Evolve Case Study: Heart Failure with Atrial Fibrillation – Flashcards
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For someone with HR what is an important question to ask that would increase risk factors?
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have you ever had a heart attack? CAD, or ischemic heart disease all cause HF
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What are S&S of right sided heart failure?
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edema, JVD, enlarged liver, abd ascites, and weight gain
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What are S&S of left sided heart failure?
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fatigue, tachycardia, dyspnea, (left = lungs), pulmonary congestion, crackles ect..
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Does L or R sided HF usually come first?
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LEFT! and then L eventuallly leads to Right sided HF!
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what rythm commonly occurs in HF?
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A-Fib
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what does no discernable P waves mean?
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that the p waves are not present or not normal or cant be identified! (p waves are not observable)
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What do you do for A-Fibb?
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FIRST GIVE DIG!!!!!!!!!!! THEN you can cardiovert!!!
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What diagnostic test is used to measure pressure within the Right Atrium?
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pulmonary artery catheterization
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what is an echocardiograph usually used for?
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to look at valvular diseases of the heart, chamber enlargement or effusions
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what is electrocardiograph used for?
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detecting if there is myocardia ischemia or injury and DYSRYTHMIAS
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What are Chest-XRays used for when looking at HF?
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to diagnose HF, elargement of the heart or pleural effusions of the heart
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what is colace used for?
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laxative/stool softener to prevent straining during a bowel movement
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what assessment should take place before administering Captopril? (ACE inhibitor)
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blood pressure! (they reduce afterload and workload on the heart)
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what is the theraputic level of dig?
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0.5 - 2 ng/ml
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what does Dig toxicity look like?
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visual disturbances (halow), confusion, nausea, HYPOkalemia, anorexia) ect..
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what is a common nursing diagnosis that comes with HF?
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impaired gas exchange!
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what are teaching instructions to give to a pt that is taking Dig?
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do not stop taking potassium supplements, regular blood draws will be necessary to get PT/INR levels, if missed a dose do NOT double the second dose,
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when taking Coreg (a medication) what do you need to tell the pt at discharge?
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avoid abrupt transistions to erect posture
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when taking ACE inhibitors like Capoten (captopril) what SE do you need to watchout for?
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angioedema
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what do lasixs do?
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reduce cardiac preload (to decrease the stretch and pressure of contraction that the heart has to do)
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What is the 1st thing you do when you suspect a person has dig toxicity?
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obtain a serum postassium level
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what imbalance places the clinet taking dig at the greatest risk for toxicity?
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hypercalcemia, hypokalemia, and hypomagnesmia (cuz calcium binds with dig to decrease the incidence of toxicity)
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what are early sign of dig toxicity?
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anorexia, nausea and vomitting
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what are late sign of dig toxicity?
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blurry of halo vision (visual disturbances)
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What drug do you give when a pt has dig toxicity?
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digibind
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what lab do you watch after giving digibind for dig toxicity?
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POTASSIUM!
