Question

Homework # 1-Sentinel Perioperative Event

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Homework 2-Interview someone with a history of cardiac issue (i.e. High blood pressure, high cholesterol, CHF, myocardial infarction, etc.).

1. How long has the client had the issue(s)?
2. Is there a family history of cardiac issues?
3. What medications are being taken to address the issue? (List name, dosage, and frequency of medications related to the cardiac condition ONLY).
4. How is the cardiac condition being managed?
5. Discuss any education you provided to the client regarding his or her treatment plan. ( 2 key points)

Answer 1

ANSWER- HOMEWORK 2- i) it is a chronic conditions  or  he had a family history also

ii) it can be family history of cardiac issue

iii) Medications are - thrombolytic agents - to dissolve and lysis the thrombus in a coronary artery ex- tissue plasminogen activator ( t-PA) , streptokinase , urokinase

• antiplatelet therapy - to prevent platelet aggregation ex- aspirin
• anticoagulant therapy - ex- heparin
• analgesic- ex - morphine sulphate
• vasodilator therapy - ex- nitroglycerin ( IV or sublingually) promote relaxation of coronary artery
• Beta- adrenergic blocking agents ( B- Blocker) - to decrease workload to heart and decrease oxygen demand to myocardium
• Ca channel blocker - to improve the balance between oxygen supply and oxygen demand

- to treat CHF - digitalis ( cardiac glycosides) - The most common prescribed form of digitalis is digoxin.

- digoxin is a cardiac glycoside derived from digitalis

-Action - it increase the force of myocardial contraction , hence increase cardiac output and improve blood flow to the periphery and kidney , decreasing oedema , congestion and fluid retention

doses of digoxin - tablet = 0.125, 0.25, 0.5mg injection - 0.25 mg/ml , 0.1 mg/ml

side effect (digoxin toxicity) - anorexia , nausea, vomiting , headache , blurred vision, diplopia and photophobia, drowsiness , fatigue, weakness, bradycardia

-implementation when patient is on digoxin - monitor the sign of toxicity and serum digoxin level (normal level is 0.5 to 2.0 ng/ml)

• monitor potassium level and if hypokalemia occur ( K level below 3.5mEQ/L) , the physician is notified because hypokalemia can cause digoxin toxicity.
• monitor pulse rate ( heart rate ) , if it is below 60, medication should be held and the physician is notified .

​​​​​​​- diuretics - they are used to increase the rate of urine production and the removal of excess of extracellular fluid from the body and reduce the workload of the heart. example - chlorothiazide , furosemide (lasix) , spironolactone.

These drug cause hyponateremia.

- inotropic reagents - ex- dopamine and dabutamine - it facilitate myocardial contractility , hence increase stroke volume and cardiac output

- angiotensin - converting enzyme inhibitor - ex- captopril . they decrease after load and preload to heart by causing vasodilation and diuresis.

iv) cardiac condition managed by -

• keep the client quiet and calm
• elevated the head and loosen any tight clothing around the neck
• continuous cardiac monitoring
• provide semi-fowler position
• O2 administration , if required
• monitor intake and output
• if client become unconscious , immediate CPR must be used
• avoid unnecessary i.v fluid , blood transfusion and Na intake

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v) Health teaching -

• the patient should be advised for bed rest at the time of pain
  • Life Style Modification - avoid alcohol , smoking, tobacco , reduces the weight
  • dietary instruction - low sodium intake , low fat and high fiber diet
  • manage diabetes mellitus or hypertension
  • manage anxiety or stress
  • avoid heavy activity
  • fluid restriction if prescribed
  • weight monitoring

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