What shall we take?
This medication class can cause lowered B/P, heart rate, and even lower respirations. It can also cause blood sugar to be lower than normal(masks s/s of hypoglycemia). The goal of this med is to decrease the workload of the heart. C/I with sinus bradycardia.
Give the drug class and an example of a med in the class
Beta Blockers
Atenolol, Metoprolol
How does an altered rhythm pattern affect the heart?
Altered rhythm can affect the heart's ability to pump blood effectively.
What is the rationale for low-sodium diet with heart failure?
Decrease fluid volume which will improve cardiac output.
Your patient has pulmonary edema, he is very anxious and is breathing very rapidly. What medication can I give that will promote muscle relaxation, slow respirations, and overall reduce the work of breathing?
Morphine Sulfate
Patient teaching for automatic implanted cardioverter defibrillator (AICD) Give me 2.
You can use your microwave.
You can use your power tools.
You need to notify the MD of frequent "kicks".
You need to opt for hand search instead of metal detector scans at the airport.
I can only breathe when I am sitting upright.
I have ______________.
Orthopnea
Crackles bilaterally, exertional dyspnea, pink frothy sputum, low SPO2 reading.
Left sided heart failure
This medication helps with HTN r/t high volume. It inhibits the angiotensin converting enzyme and increases levels of bradykinin causing vasodilation, excretion of sodium/water, retention of K+.
It can cause Angioedema, dry cough, and electrolyte imbalances
Name the drug class and an example of a med in the class
ACE Inhibitors
Captopril, lisinopril, enalapril
Why are clients with atrial fibrillation put on anticoagulants, like warfarin?
Prevention of clots which can lead to stroke/mi. Blood pools in the atria.
Blood pressure is high, the body system that is primarily involved in regulating arterial blood pressure is the
Kidneys / Renal system
Before suctioning a client that can not clear secretions from the lungs, the nurse must make sure that they have adequate oxygenation by doing what?
Hyperoxygenation with 100% oxygen
Low sodium diet teaching - How will reducing sodium help? and which foods and condiments to avoid
Lowering sodium will decrease fluid retention and improve cardiac output.
Regular canned veggies, olives, pickles, processed / packaged foods like hamburger helper,
ketchup, soy sauce, etc.
I get so tired when I shower and get dressed. I can't walk very far. (often an early sign of heart failure)
Exertional Dyspnea
What is direct blood pressure monitoring and when and why is it used?
An arterial catheter will be placed measuring the systolic, diastolic, and mean arterial pressures continuously on a monitor. It is used in clients with severe and sustained hypertension or hypotension and during and after cardiac surgery.
Helps lower B/P that is related to increased resistance. Keeps a certain mineral out of the blood and allows vasodilation to decrease the resistance in the vasculature. We must check B/P and HR before. Monitor for s/s of peripheral edema; 2 specific meds in this class cannot be admin with grapefruit juice.
Name the drug class and an example of a med in the class,
Calcium Channel Blocker
nifedipine, amlodipine
Defib- big shock; only used for 2 arrhythmias, non elective, place electrodes, clear! press discharge button
cardioversion- baby shock, elective
So, your patient has heart failure and we need to decrease the edema that is present. How can we do that? and how will we know that it is effective?
Low sodium diet, diuretics, compression stockings.
Urinary output should increase, weight should decrease as edema lessens.
How will blood pressure be monitored in a client with malignant hypertension?
via automatic B/P recording machine, every few minutes.
Name 2 risk factors for DVTs
dehydration; Drink plenty of fluids
Change from oral contraceptive to something else.
sedentary life style;Make sure to be as mobile as possible
To qualify for a heart transplant, you must always be ready. The heart must be harvested from the donor and then transplanted to the recipient within ______ hours.
6
The first (early) symptoms of this disease are often dyspnea; exertional dyspnea(nightime cough and nocturia)
CHF
This medication Class causes sodium and water to be released in the urine and thus helps with high B/P related to excess volume. We have to be careful to monitor potassium levels with these meds.
Name the class and also name two categories of the classification and a med example of each of the two.
Which class is the first line of defense with htn?
Diuretics
Potassium sparing - furosemide, HCTZ
Potassium wasting - Spironolactone
What 2 dysrhythmias do we defibrillate?
V-fib and pulseless v-tach
Your patient needs a coronary artery bypass. We have to find a vein somewhere! What is the most commonly harvested vein used for the grafting?
The great saphenous vein of the leg
Your patient is having difficulty breathing. Crackles are heard in the lungs. The heart rate is elevated and their respiratory rate is elevated. What position will you put them in?
Why will this be helpful?
head of bed elevated to high-Fowler's with feet lowered to decrease venous return and give the lungs time to recover and exchange oxygen.
If your client is taking a medication for a diagnosis of high blood pressure, what are some important teachings that we must include?
regarding position changes, diet, noncompliance
Orthostatic hypotension - dangle
diet - depending on need for potassium or no potassium
sustained elevated B/P can lead to stroke
uncontrolled HTN can lead to renal dysfunction from atherosclerosis
Anyone that has had a valve replaced with a mechanical valve must understand that they must take a(n) ________________ forever.
anticoagulants
Teaching and expected findings after cardiothoracic surgery.2 atleast
It will take several weeks for normal appetite to return. Depression is normal and temporary, Refrain from lifting, pushing, or pulling over 10 lb until restriction released (6-12 weeks).
You have A-fib and need something to slow the heart but contracts more effectively. I expect you will be prescribed ____________. I have to be careful of toxicity of this drug, especially if taking __________ for your hypertension. The risk is even higher if you are geriatric!
Digoxin
Furosemide
If a client is complaining of frequent or near constant "fluttering" or "palpitations", they may show irregular beats when the pulse is palpated. This patient will be monitored by EKG which shows extra QRS runs.. This arrythmia is call ___________.
PVCs
I'm having chest pain! I have an order for nitroglycerin ______ (route). Teach me how to take it.
Sublingual
One tab every 5 minutes x 3 doses. Lay down and rest. Call 911 when you take your second dose.
let you Dr. know that you had to take the nitro, even if it goes away.
Clients that are placed on cardiopulmonary bypass will be required to take this medication class to prevent clots. Also with mechanical valve replacement.
anticoagulant
Your patient just had surgery(cabg). We do not want wound dehiscence which is ____________. To prevent it, we teach the client to do what?
Dehiscence is the opening of the surgical incision. Teach the client to splint the incision with a pillow with doing the needed coughing and deep breathing.
A transplanted heart beats ____________ than the client's natural heart. the average is about _____ to ______ beats/min because nerves that affect heart rate have been severed.
Faster
100 - 110
Gradual unexpected weight gain, wakes up at night with +3 pitting edema to the BLE, JVD, lack of appetite and nausea
Right sided heart failure