Unit 9 Specific slides - Patient centered care
After the physician explains the prognosis and medical management for atrial septal defect to a primipara client whose 2 day old female neonate was diagnosed with this condition, the nurse determines that the mother needs further instructions when she says which of the following?
"About half of the children born with this defect heal spontaneously" -More common in females than males -May have increased fatigue and difficulty breathing with growth -Needs antibiotics before dental procedure
Prevention and management of heart disease:
-Avoid smoking - stop even if smoking because stopping reduces risk 50% of coronary heart disease no matter how long they have smoked -Reduce saturated fats in diet -Weight loss (healthy BMI) -Exercise -Manage blood sugars -Watch oral contraceptives and hormone replacement therapy -low LDL high HDL -Manage stress -Avoid illegal drug use -Teeth/gum health
When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse the client understood the teaching? (Select all that apply):
-Becoming increasingly short of breath at rest -Weight gain of 3 lb. or more in 1 day -Having to sleep sitting up in a reclining chair
Beta blockers/Metoprolol teachings:
-Change positions slowly - risk for orthostatic BP, fatigue, dizziness, light headedness -Take every day -Take own BP -Hold if HR is low -Can cause hypoglycemia in Dm patients
Home management of heart failure:
-Daily weights taken at same time every day; call if there is more than a 2 lb weight gain in one day -Increasing edema and shortness of breath - will need to sleep with HOB elevated -Diet low in NA and teaching on that -Organize activities so have rest periods and uninterrupted sleep - pace activities -Know s/s of MI and what to do : MONA if at hospital, at home take ASA 325 and call 911
Nonmodifiable risk factors of CAD:
-Family history of CAD -Increasing age (45 years for men, 55 years for women -Gender -Race (higher incidence of heart disease in African Americans)
The On Call M.D calls you back: you have also found Coarse crackles in bottom 50% of lungs posteriorly. Using SBAR give report to the M.D. on the phone;
-Idenitify self/patient/attending MD -Situation briefly -Background: admitting diagnosis/meds received -Assessment findings -Any recommendations
Which of the following nursing diagnoses would be appropriate for a client with heart failure? (Select all that apply):
-Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output -Decreased cardiac output related to structural changes
Possible additional orders for a heart failure patient:
-Labs: lipid profile, thyroid studies (hyperthyroidism is a risk factor of heart fialure) -Daily PO furosemide) -Order for daily weights -Order for echocardiogram -Potassium 3.4 -ASA 325 should be given immediately -No orders for oxygen unless needed per oxygen SAT readings
Symptoms of tetralogy of fallout:
-Limits blood flow to lungs -Shunting of oxygen-poor blood from the right ventricle to the body results in a reduction of arterial oxygen saturation - cyanosis -Oxygen levels determine when surgical treatment is initiated -If oxygen levels are critically low soon after birth, a prostaglandin infusion is usually initiated to keep the ductus arteriosus open which will provide additional pulmonary blood flow and increased oxygen level
Left sided heart failure:
-Restlessness -confusion -Orthopnea -Tachycardia -Exertional Dyspnea -Fatigue -Cyanosis -Tachypnea -Blood-tinged sputum -Wheeze -Crackles -Cough -Pulmonary congestion -Elevated pulmonary pressure -Paraoxysmal nocturnal dyspnea
Modifiable risk factors of heart disease:
-Smoking -High blood pressure -High blood cholesterol -Obesity -Physical inactivity -Diabetes All can be controlled by lifestyle changes or medications -Stress and alcohol intake are secondary risk factors that CONTRIBUTE to developing disease
Nitrate therapy for angina:
-Take if no relief with rest after 2 to 3 minutes. Works fast; if no relief after 3 - 5 minutes, take another one. If no relief after 3 doses, call 911 for help -Headache/ sit when talking. May cause: dizziness/light headedness. Wait until gone before walking or rising. Can cause hypotension. -No alcohol with NTG. Can add to hypotension -Keep fresh supply - check expiration date -Patient should have a stinging sensation under tongue if fresh. Keep bottle out of sunlight -Use MONA when patient is in the hospital and experiencing chest pain with no relief when stopping exertion
Ventricular septal defect:
-Typically symptomless at birth -Manifests a few weeks after birth -Acyanotic congenital heart defect - left ro right shunt so there are no signs of cyanosis -Uncorrected VSD can increase pulmonary resistance leading to the reversal of the shunt and corresponding cyanosis
Self-administration of nitro:
-Under tongue -Carry medication at all times as precaution -Keep in original container -Volatile medication and is inactive by heat, moisture, air, light and time -Mediations should be taken in anticipation of any activity that can produce pain -Monitor how long takes nitro to relieve pain, if it isn't resolving - take 5 minutes apart until 3 pills have been taken and then call ambulance if no change -side effects: flushing, throbbing, headache, hypotension, and tachycardia -Sit down to avoid hypotension and syncope
A nurse is assessing a client with heart failure. The nurse should asses the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply.
-Ventricular hypertrophy -Renin-angiotensis-aldosterone system -Sympathetic nervous stimulation These are the three major compensatory systems of heart failure
Atrial septal defect:
-Will be monitored by a cardiologist -May need surgical closure -10% of female and male neonates with heart defects have this one - more in females -As the child grows they may experience fatigue and dyspnea on exertion. A large defect may result in congestive heart failure if the lesion is unrepaired
Enalapril (Vasotec) (Ace inhibitor) Teachings:
-watch first does for hypotension and risk for falls -Ace inhibitor inhibits andgiotensis converting enzyme and blocks vasoconstriction -Check BP and orthostatic hypotension -Cough is the common side effect -Neutropenia needs to be monitored -Impact potassium for 1% of patients
You are getting Mary Jefferson situated in her room, when she indicates she needs to go to the bathroom. She talks to you in short sentences and is extremely short of breath (SOB). As you assist her to the commode, you note her skin is cool and clammy. She vomits while urinating. On a scale of 0-10, how do you rate the severity of the situation? ______ Support your decision with rationale.
8-9: not a full code yet but can turn that way -Cold and clammy skin indicates a perfusion issue - cardiac ischemia
Frank starling mechanism:
A mechanism by which the stroke volume of the heart is increased by increasing the venous return of the heart (thus stretching the ventricular muscle). -Greater stretch of cardiac muscle fibers, the greater the force of contraction
Non modifiable risk factors for heart disease:
Age Gender Race (black females increased risk for HTN) Family history of CAD Genetics Diabetes and insulin resistance Kidney disease Elevated homocysteine levels = inflammation process
Right sided heart failure = BACONED
B:loating/Weight gain/Englarged liver and spleen A:norexia/GI distress Cyanosis/Cool legs O:liguria N:ausea E:dema/dependent D:istended neck veins
A 69 year old female with history of heart failure is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission, which of the following should the nurse assess first?
Blood pressure -People with pulmonary edema typically experience severe hypertension that requires early intervention
A client is prescribed metoprolol for a heart disorder. What should the nurse teach the client about this medication?
Change positions slowly -It is a beta blocker -Use care when ambulating and change positions slowly to avoid orthostatic hypotension
During an assessment of neonate born at 33 weeks gestation, a nurse finds and reports a heart murmur. An echocardiogram reveals patent ductus arteriosus, for which the neonate received indomethacin, an expected outcome after the administration of indomethacin to neonate with patent ductus arteriosus is:
Closure of a patent ductus arterioles -indication for the use of indomethacin is to close the patent ductus arteriosus
Which of the following sets of conditions is an indication the client with a history of left-sided heart failure is developing pulmonary edema?
Coarse crackles and tachycardia -Left stands for Lungs
Tetralogy of fallout:
Combination of four heart defects at birth -Pulmonic stenosis -Right ventricular hypertrophy -Ventricular septal defect -Overriding aorta This disease also characterized by decrease pulmonary blood flow and polycythemia
Neuroendocrine response to heart failure:
Decrease CO stimulated the SNS and catecholamine release -Renin-angiotensin stimulates aldosterone release
A child with congenital heart defects should receive antibiotics before what?
Dental procedures -Reduce risk of endocarditis and other infections
Left sided hart failure = FORCED
F:atigue O:rthopnea R:ales/Restlessness C:yanosis/confusion E:treme weakness D:Dyspena
An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect?
Failure to thrive -Symptoms include shortness of breath, fast, difficult breathing, fast heart rate, sweating, frequent respiratory infections, hard time gaining weight, paleness
Modifiable risk factors for CAD:
Hyperlipidemia Smoking Tobacco use Hypertension Diabetes Metabolic syndrome Obesity Physical inactivity
The major goal of therapy for a client with heart failure and pulmonary edema should be to:
Increase cardiac output -Pulmonary edema is an acute medical emergency -Respiratory status and comfort will be improved with cardiac output increase
Ventricular hypertrophy:
Increased cardiac workload causes myocardial muscle to hypertrophy and ventricles to dilate -Response to heart failure -Increased contractile force to maintain CO
What nursing diagnosis during heart failure takes priority?
Ineffective tissue perfusion Excess fluid volume - cardiac output
The nurse is caring for a term neonate who is diagnosed with patent ductus arteriosus. While performing a physical assessment of the neonate, the nurse anticipates that the neonate will exhibit which of the following?
Loud cardiac murmurs through systole and diastole -Marked by failure of the patent ductus arterioles to close after birth -Increases workload of the left side of the heart
MONA:
Morphine Oxygen Nitrate ASA
Stable angina:
Most common and predictable form -Common manifestation of CAD -Stops during rest periods
The nurse's discharge teaching plan for the client with heart failure should stress the significance of which of the following?
Obtaining daily weights the same time every day -Call physician if there has been a weight gain of more than 2 lb or more -indicates fluid overload and can be treated early and on an out-patient basis -Stops symptoms from becoming life-threatening
Atypical angina (prinzemetal angina):
Occurs at same time each day, typically at rest -Unrelated to activity -Cause by coronary spasm -Cause is unknown
Cardiac catheterization has shown that the infant has a malformation of the mitral valve. The nurse specifically monitors the client for the development of problems associated with delivery of which of the following?
Oxygenated blood to the body -The Mitral valve separates the left ventricle from the left atrium. Problems with this valve will impede flow of oxygenated blood from the left atrium into the left ventricle for delivery to the body.
A client is admitted with complaints of lower extremity edema and occasional shortness of breath. Which electrocardiogram finding supports that the client is at risk for an alteration in perfusion?
PR interval of 0.30 seconds -Delay in conduction from the SA node to the ventricles
Mary Jefferson awakes during the night very SOB and scared; what is this called & why does it occur?
Paroxysmal nocturnal dyspnea -Occurs when edema/fluid accumulated during the day is reabsorbed into the circulation at night -Causes fluid overload and pulmonary congestion -Client awakens at night being short of breath and frightened
Risk factors for congenital heart defects:
Premature Genetics Diabetic Smoking Alcohol Mother's medications
What type of PR interval would indicate an issue of alteration in perfusion?
Prolonged PR interval - over 0.20 may indicate a first degree heart block or be associated with hypokalemia
Low dose APA teaching:
Report bleeding or bruising Take enteric coated Report any GI upset - black stools Reduces risk of MI in patients who have already had one in other selected populations -Check with healthcare provider before taking herbal remedies of any kind
Heart failure:
Result of structural and functional abnormalities of the heart muscle -Heart muscle becomes weak and does not pump blood out of chambers -Blood pops in left ventricle and backs up into left atrium and then lungs -This decreases cardiac output -Patients have ejection fraction of less than 50% and poorly tolerated activity
In which of the following positions should the nurse place a client with suspected heart failure?
Sitting almost upright -High fowlers position -decreases venous return to the heart, reducing myocardial workload -Sitting position allows maximum space for lung expansion
Lovastatin teachings:
Take with evening meals No grapefruit juice Report any muscle pain or weakness Monitor liver function No alcohol while taking
Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following 2 g. sodium diet?
Tomato juice -Canned foods and juices are high in sodium and should be avoided -Read labels
Female cardiac disease s/s:
Women report typically different symptoms than men -Fatigue, tiredness, not sleeping well, nausea and vomiting, heart burn, problems breathing, intermittent chest discomfort (pressure)
Coronary artery disease:
atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
The nurse is planning care for a pediatric client recovering from surgery to repair a congenital heart defect. Which intervention should the nurse include to support the client's fluid status?
encourage fluids -Intake and output should be monitored
Problems with the pulmonic valve:
impede delivery of deoxygenated blood back to the lung. The blood that returns to the right atrium is deoxygenated. The blood delivered to the left ventricle is oxygenated -Separates right ventricle from pulmonary artery
Problems with the mitral valve will lead to:
impede flow of oxygenated blood from the left atrium into the left ventricle for delivery to the body -Separates left ventricle from left atrium
