Med Surg Chapter 35 Care of Patients with Cardiac Problems
What is the priority nursing action for a patient on digoxin due to heart failure?
Monitor early signs of toxicity such as bradycardia on the EKG.
Which patient meets the criteria for selection as a candidate for heart transplant surgery?
New York Heart Association class III
Which patients are at risk for developing infective endocarditis?
-IV drug user -patient with mitral valve replacement postop -patient with mitral stenosis who recently had an abscessed tooth removed -older adult patient with urinary tract infection and valve damage
the cause of dilated cardiomyopathy may include which factors? (DCM usually starts in left ventricle)
-alcohol abuse -infection -chemotherapy -poor nutrition
Which are signs and symptoms of rheumatic carditis?
-cardiomegaly (enlarged heart) -new murmur development -existing strep infection -pericardial friction rub
A patient had an emergency pericardiocentesis for cardiac tamponade. What nursing intervention is included in postprocedural care?
-closely monitor for tamponade reoccurance -be prepared to replenish fluid to increase cardiac output -prepare patient for immediate sternotomy if tamponade reoccurs. -send pericardial effusion specimen to the lab for culture
The patient has infective endocarditis. Which findings does the nurse expect when assessing this patient?
-oslers nodes -petechiae -a new regurgitant murmur -fever associated with chills and night sweats
Which are proposed criteria for diagnosis of acute pericarditis.
-pericardial chest pain -presence of pericardial frictional rub -new ST elevation on all EKG leads -new or worsening pericardial effusion
Which description accurately characterizes restrictive cardiomyopathy (when your hearts lower chambers are too stiff to allow blood back into them)?
-poor prognosis -symptoms are similar to R/L heart failure -rarest of cardiomyopathies -filling is restricted during diastole
A patient received a heart transplant, what characteristics suggest transplant rejection?
-shortness of breath -new bradycardia -hypotension -decreased activity tolerance
which interventions are effective for a patient with pulmonary edema caused by heart failure?
1) sodium and fluid restriction 2) administration of loop diuretics 3) Position in semi-fowlers to high fowlers position
A patient with aortic valve endocarditis reports fatigue and SOB. Crackles are heard on lung auscultation. What does these findings most likely indicate?
valve incompetence resulting in heart failure
Long-term anticoagulant therapy for a patient with valvular heart disease and chronic atrial fibrillation includes which drug?
warfarin sodium
A patient has received a heart transplant for dilated cardiomyopathy. He is at high risk for developing tamponade so the nurse notifies the provider immediately if:
-they assess pulsus paradoxus (the decrease of systolic BP by more then 10mm Hg during the inspiratory phase) and muffled heart sounds
What signs/symptoms occur with chronic constrictive pericarditis?
-thick rigid pericardium -jugular venous distention -exertional fatigue and dyspnea -dependent edema
What are signs that heart failure is returning or worsening?
1) cold symptoms (cough) lasting more then 3-5 days 2)excessive awakening at night to urinate 3) dyspnea or angina at rest 4) increased swelling in the feet ankles, or hands
What is expected to see in an assessment of a patient with right sided heart failure?
1) dependent (involving gravity, so lower extremities) edema 2) jugular venous distention 3)hepatomegaly (enlarged liver)
A patient is diagnosed with moderate mitral valve stenosis, what findings is the nurse likely to encounter during the physical assessment?
1) dyspnea on exertion 2) orthopnea 3)palpitations 4)neck vein distention
What characteristics describe mitral valve prolapse?
1) leaflets enlarge and fall back into left atrium during systole 2)most patients are asymptomatic 3)patients have normal heart rate and blood pressure 4) a midsystolic click and late systolic murmur can be heard at the apex of the heart
What are major self-management categories should a nurse include for heart failure?
1) medications 2) weight 3)activity 4) diet 5)what to do when symptoms get worse
What nursing interventions are included for a patient with inadequate tissue perfusion?
1) monitor respiratory rate, rhythm, and quality every 1-4 hours. 2)listen to breath sounds every 4-8h 3)provide O2 4) Assist the patient in performing coughing and deep breathing exercises every 2 hours.
What medications can be used to treat a patient with acute pulmonary edema?
1) nitroglycerin SL 2) furosemide IV 3)Morphine sulfate IV 4)Nitroglycerine IV
What characteristics describe mitral valve stenosis?
1) rumbling apical diastolic murmur 2) right-sided heart failure results in the neck vein distention 3) mild mitral stenosis is usually asymptomatic
The nurse is giving discharge instructions to a patient who had a valve surgery. Which home care instructions does the nurse include in the teaching plan?
1) use an electric razor to avoid skin cuts, 2)report any bleeding or bruising (excessive), 3)watch for and report any fever, drainage or redness at the site. 4) report dyspnea, syncope, dizziness, edema, and palpitations
What is expected to see in an assessment of a patient with left sided heart failure?
1)S3 heart sounds 2) paroxysmal nocturnal dyspnea 3)oliguria during the day (decreased) 4) wheezes or crackles
A student is working with a patient with right sided heart failure, in addition to a stethoscope what else should be bring?
A tape measure
For a patient on digoxin, what does the nurse assess for prior to administering?
Apical pulse rate and heart rhythm
What is the difference between atherosclerosis and arteriosclerosis?
Arteriosclerosis: thickening/stiffening of arteries Atherosclerosis: buildup of fat, cholesterol, and plaque.
A patient who is at risk for heart failure but does not have a medical diagnosis comes in and you are listening to the lungs. You hear profuse crackles. What do you do next?
Ask the patient to cough and reauscultate the lungs.
A provider has ordered an ARB for a patient with heart failure. The parameters are to maintain a BP systolic of 90-110, today it is 110/80. He is feeling dizzy and light headed, what is the nurses priority action?
Assess the patient for other symptoms of tissue perfusion
A nurse is reviewing the lab results for a patient admitted for dyspnea, what is the test that best differentiates between heart failure and lung dysfunction?
B-type natriuretic peptide
A patient recently diagnoses with heart failure gets a new medication. Which medication does the nurse question?
Carvedilol, a beta blocker
A patient with a history of heart problems and HTN makes a statement that makes the nurse concerns for heart failure. What is an example of this statement:
I had to take my wedding ring off last week
What is the best definition of left sided heart failure?
Decreased tissue perfusion r/t poor cardiac output and pulmonary congestion r/t increased pressure in the pulmonary vessels
In what way does arterial embolization to the brain manifest itself in a patient with infective endocarditis?
Dysphagia (difficulty swallowing)
Which treatment intervention applies to a patient with infective endocarditis?
Hospitalization for initial IV antibiotics, then home to continue IV therapy
A patient with heart failure is volume depleted and has a low sodium level. The provider has ordered Valsartan, a angiotensin receptor blocker (ARB). After the initial dose what is a complication that needs to be monitored for?
Hypotension
What is the primary nursing assessment for a patient with heart failure on nesiritide?
Hypotension
A patient is diagnosed with mitral valve stenosis, what finding warrants an immediate notification to the provider?
Irregular rhythm signifying arial fibrillation
A nurse is reviewing the ECG of a patient on digoxin, what early signs of digitalis toxicity does the nurse look for?
Loss of P wave
A patient with heart failure has excessive aldosterone secretion and keeps asking for water. What does the nurse do?
Restrict fluid intake to 2L daily, strict I/O
A patient with a sore throat now complains of chest pain. The nurse assesses a new heart murmur, pericardial friction rub, and tachycardia. ECG shows prolonged P-R interval. What condition does the nurse predict?
Rheumatic carditis (inflammation of any part of the heart resulting from rheumatic fever)
The nurse is reviewing the ECG of a patient with acute pericarditis. What does the nurse anticipate?
ST-T spiking
A patient is prescribed diuretics for a tx of heart failure. Due to this the nurse monitors what?
Serum Potassium
Which lab test does the nurse monitor for potential cardiac problems and digoxin toxicity?
Serum Potassium
The patient is admitted for aortic stenosis. Diagnostic testing reveals that the surface area of the valve is less than 1 cm. Which urgent intervention is required at this time?
Surgical heart valve replacement
A patients bilateral radial pulses are occasionally weak and irregular. What assessment technique does the nurse use first to investigate this?
Take the apical pulse for 1 min, noting any irregularity in heart rhythm.
A patient is diagnosed with new-onset infective endocarditis. Which recent procedure is the patient most likely to report?
Teeth cleaning
A patient ambulates down the hall 200 feet and their blood pressure change is greater then 20mm Hg. What is the interpretation?
This activity is too stressfull
A nurse is taking the history of a patient recently diagnosed with heart failure. He says he has been having trouble catching his breath but doesnt provide more info. What does the nurse ask?
What has been your most strenuous activity in the past week?
When is B-type natriuretic peptide (BNP=a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume.) produced and released for a patient with heart failure?
When a patient has fluid overload
A patient is admitted to the unit with assessment findings that include substernal pain that radiates to the left shoulder. The pain is described by the patient as grating and is worse on inspiration and coughing. What is likely the cause of this patients symptoms?
acute pericarditis
patient presents with acute pericarditis, neck vein distention, tachycardic, tachypnea, and >10mm change in systolic pressure on inspiration v expiration. What is nurses initial response?
administer O2 and immediately report the findings to the health care provider.
A patient comes to the ED anxious, tachycardic, struggling for air, with a moist cough producing frothy, blood tinged sputum. What is the priority nursing intervention?
administer high flow O2 via facemask
A patient with an ejection fraction of less then 30% is going to receive education about which potential treatment?
an automatic implantable cardioverter/defibrillator
A patient with valvular disease is requiring an invasive dental procedure. The nurse notifies the health care provider to obtain a patient prescription for which type of medication?
antibiotics
What is the common tx for rheumatic carditis?
antibiotics 10 days
A patient is scheduled for valve surgery. Which medication does the nurse instruct the patient to d/c at least 7 hours before this procedure?
anticoagulants
A patient with prosthetic valve replacement must understand that postoperative care will include lifelong therapy on which type of medication?
anticoagulants
The nurse is assessing the pulses of a patient with valvular disease and finds bounding arterial pulses. What is this finding most characteristic of?
aortic regurgitation
Which type of cardiomyopathy results from replacement of myocardial tissue with fibrous and fatty tissue?
arrhythmogenic right ventricular cardiomyopathy
The nurse is caring for a patient who had a valvuloplasty. The nurse monitors for which common complication in the postprocedural period?
bleeding and emboli
A patient is admitted for possible infective endocarditis. Which test does the nurse anticipate will be performed to confirm a positive diagnosis?
blood culture
The patient has excess fluid in the pericardial cavity seen on the echo, for which complication is the patient at an increased risk for ?
cardiac tamponade
What is the characteristics of dilated cardiomyopathy (when the heart muscle becomes inflammed and doesnt function properly)
causes symptoms of left ventricular failure
What does a nurse plan to do next with a patient who has been having paroxysmal nocturnal dyspnea?
check on the patient several hours after bedtime and assist the patient to sit upright and dangle feet when dyspnea occurs
What is an early symptom of mitral regurgitation (insufficiency) that a patient will report?
chronic weakness
What is the expected outcome for a patient with the collaborative problem of preventing and managing pulmonary edema?
clear lung sounds
What test is commonly used to assess for valvular heart disease?
echo
What is the test best for diagnosing heart failure?
echocardiography
Pain related to pericarditis is described as:
grating substernal pain that is aggravated by inspiration
In order to make a patient with pericarditis more comfortable the nurse should:
have the patient sit up and lean forward
A patient may die without any symptoms from which type of cardiomyopathy (this also occurs at any age and to men/females equally)
hypertrophic cardiomyopathy
What is an important teaching point for the medication bumetanide?
information about potassium rich food to include in their diet
A patient at risk for valvular disease is found with pitting edema. This is a sign for which type of valvular disease?
mitral valve stenosis and insufficiency
What is an early sign of of left ventricular heart failure that a patient is most likely to complain of
nocturnal coughing
The surgical noninvasive intervention of a balloon valvuloplasty is often used for which type of patient?
older adults who are nonsurgical candidates
Which priority medical surgical concept applies to a patient with heart failure?
perfusion
The nurse assesses a patient and notes red, flat, pinpoint spots on the mucous membranes, which finding has the nurse assessed?
petechiae
For a patient with pericarditis, in order to hear a pericardial frictional rub, which technique does the nurse use?
place the diaphragm at the lower sternal border
The nurse is reviewing the lab results of a patient who is hypertensive. Which result is an early warning sign of decreased cardiac compliance and requires the nurse to immediately notify the provider?
presence of microalbuminuria (urinary albumin excretion of 30-300mg/day)(the direct correlation between CVD and albumin in the urine is unknown but there is a link somehow).
In a patient with heart failure and their pulses alternate in strength what does this mean
pulsus alternans
What is the most common problem for the patient with valvular heart disease?
reduced cardiac output
A patient is a candidate for xenograft valve. The nurse emphasizes that this type of valve does not require anticoagulant therapy but will require what intervention?
replacement in about 7-10 years
A patient is admitted with edema, ascites, and neck vein distention, what is the most reliable way to monitor fluid gain or loss?
same scale same time
What is the definitive tx for a patient with chronic constrictive pericarditis?
surgucal excision of the pericardium
when heart failure developes what is the initial compensatory mechanism of the heart that maintains cardiac output?
sympathetic stimulation
Why does the nurse document the precise location of crackles auscultated in the lungs of a patient with heart failure?
the level of the fluid ascends as the pulmonary edema worsens
Based on the etiology and the MAIN cause of heart failure, which patient has the greatest need for health promotion measures to prevent heart failure?
the patient with HTN
