Exam One Medical Surgical Nursing 2

A patient seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be most useful to monitor? - B-type Natriuretic Peptide A patient who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. The nurse notes that no pulse is palpable in the left foot and that it is cold and pale. Which action should the nurse take next? - Notify the health care provider about the change in status A patient who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol? - Troponin I A patient who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which patient information is most important for the nurse to communicate to the health care provider (HCP) before the procedure? - Patient took metformin 500mg this morning A patient whose systolic blood pressure is always higher than 140 mm Hg in the clinic tells the nurse, "My blood pressure at home is always fine!" What action should the nurse take next? - Ask the patient to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week. A patient with stable angina has a prescription for ranolazine 500 mg twice a day. Which patient finding is most important for the nurse to discuss with the health care provider (HCP)? - Patient reports having chronic constipation (adverse effect of the medication, does not impact heart rate or BP and can be taken with beta blockers or nitrates) ACS Nursing Management - Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with an ACS Oxygen should be given along with medication therapy to assist with relief of symptoms. Administration of oxygen raises the circulating level of oxygen to reduce pain associated with low levels of myocardial oxygen. The route of administration (usually by nasal cannula) and the oxygen flow rate are documented. A flow rate of 2 to 4 L/min is usually adequate to maintain oxygen saturation levels of at least 95% unless chronic pulmonary disease is present. Vital signs are assessed frequently as long as the patient is experiencing pain and other signs or symptoms of acute ischemia. Physical rest in bed with the head of the bed elevated or in a supportive chair helps decrease chest discomfort and dyspnea. Elevation of the head and torso is beneficial for the following reasons: Tidal volume improves because of reduced pressure from abdominal contents on the diaphragm and better lung expansion. Drainage of the upper lung lobes improves. Venous return to the heart (preload) decreases, reducing the work of the heart. ACS Pathophysiology - In unstable angina,