NURSING MED SURG MS EXAM 2 - Jersey College 100%VERIFIED

1. What are some reasons you would have an increased heart rate? Pg 693  Stimulation of the sympathetic nervous system (positive chronotropy)  Conduction through the AV node (positive dromotropy)  The force of myocardial contraction (positive inotropy)  Dysrhythmias  Exercise  Anxiety  Fever  Administration of catecholamines(dopamine, aminophylline, dobutamine)  Hypovolemia  Shock  Infection  Respiratory issues (distress)  Dyspnea 2. What lab result would tell you your patient is in heart failure? Pg 675  BNP(Brain Natriuretic Peptide) >than 100 pg/ml  The BNP level is a key diagnostic indicator of HF; high levels are a sign of high cardiac filling pressure and can aid in both the diagnosis and management of HF 3. What medication would you use for peripheral vascular disease? Pg 837  Statins  Vasodilators(pentoxifylline & cilostazol (Pletal)  Antiplatelets or blood thinners:aspirin or clopidogrel (Plavix) 4. What are the signs and symptoms for pericarditis? Pg 791  May be asymptomatic  Chest pain- hook up to ECG first, then vitals, then cath lab for diagnostic  Pain radiating to beneath the clavicle, neck or scapula  Creaky or scratchy friction rub  Mild fever  Increase WBC count  Anemia  Elevated ESR or C-reactive protein level  Nonproductive cough or hiccup  Dyspnea  Other S&S of heart failure 5. After a stress test what would you further assess your patient for?  chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias, or ST-segment changes on the ECG during the stress test.  Facial flushing, chest discomfort, anxiety, ischemia, ↑HR(vitals, ECG), rest, atropine-dilates. ASSESS-ASSESS  If chest discomfort persist during stress test: stop test, ECG, vitals 5. Define murmur  Sounds created by abnormal, turbulent flow of blood in heart Intensity A grading system is used to describe the intensity or loudness of a murmur. Grade 1: Very faint and difficult for the inexperienced clinician to hear Grade 2: Quiet but readily perceived by the experienced clinician Grade 3: Moderately loud Grade 4: Loud and may be associated with a thrill Grade 5: Very loud; heard when stethoscope is partially off the chest; associated with a thrill Grade 6: Extremely loud; detected with the stethoscope off the chest; associated with a thrill 6. Patient teaching before, during, and after, cardiac catheterization. Nursing responsibilities before cardiac catheterization include: • Instructing the patient to fast, usually for 8 to 12 hours, before the procedure • Informing patient that if catheterization is to be performed as an outpatient procedure, a friend, family member, or other responsible person must transport the patient home • Informing the patient about the expected duration of the procedure and advising that it will involve lying on a hard table for less than 2 hours • Reassuring the patient that IV medications are given to maintain comfort • Informing the patient about sensations that will be experienced during the catheterization. Knowing what to expect can help the patient cope with the experience. The nurse explains that an occasional pounding sensation (palpitation) may be felt in the chest because of extra heartbeats that almost always occur, particularly when the catheter tip touches the endocardium. The patient may be asked to cough and to breathe deeply, especially after the injection of contrast agent. Coughing may help disrupt a dysrhythmia and clear the contrast agent from the arteries. Breathing deeply and holding the breath help lower the diaphragm for better visualization of heart structures. The injection of a contrast agent into either side of the heart may produce a flushed feeling throughout the body and a sensation similar to the need to void, which subsides in 1 minute or less. • Encouraging the patient to express fears and anxieties. The nurse provides education and reassurance to reduce apprehension. Nursing responsibilities after cardiac catheterization are dictated by hospital policy and primary provider preferences and may include: • Observing the catheter access site for bleeding or hematoma formation and assessing peripheral pulses in the affected extremity (dorsalis pedis and posterior tibial pulses in the lower extremity, radial pulse in the upper extremity) every 15 minutes for 1 hour, every 30 minutes for 1 hour, and hourly for 4 hours or until discharge. BP and heart rate are also assessed during these same time intervals. However, a recent study did not find an association between changes in these vital signs and bleeding complications (Mert, Intepeler, Bengu, et al., 2012). These results suggest that the best method for discovering bleeding is through frequent nursing assessments of the catheter access site (Chart 25-5). • Evaluating temperature, color, and capillary refill of the affected extremity during these same time intervals. The patient is assessed for affected extremity pain, numbness, or tingling sensations that may indicate arterial insufficiency. The best technique to use is to compare the examination findings between the affected and unaffected extremities. Any changes are reported promptly. • Screening carefully for dysrhythmias by observing the cardiac monitor or by assessing the apical and peripheral pulses for changes in rate and rhythm. A vasovagal reaction, consisting of bradycardia, hypotension, and nausea, can be precipitated by a distended bladder or by discomfort from manual pressure that is applied during removal of an arterial or venous catheter. The vasovagal response is reversed by promptly elevating the lower extremities above the level of the heart, infusing a bolus of IV fluid, and administering IV atropine to treat the bradycardia