Synthesis Exam 3
teaching plan for patient with heart failure
sodium restriction dairy restriction
acute angina treatment
SL nitroglycerin
early signs of acute decompensated HF
SOB fatigue orthopnea
Systolic dysfunction
A defect in ventricular ejection with reduced EF
heparin
Anticoagulant prevents new clots but does not break up existing
Treatment of PVCs if asymptomatic vs. symptomatic
Asymptomatic: none Symptomatic: beta blockers
first thing to do with v fib
CHECK PATIENT
beta adrenergic blocker MOA
Decrease sympathetic vasoconstriction tone Decrease CO
Thiazide diuretics MOA
Inhibit sodium reabsorption in the distal tubule
what drug should be avoided with ACE inhibitors
NSAIDS
care post cardiac cath
bedrest assess pulses in extremity used for access color, sensation, movement of extremity
BNP greater than 100
can indicate HF
NSTEMI
non-ST elevation myocardial infarction
precautions with ICD
tell staff at airport no special precautions with household applicances MRI needs to have special procedure followed
what is heart failure?
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
what is a major reason people stop taking anti-hypertensives
they think their BP is fine
alteplase
thrombolytic
what is the gold standard lab for MI
troponin
why might patients stop taking diuretics
urinating too much
treatment of second degree Type 1 heart block
usually not necessary if causes severe bradycardia, atropine
diastolic dysfunction
A defect in ventricular filling with preserved EF
nursing considerations ACE inhibitors
ACE inhibitor cough persistent Potential for angioedema, dyspnea, facial swelling
what needs to be monitored with beta blockers?
BP and HR, both can block drastically
A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. the client is experiencing weakness and an irregular hear rate. which of the following actions should the nurse take first? A- obtain clients current weight B-Determine the time of the last digoxin dose C- Check the clients urine output D- Review serum electrolyte Values
D Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.
ACE inhibitors for heart failure
Decreases the ventricular remodeling that can occur with heart failure
clopidogrel
Inhibits platelet aggregation, used after PCI
enoxaparin
Lovenox prevents formation of new clots
Treatment of First degree AV block
Usually nothing. Often a side effect of another drug, so stopping that medication may be indicated. may require pacing
complications of hypertension
∙LVH ∙CHF ∙Coronary heart disease ∙Renal Disease CAD Nephrosclerosis (kidney disease) Cerebrovascular disease Stroke Heart failure Damage to eyes
nonmodifiable risk factors for CAD
Age Gender Ethnicity Family history Genetic predisposition
If PCI cannot be performed within 90 minutes of arrival in the emergency department, the patient should receive
TPA
adrenergic inhibitors examples
clonidine
teaching for pacemaker
Should avoid lifting on the operative side above the shoulder for about a week No lifting heavier than a gallon of milk Do not have to worry about security alarms or issues with microwaves
calcium channel blockers examples
- Diltiazem (Cardizem) - Amlodipine (Norvasc) - Verapamil (Calan) - Nifedipine (Procardia/Adalat)
signs of digitalis toxicity
-headache -nausea -vomitting -change in ECG wave
troponin normal level
0-0.4
normal troponin levels
0-0.4 ng/mL
right sided heart failure
1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement)
when are calcium channel blockers contraindicated?
2nd and 3rd degree heart blocks
normal HgbA1C
4-6%
MAP for patient with VAD
65-85 do not want to exceed 90
A nurse is teaching a client who is starting to take an ace inhibitor to treat hypertension . the nurse should instruct the client to notify his provider if he experiences which of the following adverse effects of this medication A- Persistent Cough B- Frequent Urination C- Constipation D- Tendon Pain
A A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.
A nurse is planning a presentation for a group of clients who have hypertension. which of the following lifestyle modifications should the nurse include: SATA A. Tobacco cessation B. Decreased magnesium intake C. reduced potassium intake D. regular exercise program E. limited alcohol intake
A, D, E
The nurse administers 40mg of furosemide instead of 20mg by mistake. What are the steps the nurse takes when she realizes the mistake?
Assess for any immediate VS changes or side effects Notify physician using SBAR Check another set of electrolytes Keep close eye on BP Safety report Prevent falls due to hypotension
how to help patient with shortness of breath
Assess vital signs (especially O2 sat and HR) Sit patient up to try to make it easier to breathe (high fowlers) bolt upright to increase thoracic capacity Place oxygen on if needed Monitor lung sounds and check for crackles
nursing considerations calcium channel blockers
Avoid drinking grapefruit juice hypotension bradycardia reflex tachy
A nurse is assessing a client who has pulmonary edema related to heart failure. which of the following findings indicates effective treatment of the clients condition A- Decreased Respiratory rate at rest B- Absence of adventitious breath sounds C- Presence of nonproductive Cough D- SaO2 86% on room air
B Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving.
A nurse is caring for a client who is being rated for heart failure and has a prescription for furosemide. the nurse should plan to monitor for which of the following as an adverse effect of this medication A- Metallic taste B- Lightheadedness C- Dry Cough D- Shortness of breath
B Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.
nursing considerations beta adrenergic blockers (-lol)
BP and HR monitored frequently, meds can drop both drastically May be less effective for African American patients due to effect on renin Cardio-selective
foods high in sodium
Bacon Butter Canned food Cheese/Cottage cheese Frankfurters Ketchup Lunch meat Milk Mustard Processed food Snack food Soy sauce Table salt White & Whole wheat bread
A nurse is caring for a client following insertion of a permanent pacemaker. which of the following client statements indicates a potential complication of the insertion procedure A- I feel dizzy when I stand B- my incision site stings C- I cant get rid of these Hiccups D- I have a headache
C sign that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.
When are beta blockers contraindicated?
CHF with cardiogenic shock or arrhythmia, diabetes or kidney failure, and printzmetal angina. heart block
treatment for v fib
CPR defibrillate
calcium channel blockers MOA
Cause coronary artery vasodilation Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance Reduce the workload of the heart Result: decreased myocardial oxygen demand
alpha adrenergic inhibitors
Causes vasodilation Also used for BPH, causes relaxation
thiazide diuretic examples
Chlorothiazide Hydrochlorothiazide
patient education & lifestyle modifications for the patient w/ newly diagnosed HTN
Decrease alcohol Smoking cessation Weight reduction More active lifestyle Low sodium low fat DASH diet Teaching to adhere to BP meds at home and monitor BP at home
DASH diet
Dietary Approaches to Stop Hypertension
diuretics for heart failure
Diuretics are used to decrease preload. Loop diuretics: such as furosemide and bumetanide Thiazide diuretics: such as hydrochlorothiazide Potassium‑sparing diuretics: such as spironolactone NURSING CONSIDERATIONS ● Administer furosemide IV no faster than 20 mg/min. ● Loop and thiazide diuretics can cause hypokalemia, and potassium supplementation can be required. CLIENT EDUCATION: Teach clients taking loop or thiazide diuretics to ingest foods and drinks that are high in potassium to counter the effects of hypokalemia.
expected diagnostics for patient with MI
EKG troponin CK-MB lipid pane BMP CR-P
Risk factors for primary hypertension
Family history, comorbidities, African American, age (risk increases with age), excessive alcohol use, tobacco, obesity, stress
drug for a flutter
Flecainide can convert to NSR
dopamine cardiogenic shock
Increase myocardial contractility, increase CO, high doses can cause vasoconstriction, monitor for cap refill Give through central line if you can
causes of v tach
MI Heart disease K imbalance Digoxin toxicity
nursing considerations thiazide diuretics
Monitor for orthostatic hypotension, hypokalemia, ensure patient is on sodium restriction
MONA
Morphine Oxygen Nitroglycerin Aspirin
what is rationale for using morphine in patient with MI
Morphine reduces BP Reduces respiratory rate Reduces anxiety overall Dilates blood vessels, decreases preload, afterload, pulmonary pressures which causes improvement in O2 exchange → less dyspneic
what other drug needs to be avoided with thiazide diuretics
NSAIDs- can make them not as effective and cause renal impairment
Chronic angina treatment
NTG, taken before activity that may cause chest pain lifestyle changes
Normal Left Ventricular Ejection Fraction:
NV: 55-70%; Reduced LVEF w sx is systolic congestive HF; in diastolic CHF - LVEF will be normal... If echo shows LVEF <40 - SCHF
nursing considerations for patient with VAD
Observe for infection Adequate tissue perfusion Dysrhythmias Blood clots Bleeding sternal precautions
anticipated treatment for STEMI
PCI within 90 minutes Stents have antiplatelet coated on them to avoid having them clot off ASA or plavix afterwards
Digitalis side effects
Palpitations, fatigue, visual changes (yellow vision), decreased appetite, hallucinations, confusion, depression
treatment of complete heart block
Permanent pacemaker insertion IV atropine if atropine not successful, dopamine and epi
Modifiable risk factors for CAD
Smoking, HTN, DM, obesity, diet, activity level, hyperlipidemia
pacemaker teaching
Take pulse at same time each day & report if HR is less than 5bpm below the pacemaker rate Report dizzy, fatigue, hiccups or palpitations for 1-2 months do not lift anything heavier than 5 pounds do not drive until cardiologist says its ok
norepinephrine cardiogenic shock
Vasopressor Beta adrenergic agonist, increases BP Needs to go in through a central line
beta blockers for HF
Very effective for people who have had MI in decreasing recurrence Decrease mortality of people who have heart failure Decrease tachycardia- helpful to decrease the workload of the heart
difference between heparin and alteplase
alteplase breaks up clots heparin prevents new clots from forming
consideration if femoral artery used for cardiac cath
cannot put head up
ACE inhibitor examples
captopril, enalapril, lisinopril, quinapril
treatment of v tach
cardioversion amiodarone lidocaine
considerations for giving NTG
check BP to ensure you do not bottom out patient
late signs of acute decompensated heart failure
coughing up pink tinged sputum confusion as perfusion to brain becomes decreased anasarca pitting edema decreased cap refill pleural effusions a fib
how to store NTG
dark dry place replaced every 6 months
side effects that might cause patients to stop taking anti hypertensives
dizziness, weakness, ACE inhibitor cough, orthostatic hypotension sexual side effects
discharge instructions for ICD
do not raise arm above shoulder level in the beginning will be non-functioning until patient goes into v tach will be painful when it fires wear medical alert bracelet
Care of patient pre- cardiac catheterization
ensure informed consent explain procedure and what will happen after check for allergy to shellfish for the contrast ensure they have a working IV NPO status chest x ray EKG
What total cholesterol increases risk for heart disease?
greater than 200
NTG side effects
headache, hypotension, tachycardia
when to call doctor with pacemaker
hiccups more than 15 minutes weight gain of 3 lbs or more in 2 days signs of infection chest pain dizziness fainting spells dyspnea swelling
vasodilators example
hydralazine
troponin in MI
increases 4-6 hours after MI and peaks 10-24 hours returns to baseline 10-14 days
treatment of second degree type 2 heart block
initiate pacing immediately require transvenous pacing until pacemaker can be placed
nursing care of patient with complete heart block
keep pacer pads on patient atropine epi "sandwich the heart" dial up to about 60 placement of pacemaker
most common type of heart failure
left sided heart failure
ideal sodium for heart failure
less than 1,500 mg per day
teaching for ICD
monitoring every 3-6 months call doctor if shock delivered if more than one shock, lost consciousness after shock, or other symptoms, call 911 stop driving for one week after ICD implantation, 6 months after a shock
what amount of weight gain should be reported with a HF pt:
more than 2 in a day or 3-5 in a week
NTG for angina
one pill every 5 minutes up to 3 times, if no relief call EMS
alpha adrenergic inhibitor nursing considerations
orthostatic hypotension is the major side effect sexual side effects
A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. The nurse should identify that which of the following findings indicates the medication is effective? A. INR 2.0 B. Decreased blood pressure C. Hemoglobin 14 g/dL D. Minimal bruising of extremities
A within the desired range of 2-3 for a client on warfarin
A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A. Weight gain of 0.9 kg (2 lb) in 24 hr B. Increase of 10 mmHg in systolic blood pressure C. Dyspnea with exertion D. Dizziness when rising quickly
A. this is an indication of fluid retention from worsening heart failure
A nurse in an emergency department s caring for a client who has a blood pressure of 254/139 mm hg. the nurse recognizes that the client is in a hypertensive crisis. which of the following actions should the nurse take first. A- tell the client to report vision changes B- elevate the head of the clients bed C- Start a peripheral IV D- Initiate Seizure precautions
B The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.
A nurse is monitoring a client ECG monitor and notes the clients rhythm has change from normal signs rhythm to supraventricular tachycardia. the nurse should prepare to assist with which of the following interventions A- Administration of atropine IV B- Vagal Stimulation C- Defibrillation D- Delivery of precordial Thump
B The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.
A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hours. which of the following client statements indicates a need for further clarification by the nurse A- my arthritis is really bothering me because I haven't taken my aspirin in a week B- I will check my blood sugar because I took a reduced does of insulin this morning C- I took my warfarin last night according to my usual schedule D- my blood pressure shouldn't be high because I took my blood pressure medication this morning
C Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.
A nurse is caring for a client who had an onset of chest pain 24hr ago. the nurse recognize that an increase in which of the following is diagnostic of myocardial infarction (MI) A- C Reactive protein B- Myoglobin C- Creatine Kinase- MB D-Homocysteine
C Elevated creatine kinase-MB indicates myocardial muscle injury.
a nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? A. I'm still hungry after the bowl of cereal I ate this morning B. I didnt take my heart pills this morning C. I have had chest pain a few times this week D. I smoked a cigarette this morning
D
considerations for IV furosemide
Reduced blood volume is the goal Watch for severe hypotension Lab values such as potassium (may be low) For pulmonary edema, given IV (On test, look at the route- would expect IV, if ordered PO you would call and ask for IV) Decreases venous return, LV can contract and function better Look at BP
Adrenergic Inhibitors MOA
Relax blood vessels to reduce BP
troponin in MI
Rise 3-12 hours after and stay for 7-14 days
A nurse in an emergency department is caring for a client who had an anterior MI . the clients history reveals she Is 1 week postoperative following an open cholecystectomy . the nurse should recognize that which of the following interventions is contraindicated. A- administering IV Morphine Sulfate B- Assisting with thrombolytic therapy C- administering oxygen at 2 L/min via nasal cannula D-helping the client to the bedside commode
B The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.
a nurse is caring for a client who has endocarditis. which of the following findings should the nurse recognize as a potentialcomplication A- Guillain- Barre syndrome B- Valvular Disease C- Ventricular Depolarization D- Myelodysplastic syndrome
B Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.
a nurse is assessing a client who has dilated cardiomyopathy. which of the following findings should the nurse expect A-weight loss B- pericardial rub C- tracheal deviation D- dyspnea on exertion
D The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.
A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? A. increase the heparin flow rate B. continue to monitor heparin infusion as prescribed C. request a prothrombin time D. Stop heparin infusion
D This is above the critical value and the patient is exhibiting signs of bleeding, heparin should be discontinued
A nurse is caring for a postoperative client 1 hr following an aortic aneurysm repair. which of the following findings can indicate shock and should be reported to the provider A- urine output of 20ml/hr B- Severe pain with coughing C- Serosanguineous drainage on dressing D- increase in temperature from 98.2 to 99.5
A Urine output less than 30 mL/hr is a manifestation of shock.
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? A. Slurred Speech B. Irregular pulse C. Dependent edema D. persistent fatigue
A this is a manifestation of stroke, which the client with a fib is at risk for
Aspirin as Anticoagulant
prevent platelets from clumping together to form a clot
beta adrenergic blockers examples
propranolol, esmolol, acebutolol, metoprolol
what is anticipated treatment for a fib?
rate control drugs such as amio, digoxin or beta blockers cardioversion anticoagulants
contraindications to TPA
recent surgery history of intracranial bleed 3 months out from stroke pregnancy uncontrolled hypertension bleeding episode
Digitalis MOA
reversibly inhibits Na/K ATPase, increasing Ca stored, increasing contraction
nursing considerations adrenergic inhibitors
sedating
when must patient with MI be taken to cath lab?
within 90 minutes of arrival
A nurse is providing teaching for a client who is 2 days postoperative following a heart transplant. which of the following statements should the nurse include in the teaching A- " your level of activity intolerance will not change" B- " you will be able to stop taking immunosuppressant's after 12 months C- " after 6 months you will no longer need to restrict your sodium intake" D- "You might no longer be able to feel chest pain"
D Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.
A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. the nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer. A- ask if the client has had a recent infection B- Explore the clients family history of peripheral vascular disease C- Note the presence of absence of pain at the ulcer site D- inquire about the presence or absence of claudication
D Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.
Causes of PVCs
Digoxin toxicity, hypoxia, hypokalemia, fever, acidosis, exercise
premature ventricular contraction
a ventricular contraction preceding the normal impulse initiated by the SA node
A nurse is preparing a client for coronary angiography. the nurse should report which of the following findings to the provider prior to the procedure A- Hemoglobin 14.4 g/dl B- History of peripheral arterial disease C- Previous allergic reaction to shellfish D- Urine output 200ml/4hr
C The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure.
A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? A. cholesterol 180 mg/dL, HDL 70, LDL 90 B. cholesterol 185, HDL 50, LDL 120 C. cholesterol 190, HDL 25, LDL 160 D. cholesterol 195, HDL 55, LDL 125
C outside the expected range
a nurse is providing health teaching for a group of clients which of the following clients is at risk for developing peripheral arterial disease A- a client who has diabetes mellitus B- a client who has hypothyroidism C- a client who consumes two 12-oz bottles of beer a day D- a client whose daily caloric intake consists of 25% fat
A Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.
A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. which of the following instructions should the nurse include in the teaching. A- Place the patch on an area of skin away from skin folds and joints B- Apply the new patch to the same site as the previous patch C- Replace the patch at the onset of angina D- Keep the patch on 24 hr per day
A The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly.
A nurse is caring for a client who is 8 hr postoperative following a coronary artery graft. which of the following client findings should the nurse report A- Temp 98.8 B- BP 160/80 C- Potassium 4.0 D- Mediastinal drainage 100 ml/hr
B The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.
A nurse in an emergency room is assessing a client who has bradydysrhythmia. which of the following findings should the nurse monitor for? A- Friction Rub B- Confusion C-Dry Skin D-Hypertension
B can cause decreased systemic perfusion, which can lead to confusion
A nurse is assessing a client who has Left-Sided heart failure. which of the following manifestations should the nurse expect to find A- Increased Abdominal Girth B-Weak Peripheral Pulses C- Dependent Edema D- Jugular Venous Neck Distention
B Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure.