Question

Initial Post

For your initial post, you should answer the prompt for the pediatric, adult, or geriatric population based on the first initial of your last name:

• A through H: Pediatric
• I through P: Adult
• Q through Z: Geriatric

Your initial post is due by Thursday at 11:59 PM EST.  Your responses are due by Sunday at 11:59 PM EST. 

Alyssa Carter (Pediatric Patient)

Brian Estes (Adult Patient)

Gladys Jones (Geriatric Patient)

PEDIATRICADULTGERIATRIC

Alyssa Carter is a 7 year old female who was born at 32 weeks gestation and was diagnosed with a Ventricular Septal Defect (VSD) at one year of age. Alyssa has been medically managed and has not required operative intervention. Her development matches her chronological age. She is in the second grade in a public elementary school. She is up to date on all immunizations.Alyssa presented to the emergency department twice over the past month with complaints of her “heart pounding”. Each time she was assessed and sent home without intervention. Alyssa’s mother brings her to the emergency department today again and reports that she was outside playing and came into the house complaining of her heart pounding and feeling like she had just gotten off the merry go round. The mom reports she was pale and sweaty. Her mother had her lie down on the sofa for 30 minutes, but the lightheadedness and pounding in her chest did not dissipate. The nurse places Alyssa on the cardiac monitor and notes a regar, narrow, complex rhythm with a rate of 174.

Brian Estes is a 52-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia. He is at the clinic today for a yearly physical examination at the urging of his wife. He is a mid-level manager at an electronics company and has been under considerable work stress in the past six months. He admits to being a “couch potato”. He was prescribed amlodipine (Norvasc) at his last physician appointment 15 months ago. He admits to taking his medication on “most days”. His total cholesterol is 224 mg/dL; HDL 45 mg/dL; LDL 179 mg/dL; and triglycerides 200 mg/dL. He is 5’ 10” and weighs 201 pounds with a BMI of 28.8, He has a positive family history of CAD. His father had a myocardial infarction at age 54, and his grandfather died of a myocardial infarction at age 42. His current vital signs are temperature 97.6 orally; pulse 86 and regular; blood pressure 178/96 mmHg; and respirations 14/min.

Gladys Jones is a 75 year old woman who was admitted to the telemetry unit from the emergency department with a diagnosis of new onset atrial fibrillation with rapid ventricular response. Her past medical history includes Type 2 DM and hypertension. She has a 40 pack-a-year smoking history but quit smoking one year ago. She has a saline lock in the left forearm, is on oxygen at 2 liters per minute via nasal cannula, and is on a telemetry monitor. Current vital signs include temperature 97.2 orally; respirations 22/min; pulse 127 and irregular; blood pressure 90/62 mmHg; and oxygen saturations 91%. The provider has written the following orders: Transesophageal echocardiogram today; Serum TSH, T3 and T4; liver function tests, CBC, and metabolic panel; Sotalol 10 mg po bid; Warfarin 5 mg po each evening; prepare for synchronized cardioversion tomorrow morning

In your initial post, please address the following questions:

1. What physical assessment findings will the nurse expect?
2. Describe the three priority interventions and the rationale for these interventions the nurse will perform.
3. The vagal maneuvers are not successful and the ED physician has ordered Adenosine to be administered. Describe the pharmacologic action of Adenosine and the key nursing considerations of administering this medication.
4. Alyssa converts to an NSR at 90 beats per minute after two doses of adenosine. The physician discharges her with a prescription of oral digoxin. Develop patient/family medication education for Alyssa prior to discharge.

Answer 1

1 CARDIOVASCULAR PHYSICAL ASSESSMENTS OF THESE PATIENTS; First take the proper history of the patient and record it with name and identification number

1 Inspection; provde privacy and up right position then start to inspect from throx from front and back. the symmertry and posture . The gross deformites of the skin and bones of neck face and eyes also the color.

2 Observe the cynosis; central ,and pheripheral. In cnetral cynosis there will be bue is discolouration in the Lipls,Mouth,Conjunctiva. The Peripheral cynosiswill cause mainly in Lips .Ear lobe,and Nail beds

3 Palpation; palpateand see the dialation of jugular veins

4 Auscultation ; to listen the abnormal sounds especially in the cse of VSD

2 Nursing Inervetions; aAsess the vitals ,Observe the cynosis , check the perperal pluse and capillary refils , reduce the activity of patient and assess the severity of pain

2 Adenosine the drug of choice of supra ventricular tachy cardia.

Nursing consideration during administraion of adenosine

1 adenosine can only be administered when cardiac defrillation facilities are available

2 a 12 lead ECG should be attended priorto administration and repeated after reversion

3 warn patients of possible side effects and stay with them throughout therepy although usually transient these can cause considerable discomfort

4 PVC's (premature ventricular contraction) commonly accompanies termination of a tachycardia by adenosine

5 dose must be given as a rapid injection and immediately flushed with 0.9% sodium chloride because of short half life

DIGOXIN

1 take this medication by mouth with or without food usually daily once

2 carefully measure the dose using the dropper

3 do not use household spoon as it has no acuurate measure.

4 the dosage of this medication is based on your medical condition,age,body weight,laboratory test and response to treatment

5 strictly follow up meeting physician in regular intervals

6 and blood digoxin level should be checked in regular intervals