-chest pain, angina or dyspnea, elderly more sensitive Interventions-Treat cause, digoxin, calcium Channel blockers, Beta blockers ATRIAL DYSRHYTHMIAS PREMATURE ATRIAL CONTRACTIONS Rhythm: PAC Interrupts Rhythm Heart Rate: Per Underlying Rhythm P Waves: Early Beat, Abnormal Shape P-R Interval: Usually Normal QRS Interval: < 0.10 Seconds s/s-palpitations in chest Interventions-Treat Cause, Beta Blockers ATRIAL FLUTTER Rhythm: Atrial Rhythm Regular Heart Rate: Varies P Waves: F Waves, SAWTOOTH Pattern P-R Interval: None Measurable QRS Interval: < 0.10 Seconds CAUSE: s/s-Ventricular rate normal-none Rapid Ventricular rate-palpitations, angina, dyspnea Interventions to slow heart rate-Cardioversion, rapid atrial pacing, ablation therapy (destroy/modify tissues responsible), calcium channel, beta blockers, digoxin AFIB-ATRIAL FIBRILLATION Rhythm: Irregularly Irregular Heart Rate: Atrial Rate Not Measurable, Ventricular Rate <100 Controlled Response, >100 Rapid Ventricular Response P Waves: No Identifiable P Waves P-R Interval: None Measurable QRS Interval: < 0.10 Seconds CAUSE:age, smoking, high risk for stroke s/s-palpitations, faint radial pulse, decreased stroke volume and decreased cardiac output can lead to left heart failure Interventions-synchronized cardioversion : MEDS: digoxin, beta blockers, calcium channel blockers, amiodarone or Dronedarone, warfarin Ablation, Biatrial pacing, implantable atrial defbrillators, Srugical Maze procedure

VENTRICULAR DYSRHYTHMIAS

SUPRAVENTRICULAR TACHYCARDIA Rhythm: regular, very rapid Heart Rate: usually very rapid >160 bpm P Waves: No Identifiable P Waves P-R Interval: None Measurable QRS Interval: < 0.10 Seconds S/S-palpitations, (drinking an energy drink for the first time), Faint Radial Pulse-decreased stroke volume and decreased cardiac output Interventions-synchronized cardioversion, meds: Valsalva, adenosine (6 mg followed by 12 mg IVP), treat pt symptoms VENTRICULAR DYSRHYTHMIAS PREMATURE VENTRICULAR CONTRACTION PVC ABSENT-wide bazar looking QRS coplexes-premature SA nodes CAUSE: anxiety, caffeine, alcohol s/s-palpitations, fatigue, dizziness, severe dysrhythmias interventions-none, antidysrhythmics: amiodarone (CORDARONE, PACERONE), beta blockers VENTRICULAR TACHYCARDIA different rhythms-slow but still high (less than 150) and then high 150-250 CAUSE: digoxin toxicity, cardiac cath procedure, low potassium levels s/s-dyspnea, palpitations, light headedness, angina, cardiac arrest Interventions-if pulseless-CPR, defibrillation, vasopressors, anti-arrhythmics, amiodarone, lidocaine, consider magnesium IF STABLE-amiodarone, monitor on telemetry VENTRICULAR FIBRILLATION chaotic, extremely irregular!!!!! no p wave, no pr interval, no qrs interval Causes: high levels of potassium, low levels of magnesium, heart attack s/s-unconscious,, no heart sounds, peripheral pulses,, BP, respiratory arrest, cyanosis, pupil dilation Immediate intervention-defibrillation-TIME IS MUSCLE CPR, EPI, ammiodarone, magnesium, Endotracheal intubation

A nurse is monitoring a client following cardioversion. Which of the following observations would be of highest priority to the nurse?

Status of the airway

Antidysrhythmics

Suppress dysrhythmias by inhibiting the normal pathways of electrical conduction through the heart. Class I - Sodium Channel Blockers Class II - Beta Blockers Class III - Potassium Channel Blockers Class IV - Calcium Channel Blockers

Explain the pathophysiology, etilogy, s/s, diagnostic tets, therapetuic measures, and nursing care for thrombophlebitis

THROMBOPHLEBITIS clot formation and inflammation within vein patho: superficial veins, DVT, emboli danger Etiology : Venous Stasis -Reduced Blood Flow Damage to Vein Lining -IV Catheters Increased Blood Coagulation Smoking, Oral Contraceptives, Estrogen Therapy , Hematological Disorders s/s-NONE 50%, superficial veins, redness warmth, swelling, tenderness vein feels like a firm cord, (INDURATION), saphenous vein commonly deep veins-leg usually, sweelling, edema, pain, warmth, tenderness Complications Pulmonary Embolism Life-threatening Emergency Chronic Venous Insufficiency Varicose Veins Recurrent Deep Vein Thrombosis Diagnostic Tests Duplex Ultrasound Impedance Plethysmography Magnetic Resonance Imaging (MRI) Venography d-dimer and Coagulation Tests Therapeutic Interventions SUPERFICIAL VEINS Warm, Moist Heat Analgesics NSAIDs Compression Stockings Measure the calf circumference and document daily Therapeutic Interventions (cont'd) DEEP VEINS Low-molecular Weight Heparin/Heparin -PTT Warfarin (Coumadin)-INR/PT Bedrest (Elevate Extremity) Warm, Moist Heat Compression Stocking Therapy TEDS and SCDs on unaffected leg only until acute symptoms are gone in affected leg Thrombolytic Therapy Thrombectomy Vena Cava Filter anticoagulants-signs for bleeding

Plan nursing care for acute and chronic heart failure treating congestive heart failure:

Upright position Nitrates-low dose Lasix Oxygen Aminophyline Digoxin Fluids-decrease Afterload-decrease Sodium restriction Tests- DIG level, ABGss, potassium levels CHRONIC HEART FAILURE INTERVENTIONS: Activity Sodium and Weight Control Pacemakers, ICD Cardiac Resynchronization Therapy Mechanical Assistive Devices -Intra-aortic Balloon Pump -Ventricular Assist Device -Total Artificial Heart -Implantable Replacement Heart Oxygen Rest and Activity Positioning Fluid Management Reduce Oxygen Consumption Medications/Teaching Low-sodium Diet Weight Control Education Coping

The nurse is reinforcing teaching for a client who has had a mechanical valve replacement. What should be taught regarding safety during warfarin therapy?

Wear Medic-Alert identification.

Potassium Channel Blockers

amiodarone(Cordarone-Pacerone) bretylium sotalol(Betapace, also has Class II properties) Prolong repolarization and the refractory period Decrease intraventricular conduction May be used for VTach, VFib, SVT, Afib Do not abruptly discontinue therapy, may cause rebound effects.

pulmonic valve

bettween the right ventricle and pulmonary arteries

mitral valve

between the left atrium and ventricle

aortic

between the left ventricle and aortic arch

tricuspid

between the right atrium and right ventricle

If someone with a pacemaker's heart rate is less than 70

call the provider/charge nurse-REPORT

Cardiomyopathy

enlargement of heart muscle NO CURE s/s-Heart Failure Dilated Cardiomyopathy -VENTRICULAR CAVITY ENLARGES, CONTRACTILITY DECREASES, MOST COMMON Exertional Dyspnea, Orthopnea, Fatigue Hypertrophic Cardiomyopathy -LEFT VENTRICLE MUSCLE WALL ENLARGEMENT, DECREASES VENTRICULAR FILLING, DEATH IN ATHLETES Athletes that suddenly die) 1 out of 500 ppl-don't know it Exertional Dyspnea, Angina at Rest Restrictive Cardiomyopathy -CARDIAC MUSCLE STIFFNESS-IMPAIRS VENTRICLE STRETCH, LIMITS FILL, RAREST FORM Exertional Dyspnea, Syncope, Arrhythmias Diagnostic Tests Chest X-Ray (Cardiomegaly) Echocardiography ECG Cardiac Catheterization Vital Signs Heart Failure/Emboli Signs Signs of Digoxin Toxicity Activity Tolerance/Energy Conservation Emotional Support Education Home Health Care

The nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. Which are concerns related to the administration of this medication? Hypouricemia, hyperkalemia Increased risk of osteoporosis Hypokalemia, hyperglycemia, sulfa allergy Hyperkalemia, hypoglycemia, penicillin allergy

hypokalemia, hyperglycemia, sulfa allergy potassium wasting medication

ST segment elevated

infarction

ST segment depressed

ischemia

CHAPTER 26 Describe the pathophysiology of left and right sided heart failure MULTIPLE ANSWER

left sided heart failure AFTERLOAD Preipheral Vascular Resisistance-pressure within aorta/arteries-influenced afterload hypertension major cause blood backs up from left ventricle into lungs Alveolar edema results s/s-respiratory distress, coughing, shortness of breath, cyanosis, acute pulmonary edema right sided heart failure -Left sided heart failure major cause Cor Pulmonale-right ventricle hypertrophies & fails due to increased pulmonary pressures Backward buildup of blood in systemic blood vessels Peripheral edema results s/s-abd organs can become engorged, fluid congestion in GI tract causes anorexia, ,nausea, and abd pain, LOTS OF EDEMA IN LOWER EXTREMITIES AND ASCITES, jugular vein bounding splenomegaly, hepatomegaly-systemic venous congestion Daily weights** report more than 2 pounds a day

hypertrophy

muscle mass increases --increases cardiac oxygen needs sympathetic nervous system raises heart rate

stenosis

narrowing, tightening hinder blood flow through valve end up having back flow, regurgitation of blood

preload afterload

the stretch of ventricle right before it contracts and pushes out of it. systole is always higher because its the contraction and diastole is smaller because its the relaxation) force needed to push and eject blood

A client is receiving digoxin (Lanoxin) daily. The nurse suspects digoxin toxicity after assessing which signs and symptoms? Select all that apply. Visual disturbances Nausea and vomiting Serum digoxin level of 2.3 ng/mL Serum potassium level of 3.9 mEq/L Apical pulse rate of 63 beats/min

visual disturbances-yellow/green of lights nausea/vomitting Serum digoxin level of 2.3 ng/mL