TEST 3 cardiac & rhythms

Question 1

1. Post op nursing actions for aortic valve replacement (Ch 29 pp slide 10)

Answer 1

 Daily weights
 Administer ordered pain meds round the clock
 Warming blankets (at risk for hypothermia)
 If mechanical valve will need anticoagulation meds (monitor PTT lab)

Question 2

2. Warafin K,H,K (include diet)

Answer 2

Uses:
 prevent clot formation & stops growth of existing clots
Know:
 No garlic supplements when taking warfarin(warfarin/Coumadin)- slow can take up to 5 days to work

 Antidote = vitamin K (made by bacteria in the gut)
 Risk for bleeding or hemorrhaging
 Monitor Labs-warfarin(weekly)
 INR (2-3 therapeutic level) after surgery maybe higher (Measures how long blood takes to clot)
 Watch vitamin K food (don’t eliminate, but don’t add)
 Intake should be kept at stable level
 Might see bruising, blood vessels in the face, bleeding teeth, black tarry stools, emesis

Question 3

3. Post op nursing actions and client education after cardiac surgery (pg. 317).

Answer 3

Nursing actions:
 Hemodynamic monitoring in place
 I & O hourly

Education:
 Educate client that activity increases gradually- starting w/simple walking program around 400 ft BID for 1st 2 weeks increasing to 1.25 miles by the end of 2nd week.
 Fatigue & anorexia is more common in older people for 1st month
 Encourage client to get out of bed daily
 Repeat preop instructions on coughing & deep breathing, as well as other preventive measures to prevent pneumonia and DVT formation
 No heavy lifting over 10lbs for 6-12 weeks.

Question 4

4. Elective cardioversion nursing plan of care (ch.26 pp slide 20):

Answer 4

 If no control might choose elective cardioversion(nonemergency procedure to stop rapid, but not necessarily life threatening)
 Deep sedation, supine position
 Limited oral intake
 Hold digitalis 1-3 days prior

Question 5

5. Mitral valve stenosis client education

Answer 5

 Drug therapy: daily aspirin, anticoagulants, antibiotic therapy
 Report complications (signs of emboli formation, chest pain- MI)
 Must sleep in sitting position

Question 6

5. Mitral valve stenosis manifestations (pp slide 16)

Answer 6

 Fatigue & dyspnea after slight exertion
 Tachydysrhythmias
 Dyspneic at night (must sleep in sitting position)
 Cough productive of pink frothy sputum, crackles
 Changes in heart sounds
 Neck vein distention
 Peripheral edema

Question 7

6. atrial fibrillation: medical management (ch.26 pp slide 9)

Answer 7

Chemical cardioversion
Heparin (initially if arrythmias persists longer than 48hrs), Coumadin (persistent atrial fibrillation)
 Ibutilide (Corvert)
 Elective cardioversion or digitalis

Question 8

7. Aortic regurgitation: medical management (pp slide 12)

Answer 8

 Cardiac glycosides
 Beta Blockers
 Diuretics
 Prophylactic antibiotics
 Modify lifestyle
 Surgical management: aortic valve replacement, vascular graft

Question 9

8. PVC manifestations (ch.26 pp slide 13)

Answer 9

 Pallor
 Nervousness
 Sweating
 Faintness
 “fluttering” sensation in the chest

Question 10

9. Pacemaker insertion nursing actions and client education (ch.26 pp slide 21)

Answer 10

 Complication of pacemaker: dislodgement w/in 1st several hrs ( avoid movement in affected arm)
 Educate accurate pulses every AM for one full minute on neck or wrist to ID variation
 No restrictions on using microwaves, radios ect.
 Notify provider is increase in fatigue, hiccups
 Sexual activity can after 6 weeks
 Will see a spike on future rhythm strip

Question 11

10. Ventricular dysrhythmias cause (pg.348):

Answer 11

 hypokalemia

Question 12

11. Maze procedure therapeutic response (ch.26 pp slide 9):

Answer 12

 Surgical procedure: maze procedure (restores normal conduction pathway in the atria by eliminating the rapid firing of ectopic pacemaker sites using scar-forming techniques

Question 13

12. Implantable cardiac defibrillator client ed/nursing considerations (Ch. 26 pp slide 21):

Answer 13

 Automatic Implanted cardioverter defibrillator (AICD): internal electrical device used for select clients w/recurrent life-threatening tachyarrhythmias; cardiomyopathy
 Electronic devices placed close to device could cause electromagnetic interference. (NO MRI’s)

Question 14

13. Types of rejection for transplant (ch.29 pp slide 13)

Answer 14

 Acute: 1 wk – 3 mos
 Hyperacute: rare w/in minutes
 Chronic: any other time over lifetime
 HR will beat faster than normal heart for clients that just underwent heart transplant surgery.

Question 15

13. Rejection manifestations (ch.29 pp slide 13)

Answer 15

 Fever, flu like symptoms
 SOB, chest pain
 Weight gain
 Fatigue
 Elevated BP

Question 16

14. Know OPCAB (ch.29 pp slide 6)

Answer 16

 Off- Pump Coronary Artery Bypass
 No use of cardiopulmonary bypass machine, adenosine (Adenocard) used to slow HR (about 40 bpm)
 Advantages: reduced mortality rate, fewer post op complications, decreased postop recovery time.

Question 17

15. What does a permanent pacemaker look like on an ECG strip?

Answer 17

Has a small spike followed by the P wave

Question 18

17. Medical and Nursing actions for V Fib (ch.26 pp slide 16)

Answer 18

 Rhythm of a dying heart
 PVC’s or ventricular tachycardia can precipitate it; ventricles don’t contract effectively; no cardiac output
 Treatment: cardiopulmonary resuscitation (CPR) & defibrillation
 Report to provider immediately!!