Podcast
Questions and Answers
A client at a clinic has brittle, dry hair. Which potential underlying condition should the nurse consider?
A client at a clinic has brittle, dry hair. Which potential underlying condition should the nurse consider?
- Possible anemia due to decreased circulation
- Potential allergic reaction to hair products
- Potential cardiac or vascular insufficiency (correct)
- Possible dehydration from lack of fluid intake
The nurse assesses a client and notes yellow-orange plaques under the eyelids. What condition does this finding suggest?
The nurse assesses a client and notes yellow-orange plaques under the eyelids. What condition does this finding suggest?
- Anemia due to decreased iron levels
- Dehydration from lack of fluid intake
- Elevated serum cholesterol levels (correct)
- Elevated liver enzymes due to hepatic dysfunction
During an assessment, the nurse notes that a client's jugular vein is distended when the client is at a 45° angle. What condition should the nurse suspect?
During an assessment, the nurse notes that a client's jugular vein is distended when the client is at a 45° angle. What condition should the nurse suspect?
- Hypotension secondary to vasodilation
- Left-sided heart failure caused by hypertension
- Right-sided heart failure or pericarditis (correct)
- Hypovolemia related to dehydration
A nurse auscultates crackles in a client's chest. Which condition should the nurse consider as a potential cause of crackles?
A nurse auscultates crackles in a client's chest. Which condition should the nurse consider as a potential cause of crackles?
During a cardiac assessment, a nurse notes the client's skin is dry and cool. What does this finding suggest?
During a cardiac assessment, a nurse notes the client's skin is dry and cool. What does this finding suggest?
A nurse observes clubbing of the nails during an assessment. What does this finding indicate?
A nurse observes clubbing of the nails during an assessment. What does this finding indicate?
During palpation of peripheral pulses, the nurse assesses the patient's carotid pulses. What is an important consideration when assessing pulses?
During palpation of peripheral pulses, the nurse assesses the patient's carotid pulses. What is an important consideration when assessing pulses?
A nurse auscultates the heart sounds of a patient and identifies S1 heart sounds. What is the origin of these sounds?
A nurse auscultates the heart sounds of a patient and identifies S1 heart sounds. What is the origin of these sounds?
A nurse auscultates an S3 heart sound in an adult client. Under what circumstances would this finding be considered normal?
A nurse auscultates an S3 heart sound in an adult client. Under what circumstances would this finding be considered normal?
A nurse auscultates an S4 heart sound in a client. Which condition is this sound most often associated with?
A nurse auscultates an S4 heart sound in a client. Which condition is this sound most often associated with?
A nurse notes a systolic blood pressure drop greater than 15 mm Hg and a diastolic blood pressure drop greater than 5 mm Hg when a client stands. What condition does this finding suggest?
A nurse notes a systolic blood pressure drop greater than 15 mm Hg and a diastolic blood pressure drop greater than 5 mm Hg when a client stands. What condition does this finding suggest?
A nurse plans to assess a client's peripheral veins. Which of the following would the nurse include in this assessment?
A nurse plans to assess a client's peripheral veins. Which of the following would the nurse include in this assessment?
A nurse reviews the laboratory results for a client with possible cardiac problems. Which diagnostic test measures cardiac muscle damage?
A nurse reviews the laboratory results for a client with possible cardiac problems. Which diagnostic test measures cardiac muscle damage?
A nurse reviews a client's EKG and notes the presence of a P wave, QRS complex and T wave. What does the p wave generally indicate?
A nurse reviews a client's EKG and notes the presence of a P wave, QRS complex and T wave. What does the p wave generally indicate?
A nurse reviews a client's EKG and notes the presence of a P wave, QRS complex and T wave. What does the QRS Complex generally indicate?
A nurse reviews a client's EKG and notes the presence of a P wave, QRS complex and T wave. What does the QRS Complex generally indicate?
A nurse is assessing a client with a sinus arrhythmia. Which characteristic is expected with this condition?
A nurse is assessing a client with a sinus arrhythmia. Which characteristic is expected with this condition?
A nurse notes that a client has a heart rate below 60 beats per minute. Which of the following may contribute to sinus bradycardia?
A nurse notes that a client has a heart rate below 60 beats per minute. Which of the following may contribute to sinus bradycardia?
A nurse assesses a client and notes a heart rate above 100 beats per minute. What physiological response typically causes sinus tachycardia?
A nurse assesses a client and notes a heart rate above 100 beats per minute. What physiological response typically causes sinus tachycardia?
A nurse is caring for a client with atrial fibrillation. What rhythm characteristics are expected?
A nurse is caring for a client with atrial fibrillation. What rhythm characteristics are expected?
A nurse is teaching a client about premature ventricular contractions (PVCs). Which statement by the nurse is most accurate regarding the origin of PVCs?
A nurse is teaching a client about premature ventricular contractions (PVCs). Which statement by the nurse is most accurate regarding the origin of PVCs?
A nurse is caring for a client with ventricular tachycardia. Which assessment finding is most consistent with this arrhythmia?
A nurse is caring for a client with ventricular tachycardia. Which assessment finding is most consistent with this arrhythmia?
A nurse is assessing a client with ventricular fibrillation is present. What assessment finding is consistent with this rhythm?
A nurse is assessing a client with ventricular fibrillation is present. What assessment finding is consistent with this rhythm?
A charge nurse observes a new nurse preparing to defibrillate a client. Which action by the new nurse requires immediate intervention?
A charge nurse observes a new nurse preparing to defibrillate a client. Which action by the new nurse requires immediate intervention?
A patient with a pacemaker has an order for the nurse the frequently assess their heart rate. The patient also needs additional education related to safety with a pacer. What teaching would be appropriate?
A patient with a pacemaker has an order for the nurse the frequently assess their heart rate. The patient also needs additional education related to safety with a pacer. What teaching would be appropriate?
A nurse is providing dietary education to a client who has been diagnosed with coronary artery disease (CAD). What diet education would be most impactful?
A nurse is providing dietary education to a client who has been diagnosed with coronary artery disease (CAD). What diet education would be most impactful?
Which intervention is most important when providing care to a client experiencing angina pectoris?
Which intervention is most important when providing care to a client experiencing angina pectoris?
A nurse is teaching a client about how to take nitroglycerin for angina. Which instruction is most appropriate to include in the teaching?
A nurse is teaching a client about how to take nitroglycerin for angina. Which instruction is most appropriate to include in the teaching?
A patient experiencing a myocardial infarction is complaining of increasing pain of an 8 from a 1-10. The patient's most recent EKG shows ST-segment elevation. What priority treatment should the nurse anticipate?
A patient experiencing a myocardial infarction is complaining of increasing pain of an 8 from a 1-10. The patient's most recent EKG shows ST-segment elevation. What priority treatment should the nurse anticipate?
Which nursing intervention is most appropriate for a client who has recently undergone a percutaneous coronary intervention (PCI)?
Which nursing intervention is most appropriate for a client who has recently undergone a percutaneous coronary intervention (PCI)?
A patient is ready for discharge after recovering from a myocardial infarction and a stent placement. The patient is asking about how soon they can resume sexual activity. What teaching would be appropriate?
A patient is ready for discharge after recovering from a myocardial infarction and a stent placement. The patient is asking about how soon they can resume sexual activity. What teaching would be appropriate?
Which statement accurately reflects the nature of heart failure?
Which statement accurately reflects the nature of heart failure?
A nurse is prioritizing care for an elderly client recently admitted with heart failure. The client reports increased anxiety, angina, and fatigue but has maintained normal urine output. Which finding requires action by the nurse?
A nurse is prioritizing care for an elderly client recently admitted with heart failure. The client reports increased anxiety, angina, and fatigue but has maintained normal urine output. Which finding requires action by the nurse?
Assessment of heart failure can show a lot of different assessment findings depending if it is right sided HF or left side HF. Which of the assessment findings below would be expected with Left Side heart failure?
Assessment of heart failure can show a lot of different assessment findings depending if it is right sided HF or left side HF. Which of the assessment findings below would be expected with Left Side heart failure?
Treatment for heart failure includes managing the underlying cause, medications, and symptom monitoring. MSO4 is one medication used in clinical practice. What is the purpose of giving MSO4?
Treatment for heart failure includes managing the underlying cause, medications, and symptom monitoring. MSO4 is one medication used in clinical practice. What is the purpose of giving MSO4?
Heart failure treatment involves “UNLOAD FAST” with each letter having an intervention. The U in this case stands for upright position. What does this do for the patient?
Heart failure treatment involves “UNLOAD FAST” with each letter having an intervention. The U in this case stands for upright position. What does this do for the patient?
A client who has been diagnosed with a HF exacerbation, and is retaining fluid, should be limited to how much NA daily?
A client who has been diagnosed with a HF exacerbation, and is retaining fluid, should be limited to how much NA daily?
A patient has valvular heart disease and is asking the nurse about the pathophysiology behind the disease process. What is the pathophysiological process?
A patient has valvular heart disease and is asking the nurse about the pathophysiology behind the disease process. What is the pathophysiological process?
Select the etiology that is most commonly associated with Rheumatic Heart Disease.
Select the etiology that is most commonly associated with Rheumatic Heart Disease.
Which intervention is most appropriate for a client who is in the acute stages of pericarditis?
Which intervention is most appropriate for a client who is in the acute stages of pericarditis?
Which potential etiology is most closely associated with Infective Endocarditis (IE)?
Which potential etiology is most closely associated with Infective Endocarditis (IE)?
The cardiac muscle becomes damaged in cardiomyopathy. What does this potentially cause?
The cardiac muscle becomes damaged in cardiomyopathy. What does this potentially cause?
The nurse is teaching a patient who has been diagnosed with peripheral arterial disease. What is the primary symptom that the patient will learn to look out for?
The nurse is teaching a patient who has been diagnosed with peripheral arterial disease. What is the primary symptom that the patient will learn to look out for?
The nurse is teaching a patient with peripheral arterial disease about strategies to manage their condition. What self-management strategy does the nurse emphasize?
The nurse is teaching a patient with peripheral arterial disease about strategies to manage their condition. What self-management strategy does the nurse emphasize?
Your patient is showing signs of acute arterial occlusion. What assessment finding would be expected?
Your patient is showing signs of acute arterial occlusion. What assessment finding would be expected?
A key teaching related to patients with arterial insufficiency as it relates to arterial ulcers and preventing them?
A key teaching related to patients with arterial insufficiency as it relates to arterial ulcers and preventing them?
The nurse assesses bilateral pulses. What pulse documentation is considered normal?
The nurse assesses bilateral pulses. What pulse documentation is considered normal?
A patient with Raynaud's phenomenon is asking how to cope with Raynaud's events at home in the winter. What would be the best answer to support the patient with?
A patient with Raynaud's phenomenon is asking how to cope with Raynaud's events at home in the winter. What would be the best answer to support the patient with?
A key teaching related to those with varicosities relates to what they wear on their feet. What is a recommendation?
A key teaching related to those with varicosities relates to what they wear on their feet. What is a recommendation?
What is characterized as a regularity of the heart rhythm altered during inspiration and is considered normal in healthy, young individuals?
What is characterized as a regularity of the heart rhythm altered during inspiration and is considered normal in healthy, young individuals?
A patient is diagnosed with sinus bradycardia. Which medication, if listed in the patient's chart, might be contributing to the patient's condition?
A patient is diagnosed with sinus bradycardia. Which medication, if listed in the patient's chart, might be contributing to the patient's condition?
A client with sinus tachycardia is also experiencing fever and dehydration from the flu. The nurse understands the increase in heart rate is most likely due to:
A client with sinus tachycardia is also experiencing fever and dehydration from the flu. The nurse understands the increase in heart rate is most likely due to:
A patient in the clinic is diagnosed with atrial fibrillation. What is the expected heart activity?
A patient in the clinic is diagnosed with atrial fibrillation. What is the expected heart activity?
A patient has started having premature ventricular contractions. These contractions originate where?
A patient has started having premature ventricular contractions. These contractions originate where?
A critical care nurse is evaluating a patient with sustained ventricular tachycardia. How is this arrhythmia defined?
A critical care nurse is evaluating a patient with sustained ventricular tachycardia. How is this arrhythmia defined?
Which assessment finding confirms that a patient is experiencing ventricular fibrillation?
Which assessment finding confirms that a patient is experiencing ventricular fibrillation?
The nurse is preparing to defibrillate a patient in ventricular fibrillation. What is an important step?
The nurse is preparing to defibrillate a patient in ventricular fibrillation. What is an important step?
The nurse is providing discharge teaching to a client with a new permanent pacemaker. Which instruction is most important for the nurse to include?
The nurse is providing discharge teaching to a client with a new permanent pacemaker. Which instruction is most important for the nurse to include?
When teaching a client with coronary artery disease (CAD) about dietary changes, which recommendation should the nurse emphasize to reduce the progression of atherosclerosis?
When teaching a client with coronary artery disease (CAD) about dietary changes, which recommendation should the nurse emphasize to reduce the progression of atherosclerosis?
A patient experiencing angina pectoris is likely to benefit from interventions aimed at improving myocardial oxygen supply and reducing myocardial oxygen demand. Which action is MOST appropriate when caring for a patient experiencing angina?
A patient experiencing angina pectoris is likely to benefit from interventions aimed at improving myocardial oxygen supply and reducing myocardial oxygen demand. Which action is MOST appropriate when caring for a patient experiencing angina?
A patient being treated for angina should be given which instructions about taking nitroglycerin at home?
A patient being treated for angina should be given which instructions about taking nitroglycerin at home?
A key component of treating a patient who has had an ST-segment elevation myocardial infarction (STEMI) is focused at reperfusion. What is a priority treatment for this?
A key component of treating a patient who has had an ST-segment elevation myocardial infarction (STEMI) is focused at reperfusion. What is a priority treatment for this?
The nurse is caring for a client who has recently undergone a percutaneous coronary intervention (PCI). What nursing intervention is most important during the initial post-PCI period?
The nurse is caring for a client who has recently undergone a percutaneous coronary intervention (PCI). What nursing intervention is most important during the initial post-PCI period?
A client recovering from a myocardial infarction (MI) and stent placement is preparing for discharge. What information will the nurse include about resuming sexual activity?
A client recovering from a myocardial infarction (MI) and stent placement is preparing for discharge. What information will the nurse include about resuming sexual activity?
A client is newly diagnosed with heart failure (HF). Which statement is best to describe the nature of this condition?
A client is newly diagnosed with heart failure (HF). Which statement is best to describe the nature of this condition?
The nurse assesses a client with heart failure and notes increased anxiety and angina. The client’s vital signs are stable, and urine output is within normal limits. Which finding requires immediate action by the nurse?
The nurse assesses a client with heart failure and notes increased anxiety and angina. The client’s vital signs are stable, and urine output is within normal limits. Which finding requires immediate action by the nurse?
The nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent with this condition?
The nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent with this condition?
The nurse administers morphine sulfate IV to a patient with heart failure. What is the primary reason for administering this medication to patients with exacerabated Heart failure?
The nurse administers morphine sulfate IV to a patient with heart failure. What is the primary reason for administering this medication to patients with exacerabated Heart failure?
A provider orders a treatment plan for a patient experiencing heart failure to "UNLOAD FAST". For the "U" part of the mnemonic, what position will the nurse place the patient?
A provider orders a treatment plan for a patient experiencing heart failure to "UNLOAD FAST". For the "U" part of the mnemonic, what position will the nurse place the patient?
A client with heart failure is advised to restrict sodium intake. What is a typical daily sodium restriction for a client with a heart failure exacerbation?
A client with heart failure is advised to restrict sodium intake. What is a typical daily sodium restriction for a client with a heart failure exacerbation?
A nurse is providing education to a client diagnosed with valvular heart disease. What key concept accurately describes the pathophysiology of this disease?
A nurse is providing education to a client diagnosed with valvular heart disease. What key concept accurately describes the pathophysiology of this disease?
A nurse is caring for a client with a history of rheumatic heart disease. What causative factor is most commonly associated with this condition?
A nurse is caring for a client with a history of rheumatic heart disease. What causative factor is most commonly associated with this condition?
A patient is admitted with acute pericarditis. What intervention is the nurse most inclined to implement?
A patient is admitted with acute pericarditis. What intervention is the nurse most inclined to implement?
The nurse is assessing a patient suspected of Infective Endocarditis (IE). What potential etiology is most closely associated with this condition?
The nurse is assessing a patient suspected of Infective Endocarditis (IE). What potential etiology is most closely associated with this condition?
A patient is diagnosed with cardiomyopathy which leads to cardiac muscle damage. What condition can this cause?
A patient is diagnosed with cardiomyopathy which leads to cardiac muscle damage. What condition can this cause?
The nurse is teaching a patient with peripheral arterial disease (PAD) about recognizing the primary symptom associated to PAD. What will that symptom be?
The nurse is teaching a patient with peripheral arterial disease (PAD) about recognizing the primary symptom associated to PAD. What will that symptom be?
The nurse is providing education for a patient diagnosed with peripheral arterial disease (PAD) What is the MOST important self-management strategy that the nurse should recommend?
The nurse is providing education for a patient diagnosed with peripheral arterial disease (PAD) What is the MOST important self-management strategy that the nurse should recommend?
The nurse suspects a patient is experiencing acute arterial occlusion. What assessment finding would be expected?
The nurse suspects a patient is experiencing acute arterial occlusion. What assessment finding would be expected?
The nurse is educating a patient on preventing arterial ulcers. What key teaching point will be most important for the nurse to include in the education?
The nurse is educating a patient on preventing arterial ulcers. What key teaching point will be most important for the nurse to include in the education?
The nurse is completing routine vital signs and notes bilateral pulses in the lower extremities of +3. What is the accurate interpretation of that result?
The nurse is completing routine vital signs and notes bilateral pulses in the lower extremities of +3. What is the accurate interpretation of that result?
A client diagnosed with Raynaud's phenomenon asks the nurse for advice what they should do to cope with vasospasm at home during the winter. What is the best answer?
A client diagnosed with Raynaud's phenomenon asks the nurse for advice what they should do to cope with vasospasm at home during the winter. What is the best answer?
The nurse is giving a patient discharge instructions related to strategies to implement in the prevention of varicosites. What recommendations would the nurse give regarding footwear?
The nurse is giving a patient discharge instructions related to strategies to implement in the prevention of varicosites. What recommendations would the nurse give regarding footwear?
A nurse conducts a physical assessment on a group of clients. Which of the following findings would indicate the possibility of hypertension?
A nurse conducts a physical assessment on a group of clients. Which of the following findings would indicate the possibility of hypertension?
A nurse is providing discharge instructions to a client newly diagnosed with hypertension. The nurse recognizes that teaching has been effective when the client makes which statement?
A nurse is providing discharge instructions to a client newly diagnosed with hypertension. The nurse recognizes that teaching has been effective when the client makes which statement?
The nurse is educating a patient who has recently developed hypertension. What is the best advice related to treatment regarding excess alcohol intake?
The nurse is educating a patient who has recently developed hypertension. What is the best advice related to treatment regarding excess alcohol intake?
The nurse is taking a blood pressure on a patient. What guidelines for accurate BP reading should the nurse follow?
The nurse is taking a blood pressure on a patient. What guidelines for accurate BP reading should the nurse follow?
Factors contributing to nonadherence of hypertension patients can be a complex situation. What factor listed below is associated with noncompliance patient teaching?
Factors contributing to nonadherence of hypertension patients can be a complex situation. What factor listed below is associated with noncompliance patient teaching?
The patient is entering a hypertensive crisis, which requires IV medication. What are key precipitating factors associated with entering a hypertensive crisis?
The patient is entering a hypertensive crisis, which requires IV medication. What are key precipitating factors associated with entering a hypertensive crisis?
The nurse is conducting an assessment of a patient with a thoracic aneurysm. What potential sign/symptoms would the nurse expect to find?
The nurse is conducting an assessment of a patient with a thoracic aneurysm. What potential sign/symptoms would the nurse expect to find?
The nurse is completing an assessment on a newly admitted patient who is suffering from an abdominal aneurysm. What sign/symptoms would the nurse expect to find?
The nurse is completing an assessment on a newly admitted patient who is suffering from an abdominal aneurysm. What sign/symptoms would the nurse expect to find?
The nurse is reviewing a medical record that shows Raynaud's Phenomenon as part of health history. What teaching should this patient be given?
The nurse is reviewing a medical record that shows Raynaud's Phenomenon as part of health history. What teaching should this patient be given?
What is the action when a patient is in varicosities with wearing tight clothing for prevention.
What is the action when a patient is in varicosities with wearing tight clothing for prevention.
What is the underlying cause of most cases of primary hypertension?
What is the underlying cause of most cases of primary hypertension?
How is hypertension typically diagnosed?
How is hypertension typically diagnosed?
Which modifiable risk factor contributes significantly to the development of hypertension?
Which modifiable risk factor contributes significantly to the development of hypertension?
A patient with malignant hypertension might experience damage to which organ?
A patient with malignant hypertension might experience damage to which organ?
Which symptom may be indicative of early-stage hypertension?
Which symptom may be indicative of early-stage hypertension?
A nurse is teaching a patient about accurate blood pressure monitoring at home. Which statement is most important?
A nurse is teaching a patient about accurate blood pressure monitoring at home. Which statement is most important?
What nursing intervention is essential when caring for a client with hypertension?
What nursing intervention is essential when caring for a client with hypertension?
A client prescribed diuretic medication for HTN should be taught what?
A client prescribed diuretic medication for HTN should be taught what?
A factor in a client's noncompliance relates to what?
A factor in a client's noncompliance relates to what?
What is one of the main reason hypertensive crisis occurs?
What is one of the main reason hypertensive crisis occurs?
What symptom would be expected when assessing a Thoracic Aneurysm?
What symptom would be expected when assessing a Thoracic Aneurysm?
What is an assessment finding that often accompanies abdominal aortic aneurysms?
What is an assessment finding that often accompanies abdominal aortic aneurysms?
What is the most common cause of arterial aneurysms?
What is the most common cause of arterial aneurysms?
What is an important teaching to Raynaud's patient?
What is an important teaching to Raynaud's patient?
Select activities that make Varicosities worse.
Select activities that make Varicosities worse.
Compression stockings are a key part of treatment with venous insufficiency. What describes why compression stockings provide symptom relief?
Compression stockings are a key part of treatment with venous insufficiency. What describes why compression stockings provide symptom relief?
A patient is diagnosed with thrombophlebitis. What is the best explanation of the pathophysiology?
A patient is diagnosed with thrombophlebitis. What is the best explanation of the pathophysiology?
A patient is diagnosed with deep vein thrombosis (DVT). What is a key teaching?
A patient is diagnosed with deep vein thrombosis (DVT). What is a key teaching?
A key nursing action, when applicable, for patients with peripheral vascular disease, such as DVT or venous insufficiency, is to assess the lower extremities. What is the proper way to assess?
A key nursing action, when applicable, for patients with peripheral vascular disease, such as DVT or venous insufficiency, is to assess the lower extremities. What is the proper way to assess?
The nurse walks into a room and notes the patient is massaging their extremities. What action should the nurse take?
The nurse walks into a room and notes the patient is massaging their extremities. What action should the nurse take?
Flashcards
Brittle, dry hair
Brittle, dry hair
Brittle, dry hair can indicate poor nutrition, possibly due to cardiac or vascular insufficiency.
Eye vascular changes
Eye vascular changes
Vascular changes in the eyes may indicate hypertension. A raised yellow-orange plaque under eyelids suggests high cholesterol.
Cyanotic lips/tongue
Cyanotic lips/tongue
Blue-tinged lips or tongue (cyanosis) suggests decreased oxygen. Dryness may indicate dehydration.
Jugular Vein Distention (JVD)
Jugular Vein Distention (JVD)
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Auscultate chest
Auscultate chest
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Elevated BP Value
Elevated BP Value
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Abdomen exam reveals?
Abdomen exam reveals?
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Skin appearance?
Skin appearance?
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Sacrum assessment?
Sacrum assessment?
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Nail examination findings.
Nail examination findings.
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Lower extremities appearance?
Lower extremities appearance?
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Legs/ankles/feet exam?
Legs/ankles/feet exam?
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PMI Palpation location?
PMI Palpation location?
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Peripheral pulses?
Peripheral pulses?
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Carotid Palpation?
Carotid Palpation?
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Cool, pale extremities suggest?
Cool, pale extremities suggest?
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Warm, cyanotic extremities suggest?
Warm, cyanotic extremities suggest?
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Normal S1 heart sound?
Normal S1 heart sound?
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Normal S2 heart sound?
Normal S2 heart sound?
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Abnormal S3 heart sound?
Abnormal S3 heart sound?
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Abnormal S4 heart sounds?
Abnormal S4 heart sounds?
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Heart murmurs?
Heart murmurs?
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Sys/Dias represent?
Sys/Dias represent?
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BP Variances?
BP Variances?
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Ortho hypotension?
Ortho hypotension?
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ABGs?
ABGs?
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Holter Monitor?
Holter Monitor?
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Echocardiogram ?
Echocardiogram ?
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Cardiac Cath?
Cardiac Cath?
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P wave?
P wave?
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PR interval?
PR interval?
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QRS?
QRS?
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Sinus Arrhythmias
Sinus Arrhythmias
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Sinus Bradycardia?
Sinus Bradycardia?
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Sinus Tachycardia.
Sinus Tachycardia.
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A-fib?
A-fib?
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PVC?
PVC?
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V-tach?
V-tach?
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V-fib?
V-fib?
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Asystole?
Asystole?
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Defibrillation
Defibrillation
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V-fib/ V-tach
V-fib/ V-tach
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Pacemaker Patient Teaching
Pacemaker Patient Teaching
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Nursing interventions for a pacemaker?
Nursing interventions for a pacemaker?
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Interventions for CAD?
Interventions for CAD?
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Angia Pectoris- Assessment
Angia Pectoris- Assessment
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Patient teaaching Angina?
Patient teaaching Angina?
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Myocardial Infraction?
Myocardial Infraction?
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Nursing interventions MI
Nursing interventions MI
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POST PCI (PTCA)
POST PCI (PTCA)
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Study Notes
Cardiac Problems
- Cardiac problems pertain to the various diseases and conditions that affect the heart and its ability to function properly.
Nursing Assessment
- A nursing assessment for potential or existing cardiac problems involves reviewing the patient's cardiac anatomy and physiology.
- Cardiac A&P review includes understanding the structure and function of the heart, its chambers, valves, and electrical conduction system.
- Risk factors for cardiac issues are reviewed, which are categorized as modifiable or nonmodifiable.
- Modifiable risk factors are those that can be changed, while nonmodifiable risk factors cannot.
Head to Toe Cardiac Clues
- Brittle, dry hair may indicate poor nutrition due to cardiac or vascular insufficiency.
- Vascular changes in the eyes are a result of high BP.
- Yellow-orange plaque under the eyelids can indicate chronic serum cholesterol elevation.
- A blue-tinged tongue suggest cyanosis.
- Dehydration often presents as tongue dryness.
- Distended jugular veins at a 45° angle suggest hypervolemia, right-sided heart failure, pericardial tamponade, or constrictive pericarditis.
- Crackles heard upon chest auscultation may indicate left-sided heart failure.
- Assess the chest for rate, rhythm, and presence of murmurs.
- Blood pressure over 135/85 may indicate hypertension.
- Fluid accumulation in the abdomen (ascites) or an enlarged, tender liver can indicate right-sided heart failure.
- A pulsating abdominal mass may indicate an abdominal aortic aneurysm (AAA).
- Dry, cool skin indicates poor nutrition.
- Blue-tinged skin coloration indicates cyanosis.
- Pallor of the skin may suggest anemia or decreased circulation.
- The sacrum should be checked for edema and pressure areas in immobilized clients.
- Clubbing of the nails may indicate chronic low oxygen saturation, as seen in congenital cardiac or pulmonary disease.
- Thick nails may indicate poor nutrition or impaired oxygen delivery.
- Absence of hair and thin skin on the lower extremeties are signs of poor circulation.
- The legs, ankles, and feet should be checked for edema, presence of pulses, and any changes in sensation, pressure areas.
Physical Exam Inspection
- Assess skin color.
- Observe for increased work of breathing.
- Note prominent vasculature.
- Check for dependent edema.
- Assess the shape of the chest.
Palpation
- Assess PMI (point of maximal impulse).
- Palpate peripheral pulses.
- Peripheral pulses should be compared between the left and right sides.
- Palpate only one carotid artery at a time.
- Cool, pale extremities indicates arterial problems.
- Warm, cyanotic extremities indicates venous problems.
Auscultation
- Normal heart sounds include S1 and S2.
- S1, often described as "lub," is related to the closure of the mitral and tricuspid valves.
- S1 is best heard at the apex and has a low pitch.
- S2, often described as "dub," is related to the closure of the aortic and pulmonic valves.
- S2 is best heard at the base and has a higher pitch than S1.
- Abnormal heart sounds can include S3 and S4.
- S3 sounds like "Ken-tuck-y"; this occurs at the apex, has a dull, low pitch.
- S3 may be normal in children but may indicate congestive heart failure (CHF) in adults.
- S4 sounds like "Tenn-ess-ee"; it is medial to the apex and has a higher intensity.
- S4 is associated with hypertension, aortic or pulmonic stenosis, but is not normally heard.
- Murmurs are vascular sounds that produces vibrations in the heart or great vessels.
- Murmurs are often associated with stenosis or regurgitation.
- Murmurs may be normal if no other signs of cardiovascular disease are found.
- Blood pressure should be assessed.
- Systolic pressure represents stroke volume.
- Diastolic pressure represents resistance of blood vessels.
- Systolic pressure may vary between arms.
- Pulse pressure is typically between 30-40 mm Hg.
- A systolic drop of over 15 mm Hg and a diastolic drop of over 5 mm Hg upon standing indicates orthostatic hypotension.
Other Physical Assessments
- Assessment of peripheral veins.
- Assess for edema.
- Assess lungs.
Diagnostic Lab
- CBC (complete blood count).
- ESR (erythrocyte sedimentation rate).
- Blood cultures.
- Enzymes.
- Troponin.
- BNP (B-type natriuretic peptide).
- D-dimer.
- Electrolytes.
- Cholesterol.
- Lipoproteins.
- ABGs (arterial blood gases).
- Triglycerides.
- Coagulation studies.
- Homocysteine.
Monitoring
- EKG (ECG) 12 lead.
- Telemetry.
- Hemodynamic monitoring.
- Holter Monitor.
- Stress Test.
Imaging
- Echocardiogram.
- CXR (chest x-ray).
- Angiography.
- Cardiac catheterization (cath).
- MUGA scan (multigated acquisition scan).
- Coronary Artery Calcium Score
Basics of EKGs
- EKG graph paper has specific measurements.
- Each individual horizontal box is 0.1 mv high by in voltage and 0.04 sec in time.
- Five small boxes represents 0.20 seconds in length.
- Five small boxes represents 0.5 mv in voltage.
EKG Reading
- P wave represents atrial contraction on an EKG reading.
- One P wave occurrs for every QRS complex.
- All P waves should be upright and similar in shape and size.
- PR interval signifies AV conduction and should measure between 0.12-0.20 seconds.
- QRS complex represents ventricular contraction.
- A normal QRS width measures 0.06-0.08 seconds.
- T wave represents ventricular relaxation.
- ST segment should be near the baseline on an EKG.
Arrhythmias
- Sinus arrhythmias are marked by an alteration of heart rhythm regularity that occurs during inspiration.
- Sinus arrhythmia is normal in healthy, young individuals and usually requires no treatment.
- Sinus bradycardia is defined by a heart rate below 60 beats per minute.
- Sinus bradycardia causes include sinoatrial node defects, drugs, digitalis toxicity, sleep apnea, myocardial infarction, beta blockers, calcium channel blockers, and vagal stimulation.
- Symptoms of sinus bradycardia include chest pain, shortness of breath, confusion, syncope, and hypotension.
- Sinus tachycardia features normal complexes and regularity, with a rate exceeding 100 (100-150 bpm).
- Sinus tachycardia indicates a physiological response to a need for more cardiac output.
- Causes of sinus tachycardia include exercise, fever, anxiety, pain, low fluid volume, and stimulants.
- Sinus tachycardia can trigger chest pain and ischemia in individuals with underlying cardiac disease.
- Symptoms of sinus tachycardia include palpitations, chest pain, shortness of breath, decreased level of consciousness, confusion, syncope, dizziness, and hypotension.
- Atrial fibrillation results in a chaotic atrial rhythm with a rate greater than 350-600 beats per minute.
- Atrial fibrillation is characterized by no distinct P waves.
- Untreated atrial fibrillation can result in a ventricular rate anywhere from 50-180 beats/minute.
- Other characteristics of atrial fibrillation include irregular ventricular rhythm and an irregular radial pulse.
- Atrial fibrillation may be a continuous state associated with CHF and hypertension, or a transient state in a healthy person.
- Treatment for atrial fibrillation depends on the ventricular rate, with asymptomatic cases being managed with drugs, and symptomatic cases with cardioversion (chemical or electrical).
Ventricular Arrhythmias
- PVCs (premature ventricular contractions) do not originate from SA node, but from purkinje fibers.
- PVCs present as an earlier beat than the sinus beat, with no preceding P wave.
- PVCs exhibit wide, bizarre QRS complexes and T-wave deflection opposite of the QRS complex.
- PVCs includes a compensatory pause after the PVC, often resulting in no radial pulse felt.
- PVC causes include hypoxemia, leading to myocardial irritability,
- Rare PVCs are experienced by many individuals without cardiovascular disease.
- PVC treatment involves antiarrhythmic drugs like lidocaine or procainamide.
- Ventricular tachycardia occurs as a serious arrhythmia with ventricular rate over 100 bpm.
- Ventricular tachycardia results in not being able to see P waves and QRS widening/notchting.
- Ventricular tachycardia also presents with buried T wave and decreased cardiac output.
- Ventricular tachycardia is caused by digitalis toxicity or electrolyte abnormalities including hypokalemia and hypomagnesemia; as well as underlying heart disease, hypoxemia.
- Ventricular tachycardia includes drugs (lidocaine , amiodarone, procainamide) or defibrillation with higher electrical current at 200 joules.
- Ventricular fibrillation involves the ventricles quivering, which leads to no cardiac output.
- Ventricular fibrillation has a bizarre waveform with a wandering baseline.
- Ventricular fibrillation can be related to cardiac issues, digitalis/quinidine toxicity, hyperkalemia, electrolyte imbalances, and/or an accidental electrical shock.
- Ventricular fibrillation requires CPR, electrical defibrillation and drugs to stabilize.
- Asystole means with no electrical activity.
- Asystole is characterized by no heartbeat, blood pressure, or "quivering,"
- Asystole is usually presents with poor prognosis.
- Asystole is caused by hypoxia, hyperkalemia/hypokalemia, acidosis, drug overdose, or hypothermia.
- Asystole is treated with CPR, epinephrine, atropine, or cardiac pacing.
Defibrillation
- Use a flat surface clear of any standing water.
- Do not touch the patient or bed during defibrillation.
- Electrodes require gel or conductive pads between patient's skin and paddles.
- Rhythm must be established before defibrillation.
- Initiate CPR and/or administer drugs between defibrillations as directed.
- Apply paddles at the apex and to the right of the upper sternum.
- Give a clear "CLEAR" signal before any energy discharge.
- Document the number of defibrillations, energy levels, and patient condition after.
- LPNs generally do not defibrillate.
- Cardioversion is an elective procedure performed on clients who are awake and frequently sedated.
- Use synch mode, ensure consent form, and monitor EKG for cardioversion with a dose of 50-200 joules.
- Defibrillation is for emergency treatment via non-synchronized shock, of pulseless V-Fib or V-Tach. Cardiac Output is absent.
- Defibrillation energy begins with 200 joules up to 360. The client is unconscious, and EKG is monitored.
Patient Teaching for Pacemaker
- Check the wound every day and report any signs/symptoms of an infection.
- Avoid activities that might damage the pacemaker.
- Avoid electrical power lines and large magnets.
- Check pulse daily, initially, then each week.
- Carry ID card with you at all times
- The patient's family and friends need to know about the pacemaker.
Nursing Interventions for Pacemaker
- Check HR, and ensure it is the same or higher than the set rate.
- Monitor for signs/symptoms of pacemaker malfunctions.
- Assess, and record I&O, where output should be > 30 ml/hr.
- Monitor the pacemaker insertion site throughout.
Coronary Artery Disease (CAD)
- Coronary Artery Disease is a leading cause of death in the United States.
- CAD involves arteriosclerosis and atherosclerosis.
- CAD symptoms are associated with symptoms of CHD (ex. chest pain).
- CAD results in an Ischemic heart disease.
- CAD development includes multiple contributing factors.
- Best prevention is to start early in life with healthy lifestyle habits.
- Interventions include ceasing unhealthy lifestyle habits and controlling hyperlipidemia.
- CAD may be asymptomatic, but presents with 3 major clinical problems: angina pectoris, myocardial infarction, and sudden cardiac death.
Angina Pectoris
- Precipitating factors include atherosclerosis, coronary artery spasm, exertion, emotional stress, eating a large meal, weather changes, circadian rhythms (early mornings).
- Assessments include sudden chest pain, substernal pain that may radiate, cold and clammy skin, SOB and an increase in BP and pulse.
- Angina may be transient and usually lasts for 20 minutes.
- Angina is usually relieved by change in activity or Nitroglycerin.
- Management includes complete work up evaluation.
- Medications may include nitroglycerin (most common), heparin, aspirin, Plavix, calcium channel blockers, beta blockers, and morphine (for pain).
- Invasive interventions: PTCA, CABG, or Stent.
Nursing Interventions
- Maintaining ABC's (Airway, Breathing, Circulation).
- Ensure patient comfort.
- Providing small, frequent meals.
- Allowing Rest periods and activity.
- Explain interventions to the patient so that they understand.
- Administer prescribed medications as ordered.
- Monitor vital signs regularly.
- Track and record I&O.
- Thoroughly access the respiratory system.
- Facilitate and allow verbalization of concerns and feelings to help reduce anxiety.
Patient Teaching for Angina
- Avoid large heavy meals and use rest 1-2 hours post meal.
- Avoid extreme temperatures.
- Avoid caffeine.
- Avoid tobacco products.
- Take nitroglycerin prior to activity that may trigger angina.
- Keep Nitro with them at all times.
- Keep Nitro stored in brown bottle.
- Acquire new a bottle of Nitro every 3-6 months.
- Seek medical help if pain has not decreased after taking 3 Nitro pills each given 5 minutes apart.
Myocardial Infarction ( MI )
- A myocardial infarction is a heart attack.
- One or more branches of coronary arteries become blocked and heart tissue dies (infarcts).
- Blockage does not spontaneously resolve.
- Severity depends on location, size, collateral circulation, how quickly care is received.
Assessment
- A rapid history and physical must be completed.
- The peak time of an MI is between 6 a.m. and 12 noon; especially during winter months, with the patient often awakening with discomfort.
- Sudden, severe, pressure-like pain that increases over time is likely occurring, as described when the patient makes a fist over chest.
- Patient may present with GI symptoms instead of chest pain.
- Rapid weak pulse, elevated blood pressure (catecholamine effects), diaphoresis, and pale/clammy/cool skin.
- The patient's blood pressure may drop rapidly as cardiac output decreases.
- Temp will rise within a few hours.
- Ventricular arrhythmias are high risk.
- Crackles and peripheral edema often occur.
- The patient typically exhibitErratic behavior and often exhibit dyspnea
- Weakness presents.
Diagnostic Studies
- A 12 lead EKG.
- The enzymes and isoenzymes CKMB, LDH, Troponin 1 have elevated due to this
- Serum electrolytes and coagulation studies are drawn quickly.
- A CXR gives insight into lungs and cardiac size or abnormalities
- A CBC, renal function, and basic metabolic function help give better view of system.
- An Echo and Cardiac cath help determine extent of damage.
Treatment
- Oxygen to support breathing.
- Pain relief primary importance.
- Nitroglycerin and MS04 are often drugs of choice.
- ASA, give as soon as pain starts to help reduce platelet aggregaction.
- Heparin helps prevent further clotting.
- Beta blockers/Calcium Channel Blockers provide rate control.
- Thrombolytics can help break down blockage, reducing damage.
- PCI (percutaneous intervention) and CABG may be needed.
Immediate Treatment of an MI (MONA)
- Morphine.
- Oxygen.
- Nitroglycerine.
- Administer as ordered.
- Aspirin.
Key Nursing Interventions for MI
- Continuous assessment of vital signs is crucial.
- The patient needs Bed rest for the first stage of recovery; with a gradual increase after acute phase.
- Elevate HOB with cardiac monitor. Start IV and give prescribed meds to aid in oxygenation and cardiac function.
- An EKG can determine the extent of damage.
- Allow and provide for long periods of undisturbed rest.
- Pain can be addressed with medication.
- Patient often benefits from stool softeners or laxatives to prevent straining
- It is best to keep them NPO initially with a low fat, low sodium diet. The patient will advance from liquids, and caffeine is not helpful.
Post PCI (PTCA)
-
Vital signs
-
Check the extremity for, distal pulses, color, temperature, sensation, capillary refill, and bleeding every 15 minutes x 4, then every 30 minutes x 2, then every 1 hours for 4 hours.
-
The patient with femoral artery cannulation should stay supine up to 6 hours.
-
Patients after radial or brachial procedures can be mobile within 2-3 hours
-
PCVs and VT with reperfusion are common.
Post CABG
- An ICU setting with hemodynamic monitoring.
- Restrict I&O.
- The patient needs continuous VS monitoring. Assessment of cardiac and respiratory fx for proper heart function.
- Maintain blood glucose.
- Managing chest tube. Inspect graft sites and assess pulse distally and capillary refill must be assessed.
- OOB in chair on post op day two.
- Begin walking by day 3.
- Advance diet quickly, as tolerated, to increase proteins for wound and tissue healing.
Patient Teaching for MI
- On discharge-- 1st week after.
- Limit activities to ADLs.
- Do no driving.
- Rest when you feel the need to.
- Gradually add activities to daily schedule.
- Avoid heaving lifting or straining (no more than 5 lbs).
- Avoid extreme hot or cold temperatures.
Begin and maintain a walking and structured Exercise program.
-Increase a little at a time.
- Check pulse and slow down if goes above upper limits prescribed. -Warm up and cool down.
- Avoid exercise after a meal, to increase activity wait 2-3 hours.
- Avoid exercise when tired or in extreme temperatures.
- Stop exercising if: - experiencing shortness of breath. - chest pain. - are experiencing Dizziness.
- Use prescribed nitroglycerin prophylactically.
- It is often acceptable for Uncomplicated MI resumes normal activity 7-10 days, and more complicated cases as deemed by provider and therapy. A patient needs to always fallow provider recommendations.
Invasive Therapeutic Procedures
- There are numerous invasive procedures to help heart health including Percutaneous Transluminal Coronary Angioplasty (PTCA) , Atherectomy, stents or Coronary Artery Bypass Graft (CABG). Be sure to understand each and use online links as needed!
Heart Failure
- Chronic condition that occurs due to structural and functional issues with the heart.
- This often occurs because of a fib, renal failure, COPD, or cardiomyopathy. It may be a complication of underlying heart disease where output does not meet the body's needs.
- Low Ejection fraction results.
- There is often high Readmission rates with those because lack of understandings about treatments.
Decreased Cardiac Output ( Signs and Symptoms)
- Fatigue.
- Angina.
- Anxiety.
- Oliguria or Decreased Gl motility.
- Patients will have Pale, cool skin ,with Weight gain and Restlessness occur.
Signs and Symptoms ( Right vs Left side failure)
- Right :
- Include Dependent edema, Jugular vein distention Ascites, Hepatomegaly or Splenomegaly. The patient may have Anorexia as well as N/V or Fatigue and Chest pain
Also rapid weight gain. - Left: -Include Increased respirations/HR with Cyanosis. Expect Frothy pink sputum or Cough. Crackles, wheezes happen often or S3 S4 heart sounds which increase Dyspnea or lead to Orthopnea. Finally fatigue often presents or Nocturia
Diagnostic Studies
- Use CXRs and Echocardiogram that may be ordered.
- A Cardiac cath should help rule out all other conditions.
- Always get 12 lead EKG.
Treatment
- Manage the cause and symptoms
- Drugs as ordered:
-Cardiac glycosides helps contractility
-Diuretics that to rid of extra fluid
-Vasodilators--dilates vessels and reduces preload.
-MSO4--reduces pain/anxiety.
-Oxygen.
-Implement Lifestyle modifications
- ACE inhibitors . -Human B-type Natriuretic peptides. Often need Dobutamine and dopamine. -Always asses Preload and Afterload carefully.
Interventions
- Assess and document conditions that are in play.
- Use Hi-Fowler's position to increase breathing efficiency
- Enforce strict Bed rest and space activities in order to conserve energy.
- The patient needs NPO initially, then small, frequent meals, as ordered.
- Begin Progressive physical activity early on, if tolerated.
- Restrict Strict I & O measurements.
- Monitor lab values often and abdominal girth if edema is suspected.
Dietary Management
- Sodium intake may be mildly restricted, in Mild HF, --2 gm Sodium daily.
- IN Severe CHF, sodium needs to be below-may be as low as 500 mg Sodium daily.
- Fluid levels may be restricted for all patients. Restrict intake only restricted in severe HF to control edema for mild HF.
Valvular Heart Disease
- Includes damage to valve systems.
- Often involves the mitral and aortic valves.
- Causes Include aortic Regurgitation.
- Leads to stenosis (thickens and stiff) and incompetence (leaking).
- Presents with Palpitations, chest pain, exertional dyspnea, lightheadedness, dizziness, fainting, or weight gain, during nocturnal dyspnea. May also show a Murmur and Adventitious breath sounds/ and edema. Has a treatment of Tx: open mitral commissurotomy or Valve replacement must be performed.
Rheumatic Heart Disease
- In most instances a streptocolic inflammatory event results.
- This Inflammatory condition is the result of untreated respiratory condition (group A beta-hemolytic strep)
- The Usual age occurs between (5-15 years) Often leads to other Cardiac problems later in life where valvular problems result
Signs/Symptoms
- High Fever
- Tachycardia
- Epistaxis
- Joints become enlarged and Inflamed with Polyarthritis often results and Erythema and margin the trunk (red circles and wavy lines on trunk of body)
- There can be Involuntary muscle Movements (Sydenham's Chorea known also as St. Vitus' dance)
- In acute phases, a Heart murmur (if in Carditis is present because the valves are infected) where even Carditis and Anemia manifest .
Diagnosis
- The results from an Echo determine extent of damage to valves and myocardium and that a EKG and ESR often give support data. High WBC along with ASO titer that reveals ab antibodies against strep is nearly certain. C-Reactive protein are abnormally high during an inflammatory event .
Medical Management
- Prevent the streptococcal infection.
- Penicillin can help.
- If the patient has Carditis , bed rest and cardiac support are essential.
- NSAIDs, with Heat for join are common interventions
- A healthy, Well balance diet with vitamins B and C supplements are given.
Nursing Interventions
- Bed rest during acute phase with active Carditis supports healing.
- Diversional activities help keep mind active when body is not able to function.
- Provide Proper positioning can minimize join pain.
Provide Patient/family and care giver Education for what needs to be maintained
- Daily po or monthly injections during childhood/adolescence—and before any dental/surgical procedure to ensure long-term preventative management.
- Activity level at home, when tolerated, should be promoted
- S/S monitoring and reporting should be thoroughly explained to the patient
- Provide information a Healthy diet.
Pericarditis
-
In most instances this relates to a bacterial inflammation of the outer part of theheart .
-
Can be caused by a result of being both Acute or chronic. The main cause it is related to Associated bacterial, viral, or fungal infections, May also occur as secondary from other conditions.
-
The layers of the pericardium adhere to each other and subsequently causes a decrease in ventricular.
-
If thelayers compression leads to a preventions for normal stretching and filling that decreases cardiac output . Pericardial fluid around the layers becomes infected with pus or serous fluid so that maliganat cancer becomes dangerous.
Clinical Manifestations
- Dyspnea coupled with high Fever/chills and excessive Diaphoresis. -In most patients, there is Leukocytosis and Pericardial friction of tissue (50%).
- The patients Hiccups and/or Non,productive cough. The most debilitaing aspect is Chest pain but there other issue. That being Worse when lying supine so the patient is deep breathing, coughing, and have difficulty in swallowing . It may also be dangerous to attempt, because all the previously listed issue makes the patient unfortable or worse. The pain or pressure can be temporarily Alleviated only by sitting up or sitting up /leaning forward
Management
- Analgesia for pain.
- Oxygen to keep tissues alive.
- Electrolyte solutions.
- Antibiotics for the bacterial infections.
- ASA for fever.
- Indomethacin for inflammation.
- Colchicine with ASA or NSAIDs for inflammation.
If pericardial effusion, pericardial fenestration, or pericardiocentesis happens.
Nursing Interventions
- Check for Vitals every 2-4 hours.
- Asminister all Medications
- Implement strict I&O.
- Listen to breath and heart sounds.
- A Pad over the bed table (to lean on and to ensure proper support) should be employed to reduce strain.
- Limit activity via BR with HOB elevated 45° which is often helpful
- Make sure that pain levels assessed and treated
- Follow the order to Restrict sodium as ordered by DR. Weigh daily to check edema. The Diuretics and monitoring for lyte abnormality occurs.
Infective Endocarditis
- Is an infection of the lining with valve involvement.
- Is acquired in Hospital so use care for Valves Replacement and Hemodialysis.
- Use care with Vascular catheterizations along with and the installation of Pacemaker or cardiac issues related to Defibrillator placement.
Community Acquired Risk Factor
- These are related to Immunosuppression and IV Drug users. Has links to prior Rheumatic Disease and
- High level relates to of Poor Dentition or Degenerative heart complications for valve disease Infection Damages and Deforms Valves, Chambers, and Chordae tendineae and vegetative growths may damage. Fragmentation and Embolization is a serious and devistating consequence.
Signs and Symptoms
-
The patient will experience Fever and Chills Malice and Fatigue or Anorexia and a HA (HEADACHE).
-
Flat, Redish areas will develop on palms and soles. This will lead to s/s Heart Fail with new or changed HF murmur.
-
Other issues with Anemia, Petechiae on Mouth and Dyspnea commonly result.
-
Decreased Exercise Tolerance and Orthopnea commonly result.
Diagnoses
-
Transesophageal Echocardiography and Echocardiogram checks.
-
Leukocytosis Blood.
-
Always run cultures of blood for the infection.
Medical Management.
-
Complete Bed rest and limit physical actiity if the patient has a fever and HF.
-
Administer Massive Doses of Antibiotics Via parenterally if the patient has a fever, if there is also existing HF.
-
Provide the patient with medicine as per DR order (always use preventative measures).
-
Prophylactic to make sure nothing that leads to a cardiac infection. such as procedures that create a high risk situation such as Dental work or minor surgery.
-
Surgical repair of a damaged valve or Valve replacement.
-
Be aware that Embolization is a severe life threatening problem due to it being fairly common. It can occur in all parts of body specifically:Brain and Lungs then, heart itself, coronary arteries with distal points being Spleen then the Bowel and extremitis are vulnerable.
Key Nursing Interventions
- Make sure to lower physical activity with a callm quiet environment during acute stage.
- Check Vital Signs, specifically Apical pulse, and look into when physical activity is set increase
- Provide Between meals supplements, and keep aware of appetite to avoid or remedy Decreased appitite during acute phase
Cardiomyopathic
This typically involves heart becoming enlarged, thick or ridgid in the cardiac tissue. -Often results so it best know, the Heart becomes Weaker since this point of development, and less able to efficiently pump blood into needed tissues.
- May cause electrical problems such as arrhythmias that then leads to Heart Failure Common types known include is - Dilated cardiomyopathy - Hypertrophic cardiomyopathy - Restrictive carciomyyopathy and all may be Acquired if not prevented or treated.
- Signs/Symptoms
- **"In most instances the patient experiences an acute shortness of breath particularly with Exertion."
- ** Patients often experience Angina a high Fatigue.
- The classic symptom remains Signs/Symptoms of Rt and Lft Sided . Heart Failure
- High fluid levels that build high levels causing, in lower extremeities, Edema. Liver or heart, or veins create Hepatic issues including Dysfunction. A high, Dizziness and Light-headedness results along with Syncope during Activity. (this usually creates other emergency response interventions as those may be difficult to remedy).
Medical Management
- If possible, control or eliminate the original insult
- If patient has high blood pressure, limit to reduce work for the heart to function
- Use of many, and or all medications: including
- *- Diuretics so there would be a high ACE Inhibitors and Anti-dysrhythmics along with common Beta Blockers
If the patient's status deteriorates over time, consider a Cardiac Transplantation
NURSING INTERVENTIONS.
- Stop overworking the system by avoid demanding work.
- Look for better management relieving specific Symptoms while. Monitoring for and looking for complications.
- Psychosocial supports should be set in place. (A strong, Emotional mindset, ensures a high chance for success). Also ensure use of
- Administer Medications
- Frequently to help stabilize patient the state
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