NR/MDC3_Final_Review
S/s =signs and symptoms
Tx = treatment
Dx = diagnosis
Cardiac
SVT- To stimulate a vagal reflex, the health care provider instructs the patient to bear down as if
straining to have a bowel movement.Assess the patient's heart rate, heart rhythm, and blood
pressure. Observe the cardiac monitor and record an ECG rhythm strip before, during, and after the
procedure to determine the effect of therapy. Drug therapy is prescribed for some patients to conve
SVT to a normal sinus rhythm (NSR). Adenosine (Adenocard) (6mg or 12mg) is used to terminate the
acute episode and given rapidly (over several seconds) followed by a normal saline bolus.
First thing to do - Vagal Maneuver
Supraventricular tachycardia (SVT) – atrial rate of 100 to 280 beats/minute, if the impulse originates
above the ventricles, the P wave may not be visible especially if the rate is high because the P wave is
often embedded in the preceding T wave. SVT is seen more often in women. SVT results in a re-entry
mechanism in which the impulse repeatedly reenter the atrial pathway.
A-Fib--is the most common dysrhythmia seen in clinical practice. AF can be encountered and treated
in the ambulatory and acute care settings.
Atrial Fibrillation (AF) – atrial rate of 350 to 600 beats/min with a ventricular response of 120 to 200
beats/min and irregular. The rhythm is chaotic with no clear P waves and no atrial contraction resulting
in loss of atrial kick. The rapid irregular rhythm results in decrease ventricular filling and reduces cardiac
output. Patients experiencing atrial fibrillation are at an increased risk of thrombus formation so they
must be on long-term anticoagulants.
What it can lead to -It can impair quality of life and cause considerable morbidity and
mortality, largely related to CLOTTING concerns such as embolic stroke, deep venous thrombosis
(DVT) or pulmonary embolism (PE). This alteration in cardiac function allows for blood to pool,
placing the patient at risk for CLOTTING concerns such as DVT or PE. AF is frequently associated
with underlying cardiovascular disease.
Patients with atrial fibrillation are at risk of developing a deep vein thrombosis, pulmonary embolism, or
embolic stroke as a result of pooling of blood due to inadequate emptying.
Nursing interventions-Traditional interventions for AF include antidysrhythmic drugs to slow
the ventricular conduction or to convert the AF to normal sinus rhythm (NSR).
Prepare the patient for synchronized cardioversion for atrial fibrillation.
, Tx for recurrent-Traditional interventions for AF include antidysrhythmic drugs to slow the
ventricular conduction or to convert the AF to normal sinus rhythm. Calcium channel blockers,Beta
blockers, The primary health care provider weighs the benefit of anticoagulant use versus risk of
bleeding to determine the treatment path. The patient should be made aware of the risk of stroke
development verses the risk of bleeding, and his or her preferences should also be a part of the
decision-making process. Because of the unpredictable drug response and many food-drug
interactions, laboratory test monitoring (e.g., international normalized ratio [INR]) is required when a
patient is taking warfarin. Teach patients the importance of avoiding foods high in vitamin K and to
avoid herbs such as ginger, ginseng, goldenseal, Ginkgo biloba, and St. John's wort, which could
interfere with the drug's action. Chapter 36 describes care of patients receiving anticoagulant
therapy.
Heart failure
S/s of left vs right: LEFT= Pulmonary edema RIGHT= Peripheral edema,ascites, jaundice, and
anasarca (generalized edema) as a result of prolonged congestion of the liver.
Heart failure, also called pump failure, is a common chronic health problem in which the heart is unable
to fill or eject blood to meet the body’s demands. Patients who suffer from heart failure have a
decreased ejection fraction (the percentage of blood ejected from the heart during systole). Normal
ejection fraction is 55% - 70%. Heart failure results from acute coronary disease and other structural or
functional disorders. There are three major types of heart failure:
E Left-sided heart failure – results from ineffective left ventricular contraction causing a backup of
fluid into the lungs, which results in pulmonary congestion.
E Right-sided heart failure – results from the inability of the right ventricle to effectively contract to
pump blood, causing a backup of fluid into the periphery.
Pt. teaching- daily weights, low sodium diet, fluid restrictions, how to take medications, s/s fluid
overload, Stop smoking, avoid caffeinated beverages and energy drinks as much as possible, and
drink alcohol only in moderation. • Learn ways to manage stress and avoid getting too tired
Diagnosis – labs and radiology: Creatinine kinase, troponin T levels, cholesterol levels, EKG, ECHO
Treatment for end stage- heart transplant
Nursing interventions- Nursing care of a patient diagnosed with heart failure include all the
general nursing interventions as well as: Administration of continuous positive airway pressure (CPAP) to
maintain oxygenation and ventilation. Assist patient and family in advanced directive planning. Assist in
preparation of the patient for cardiac resynchronization therapy (CRT) to restore normal rhythm. Prepare
the patient for surgical intervention if indicated. Provide patient and family education for home care to
include:
E -Dietary requirements, Daily weight, Fluid restriction, Signs and symptoms of worsening heart
failure and when to follow-up with provider, Importance of adhering to medication regimen,
Teach the patient how to take their heart rate.
E
Assess if crackles are cleared after coughing
, Auscultate for crackles and wheezes of the lungs. Late inspiratory crackles and fine profuse crackles that
repeat themselves from breath to breath and do not diminish with coughing indicate HF. Crackles are
produced by intra-alveolar fluid and are often noted first in the bases of the lungs and spread upward as
the condition worsens. Wheezes indicate a narrowing of the bronchial lumen caused by engorged
pulmonary vessels. Identify the precise location of crackles and wheezes and whether the wheezes are
heard on inspiration, expiration, or both.
Goals pg 697?(double check)
Better gas exchange with reduction of fluids in lungs, reduce CO2 in lungs. Looking for increased
perfusion and adequate cardiac output.
Mitral Stenosis
Causes:usually results from rheumatic carditis, which can cause valve thickening by fibrosis
and calcification. Rheumatic fever is the most common cause of the problem
S/s: Fatigue, Dyspnea on exertion, Orthopnea, Paroxysmal nocturnal dyspnea, Hemoptysis,
Hepatomegaly, Neck vein distention, Pitting edema, Atrial fibrillation, Rumbling, apical diastolic
murmur
Treatment options:Nonsurgical management focuses on drug therapy and rest, Diuretics,
beta blockers, ACE inhibitors, digoxin, and oxygen; Vasodilators such as calcium channel blockers
may be used to reduce the regurgitant flow for patients with aortic or mitral stenosis.
Anticoagulation with sodium warfarin (Coumadin, Warfilone) is usually a part of the plan of care to
prevent thrombus formation. Balloon valvuloplasty, mitral valvuloplasty, The Mitraclip is used to
repair the mitral valve in patients with mitral regurgitation, cardiac catheterization
Valves- Valvular heart disease is caused by structural or functional abnormalities of the mitral and aortic
valves. These abnormalities result in stenosis, regurgitation, and prolapse, which produce symptoms
based on the disease process. The mitral valve controls the blood flow from the left atrium to the left
ventricle. The aortic valve controls the blood flow between the heart and aorta. The severity of the
disease is based on the extent of the defect. In mild cases, no symptoms will be produced; however,
severe cases and be life-threatening. There are several types of valvular heart disease: mitral stenosis,
mitral regurgitation, mitral prolapse, aortic stenosis, and aortic regurgitation.
Meds and pt teaching post op replacement
Calcium channel blockers(used to reduce back flow), abx before dental work(pg707), infact let every
provider know about cardiac history so they may treat accordingly. lifelong anticoagulation therapy with
warfarin is required.(pg710) INR will need to be monitored frequently. Slowly increase activity level, plan
acitivity and rest to conserve energy.
Conditions associated with mitral valve- The mitral valve controls the blood flow from the left
atrium to the left ventricle.
Mitral stenosis is caused by a narrowing of the mitral valve. The valve leaflets become stiff due to
calcification or thickening; the valve opening becomes narrow and prevents the normal blood flow from
the left atrium to the left ventricle. The blood volume in the atrium increases and causes an increase in
left atrial pressure, causing left atrial dilation. The increased pressure forces oxygenated blood back to
