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, SpO2 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: wwwmmmm 1. Identify what rhythm, and approximate rate, this is Describe the steps the nurse needs to take now and include the rationale for your decisions. 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: 6. 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. medications he may be taking, and existing medical history, discuss the discharge education that should be provided

Answer 1

ANSWERS :

1.

• VITAL SIGNS

temparature : 98.4

respiration : 22

herat rate : 86

    Blood pressure : 148 /88 mm/hg

saturation : 92 % on 2 litre humidified 02 via nasal canula.

• SKIN

cholestrol deposits under the skin. ( xanthelasma)

• NECK

swollen neck

Dialated and visible pulsation of blood vessels.

• CHEST

​​​​​​​   

​​​​​​​ Wheezing during normal breathing.

heart murmer sound present

third heart sound present

• ABDOMEN

​​​​​​​ bruits sound present

• LOWER EXTRIMITIES

​​​​​​​ edema in the legs

2. Medication :

CORONARY ARTERY DISEASE

Tab : Atenolol - is a beta blocker :- this will treat angina, incresd cardiac action, used to control heart rhythm and reduce high blood pressure.

CONJUSTIVE HERAT FAILURE

Tab : isordil - it is a vasodilator. That widen the blood vessels, so that blood flows more easily through blood vessels.

HYPERCHOLESTEROLEMIA

Tab :Atorvastatin - anti lipid drug :- is a competitive inhibitor of HMG - CoA reductase..inhibition of the enzyme decreases de novo cholesterol synthesis, incresing expression of low density lipoprotien receptors on hepatoctes.

COPD ( CHRONIC OBSTRUCTIVE PULMONARY DISORDER)

Tab : Salbutamol is a broncho dialator

GASTRO INTESTINAL REFLEX DISORDER

Tab. pantoprazole is antacid which neutralizes stomach acidity and is used to relive heart burn , indigestion or an upset stomach.

1. this is the rhythm of artial fibrillation. Normally in irregulerly irregular ECG herat rate can be calculated by calculating the number of qrs complex in a 10 second ECG strip multiplied by 6, so here number of qrs complex is 12, so heart rate is 12 * 6 = 72 bts per minute.

2. For correcting to the sinus  rhythm, electric shock delivered to the herart through paddles placed on chest ( cardio version). If the herat rate is continuously irregular , there is chance of developing thrombus inside the heart chamber and may lead to embolization to the brain and develop stroke.

3. possible causes high blood pressure, coronary artery disease, exposure to stimulant substance like , tobacco, alcohol, smoking.

In this case the reason the precipitation factor for AF may be coronary artery disease and high blood pressure.

4. Medication used to treat the above condition

Heart rate can be controlled with medication like betablocker and digoxin.

Rhythm can be controlled with anti-arrythmic medications like propofenon, amiodarone,

anticoagulant are also used in patient at risk for developing stroke.

5. The given ECG is ventricular ectopic, this can be treated with beta blockers, radiofrequency catheter ablation.

6. Patient should be advise regarding life style modification such as :

• Mild to moderate exercise.
• Avoid excess salt intake in foods .
• Avoid worry and excess stress.
• Properly adhere to the medications given.
• Do follow up check-up every month or SOS.
• Take proper bed rest.
• Avoid heavy exercise and climbing upstairs.
• Come for check-up if developing chest pain, palpitation, excessive sweating etc...
• Don't stop medication without consulting doctor.