Question

The nurse is caring for a 74-year old gentleman who was admitted 2 days ago with chest pain. His past medical history includes coronary artery disease, CHF, hypercholesterolemia, obesity, GERD, and COPD. His 0800 vitals are: BP 142/88, HR 86, Sp02 92% on 2L humidified 02 via nasal cannula, RR 22, temp 98.4.

1.      Describe the abnormal assessment findings you might expect to see in this client’s head-to-toe assessment.

2.      Give some examples of medications you suspect this client may be taking and explain why he would be taking them.

After visiting with family this morning, he called the nurse to report a “funny feeling” in his chest. The cardiac monitor showed the following rhythm:

1. Identify what rhythm, and approximate rate, this is.
2. Describe the steps the nurse needs to take now and include the rationale for your decisions.
3. Identify at least two potential causes for this rhythm and describe the information you would need to gather to determine the exact cause.
4. Discuss at least two medications that could be used to treat this rhythm – and how they work.

Later that day, this client’s cardiac rhythm has returned to sinus rhythm. However, you notice these occasional beats on his cardiac monitor:

5. Discuss what steps the nurse should take now and include the rationale for your decisions.

The following day, the client is doing much better and receives discharge orders.

6. Considering his current diagnosis, the occurrences of this hospitalization, new medications he may be taking, and existing medical history, discuss the discharge education that should be provided.

Answer 1

1. ABNORMAL FINDINGS

Fatigue,

Irregular or rapid heartbeats

Shortness of breath,

Coughing, or difficulty breathing when lying down

Chest pain that spread to other parts of the body

High or low blood pressure

Low SPO2

Bulging or swollen neck veins may be a sign of heart failure

Fatty deposits (xanthomas) under the skin.

Changes in how the blood sounds

Listening to the heart with a stethoscope for heart murmurs and extra heart sounds.

Abnormal breath sounds

Changes in the sounds of blood flow (bruits)

Signs of heart failure (bulging neck veins, extra heart sounds, fluid in the lungs, fluid buildup in the abdomen, enlarged liver, or swelling in the legs and feet)

Diminished or unequal pulses in the arms or legs, abnormal sounds heard when listening to blood flow through blood vessels)

2. I suspect you are taking medications which control your Blood Pressure and Cholesterol levels.Kindly use the inhaler if you have difficulty in breathing and the antacids for your stomach problems.All these medicines will help you to reduce your signs and symptoms or reduce disease conditions and make you feel better.

3. Atrial Fbrillation

I didnt get any picture to rate

Medicines to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm.

POTENTIAL CAUSES

1. High blood pressure
2. Coronary artery disease

INFORMATION NEED TO GATHER EXTRA WILL BE;

• Does he smokes or drink?
• Does he has any previous heart attack or heart related surgery?
• About dietary pattern?
• Family history of heart diseases?
• Current medications list?
• Does he follows sedentary life style?

4. MEDICATIONS

Medication options may include *blood thinners, rate controllers, and rhythm controllers.

Aspirin

Warfarin

5.

• Decreased Cardiac Output related to alteration in heart rate and rhythm as evidence by EKG showing Atrial Fibrillation
• Acute pain
• Excessive fluid volume
• Ineffective breathing pattern
• Ineffective airway clearance
• Fatigue
• Fear

6. HEALTH EDUCATION

• Eat heart healthy foods
• Do exercise
• Avoid sedentary lifestyle
• Follow the physician order and medications
• Maintain a balanced diet and weight
• Maintain follow up