ATI Med Surg Final Review Latest Updated 2024
What are the guidelines for the nurse administering and interventions of Digoxin?
- ANSWER-- take apical HR 1 full minute
- hold if <60 BPM and notify provider
- observe for nausea and vomiting
- Monitor for S/S Digoxin toxicity
- hypokalemia increases risk for digoxin toxicity
- monitor ECG throughout IV administration and 6 hr. after each dose.
- monitor BP periodically
- report bradycardia or new arrhythmias
- acute and chronic kidney disease: monitor lab due to slow excretion of the med
with CKD and admin. digoxin after receiving dialysis.
- take amphojel 2 hours before or after digoxin
What are the manifestations of left-sided heat failure?
(Iggy) - ANSWER-- Decreased Cardiac Output:
- fatigue
- weakness
,- oliguria
- angina
- confusion, disorientation
- restlessness
- dizziness
- tachycardia
- palpitations
- pallor
- weak peripheral pulses
- cool extremities
- pulmonary congestion:
- hacking cough, worse at night
- dyspnea, breathlessness
- crackles or wheezes in lungs
- frothy, pink-tinged sputum
- tachypnea
- s3/s4 summation gallup
- increased pulmonary venous pressure
- decreased blood flow to major organs causing dysfunction (renal failure)
,- PACs, PVCs, and A-Fib most common
- increased heart size
What are the manifestations of left-sided heat failure?
(ATI) - ANSWER-- Dyspnea, orthopnea (SOB while lying down)
- nocturnal dyspnea
- fatigue
- displaced apical pulse (hypertrophy)
- s3 heart sound, gallop
- pulmonary congestion (dyspnea, cough, bibasilar crackles)
- frothy sputum, can be blood-tinged
- altered mental status
- manifestations of organ failure: oliguria (decrease in urine output)
Edema - ANSWER-unreliable measurement of fluid gained or lost. Weighing the
patient once a day is more reliable.
Left-sided heart failure - ANSWER-results in inadequate output from the left
ventricle, leading to poor tissue perfusion. Systolic failure includes an ejection
, fraction below 40% with pulmonary and systemic congestion. Diastolic failure
include stiffening or inadequate relaxation of the ventricle.
Right-sided heart failure - ANSWER-results in inadequate output from the right
ventricle, leading to systemic venous congestion and peripheral edema.
Pulmonary Edema - ANSWER-severe, life-threatening accumulation of fluid in the
alveoli and interstitial spaces of the lung that can result from severe heart failure.
How do you prioritize interventions with heart failure and pulmonary edema? -
ANSWER-Prompt response to this emergency includes the following:
-Positioning the client in high-Fowler's position.
- Administration of oxygen, positive airway pressure, and/or intubation and
mechanical ventilation.
- IV morphine (to decrease anxiety, respiratory distress, and decrease venous
return).
- IV administration of rapid-acting loop diuretics, such as furosemide (Lasix).
- Effective intervention should result in diuresis (carefully monitor output),
reduction in respiratory distress, improved lung sounds, and adequate
oxygenation.
What are the guidelines for the nurse administering and interventions of Digoxin?
- ANSWER-- take apical HR 1 full minute
- hold if <60 BPM and notify provider
- observe for nausea and vomiting
- Monitor for S/S Digoxin toxicity
- hypokalemia increases risk for digoxin toxicity
- monitor ECG throughout IV administration and 6 hr. after each dose.
- monitor BP periodically
- report bradycardia or new arrhythmias
- acute and chronic kidney disease: monitor lab due to slow excretion of the med
with CKD and admin. digoxin after receiving dialysis.
- take amphojel 2 hours before or after digoxin
What are the manifestations of left-sided heat failure?
(Iggy) - ANSWER-- Decreased Cardiac Output:
- fatigue
- weakness
,- oliguria
- angina
- confusion, disorientation
- restlessness
- dizziness
- tachycardia
- palpitations
- pallor
- weak peripheral pulses
- cool extremities
- pulmonary congestion:
- hacking cough, worse at night
- dyspnea, breathlessness
- crackles or wheezes in lungs
- frothy, pink-tinged sputum
- tachypnea
- s3/s4 summation gallup
- increased pulmonary venous pressure
- decreased blood flow to major organs causing dysfunction (renal failure)
,- PACs, PVCs, and A-Fib most common
- increased heart size
What are the manifestations of left-sided heat failure?
(ATI) - ANSWER-- Dyspnea, orthopnea (SOB while lying down)
- nocturnal dyspnea
- fatigue
- displaced apical pulse (hypertrophy)
- s3 heart sound, gallop
- pulmonary congestion (dyspnea, cough, bibasilar crackles)
- frothy sputum, can be blood-tinged
- altered mental status
- manifestations of organ failure: oliguria (decrease in urine output)
Edema - ANSWER-unreliable measurement of fluid gained or lost. Weighing the
patient once a day is more reliable.
Left-sided heart failure - ANSWER-results in inadequate output from the left
ventricle, leading to poor tissue perfusion. Systolic failure includes an ejection
, fraction below 40% with pulmonary and systemic congestion. Diastolic failure
include stiffening or inadequate relaxation of the ventricle.
Right-sided heart failure - ANSWER-results in inadequate output from the right
ventricle, leading to systemic venous congestion and peripheral edema.
Pulmonary Edema - ANSWER-severe, life-threatening accumulation of fluid in the
alveoli and interstitial spaces of the lung that can result from severe heart failure.
How do you prioritize interventions with heart failure and pulmonary edema? -
ANSWER-Prompt response to this emergency includes the following:
-Positioning the client in high-Fowler's position.
- Administration of oxygen, positive airway pressure, and/or intubation and
mechanical ventilation.
- IV morphine (to decrease anxiety, respiratory distress, and decrease venous
return).
- IV administration of rapid-acting loop diuretics, such as furosemide (Lasix).
- Effective intervention should result in diuresis (carefully monitor output),
reduction in respiratory distress, improved lung sounds, and adequate
oxygenation.
