Chapter 37 Care of patients with cardiac problems
What's normal EF %
55-70%
Which of these clients is best to assign to an LPN/LVN working on the telemetry unit?
A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea
____ is a common finding in both mitral stenosis and regurgitation
A-Fib
A client has been taking furosemide (Lasix) for the past 3 years. This morning, the hospital laboratory notifies the nurse that the client's serum potassium level is 2.9 mEq/L. What is the nurse's best action at this time?
Ask the lab to retest the potassium level.
In monitoring the diagnostic test of a client admitted with heart failure (HF), which finding is consistent with this diagnosis?
B-type natriuretic peptide (BNP) of 760 ng/dL
Left-sided heart failure was formerly referred to as
CHF
Right sided heart failure in the absence of L-sided heart failure is usually a result of ___
COPD
The nurse recognizes that which medication when given in heart failure may improve morbidity and mortality?
Carvedilol (Coreg) ,Beta-adrenergic blockers reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure;
The nurse is caring for a client with heart failure. For which symptoms should the nurse assess?
Chest discomfort or pain, increased HR, and DOE
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen?
Client states that she is able to sleep on one pillow.
The client who has been admitted for the third time this year for cardiac failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response?
Considers further assessment for depression
. Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance with prescribed home therapy. Which laboratory test confirms the nurse's suspicions?
Digoxin level of 0.2 ng/dL
An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action?
Draw a serum digoxin level.
What is considered the best tool to diagnosis HF
ECHO
The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, pink, frothy sputum, and crackles throughout the lung fields. Which prescription should the nurse carry out first? CHART EXHIBIT Physical Assessment Diagnostic Findings Provider Prescriptions Crackles in all fields Ejection fraction 30% Diagnosis heart failure S3 present BNP 560 Enalapril 10 mg orally daily Oliguria Sodium 130 mEq/L Heparin 5000 units subcutaneously every 12 hours Strict I & O Furosemide 40 mg IV daily
Furosemide
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8 Pulse: 48 and irregular Respirations: 20 Potassium level: 3.2 mEq/L What action does the nurse take?
Hold the digoxin, and obtain a prescription for a potassium supplement.
What is a common cause of infective endocarditis
IV drug use
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure. The nurse questions the client about the use of which medication because it raises an index of suspicion as to the cause of heart failure?
Ibuprofen (Motrin) Long-term use of NSAIDs, such as ibuprofen (Motrin), causes fluid and sodium retention
What is Frank Starling's Law
If you increase pressure, SV will increase and cardiac output will increase
Which priority problems may be considered for the client with heart failure?
Impaired Physical Mobility related to limited cardiovascular endurance Impaired Gas Exchange related to ventilation-perfusion imbalance Potential for pulmonary edema Risk for Ineffective Renal Perfusion related to hypervolemia
Most heart failure begins with
Left ventricle failure
What are the 3 major types of heart failure
Left-sided, right-sided, and high output failure
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action should the nurse take first?
Listen to the client's posterior breath sounds.
When caring for a client who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates the need for immediate action by the nurse?
Muffled heart sounds
Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit?
Obtain daily weights for several clients with class IV heart failure.
A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have?
Peripheral edema , Crackles in both lungs , Lung congestion
Which intervention will best assist the client with acute pulmonary edema in reducing anxiety and dyspnea?
Place the client in high Fowler's position with the legs down.
The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client?
Positions the client to alleviate dyspnea
Describe Rheumatic Carditis
Senitivity response that develops after URI with group A strept
A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription?
Serum potassium level of 2.8 mEq/L
The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider?
Sinus bradycardia , Fatigue, Anorexia
Rheumatic Carditis is characterized by Aschoff Bodies. What are Aschoff Bodies?
Small nodules in myocardium that are replaced by scar tissue.
The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis?
Splinter hemorrhages
After receiving change-of-shift report about these four clients, which client should the nurse assess first?
The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes
A client admitted for heart failure has a priority problem of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data obtained the day after admission is the best indicator that the treatment has been effective?
The client's weight decreases by 2.5 kg.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy?
The nurse obtains a bedside commode before administering furosemide.
The client begins therapy with lisinopril (Prinivil, Zestril). What should the nurse consider at the start of therapy with this medication?
The risk for hypotension
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions?
Weight loss of 6 pounds since the last visit
What is the most common heart valve dysfunction
aortic stenosis
What are signs of Digoxin Toxicity
blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo.
Define high-output heart failure
cardiac output remains normal or above normal. Caused by increased metabolic needs or hyperkinetic conditions
In this type of heart failure (systolic/diastolic) you can sometimes have a normal EF "Preserved"
diastolic
Aortic valve can only be replaced with
prosthetic valve
Describe arrhythmogenic Right ventricle
replacement of myocardial tissue with fibrous fatty tissue.
A client who recently had a heart valve replacement is taking warfarin (Coumadin) as prescribed. What health teaching will the nurse include before the client is discharged?
"Avoid foods that are high in vitamin K, such as kale and spinach."
The nurse caring for a client discusses the importance of restricting sodium in the diet. Which statement made by the client indicates that he needs further teaching?
"I should avoid grilling hamburgers."
The nurse is providing discharge teaching to the client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates understanding of the teaching?
"I will call the provider if I have a cough lasting 3 or more days."
The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response?
"This may be caused by a genetic trait."
