Question

Chapter 19 Ms. F. is a 45-year-old female who came into the emergency department with complaints of chest pain and a "racing heart." She notes that she has lost 15 pounds in the past two months but eats constantly. On initial assessment, she is noted to have a heart rate of 170 beats per minute (QRS duration is 0.06 sec), blood pressure of 179/109 mm Hg, and an audible S,. The physician attempts vagal maneuvers, which are ineffective. She remains tachycardic. Because of her tachycardia, anxious behavior, and obvious bulging of her eyes, hyperthyroidism is suspected. A thyroid panel of laboratory tests is ordered. ode ctheteriatnored, Questions 1. Given the potential hyperthyroidism, which drugs might be used to control her cardiac rhythm, and which should be avoided? 2. What are the top priorities of care for this patient? 3. Should the nurse be concerned about the cardiac catheterization? 4. What complications might the nurse anticipate?

Answer 1

1.Given the potential hyperthyroidism which drugs might be used to control the cardiac rhythm and which should be avoided?

A β-Adrenergic blockade may be effective to control the ventricular rate. Increased plasma clearance of β-blockers may necessitate higher doses Among them propranolol has the advantage of blocking the conversion of T4 to T3 in peripheral tissues, The cardioselective β-blockers have a longer half-life and are equally effective on the heart.

In cardiac arrhythmias, intravascular infusion of calcium blockers should be avoided due to the risk of a further fall in peripheral vascular resistance (PVR). It is still controversial whether patients with atrial fibrillation should have anticoagulant therapy to prevent systemic embolization.

2, What are the top priorities of care for this patient?

1. supportive care

2. inhibition of new hormone synthesis

3. inhibition of thyroid hormone release

4. peripheral β‐adrenergic receptor blockade

5. preventing the peripheral conversion of T4 to T3

6. identifying and treating precipitating factors.

3. Should the nurse be concerned about the cardiac catheterization?

The nurse will check your bandage regularly, for any signs of bleeding from the site and check for the vital signs intermittently

4. What complication might nurse anticipate?

The nurse should be concerned about the cardiac dilation (increase in the size of the heart cavities, which actually thins the heart muscle) and thus results in congestive heart failure or sudden cardiac arrest