Test 3 Valve Disorders

Question 1

1. Post op nursing actions for aortic valve replacement.

Answer 1

• Daily weights
• Administer ordered pain medications round the clock.
• Warming blankets (at risk for hypothermia)
• If mechanical valve will need anticoagulation meds
- Monitor pTT (range: )

Question 2

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

Answer 2

• No garlic supplements when taking warfarin
• INR:2-3
• Vitamin k antidote
• Watch for any bleeding or hemorrhage

Question 3

3. Post op nursing actions after cardiac surgery.(Slide 18)

Answer 3

• Hemodynamic monitoring in place
• I & O hourly

Question 4

3. Post op client education after cardiac surgery.(Slide 18)

Answer 4

• Educate client that activity increases gradually staring with simple walking program around 400 ft BID for first 2 weeks increasing to 1.23 miles by end of second week.
• Fatigue and anorexia are more common in older people for first month.
• Encourage client to get out of bed daily.
• Repeat preop instructions on coughing and deep breathing, as well as other preventive measures to prevent pneumonia and DVT formation.
• No heavy lifting over 10 Ibs for 6-12 weeks

Question 5

4. Elective cardioversion nursing plan of care: (Slide 20)

Answer 5

Elective electrical cardioversion: nonemergency procedure to stop rapid, but not necessarily life threatening.
Nursing Care
• Deep sedation
• Supine position
• Limited oral intake
• Hold digitalis 1-3 days prior.

Question 6

5. Mitral valve stenosis manifestations: (Slide 16 )

Answer 6

• Fatigue and dyspnea after slight exertion
• Tachydysrhythmias
• Dyspneic at night
• Cough productive of pink, frothy sputum
• Crackles
• Change in heart sounds.
• Neck vein distention
• Peripheral edema

Question 7

5. Mitral valve stenosis client education

Answer 7

• Must sleep in sitting position due to dyspneic at night?

Question 8

6. Atrial fibrillation: medical management (slide 9)

Answer 8

• Chemical cardioversion
• Heparin: prescribe initially if the Arrhythmia persist longer than 48 hours; Coumadin: persistent atrial fibrillation
• Ibutilide (corvert)
• Elective cardioversion or digitalis: atrial fibrillation

Question 9

7. Aortic regurgitation: medical management (Slide 12)

Answer 9

• Cardiac glycosides
• Beta blockers
• Diuretics
• Prophylactic antibiotics
• Modify lifestyle.

Question 10

7. Aortic regurgitation: surigical management (Slide 12)

Answer 10

• Aortic valve replacement
• Vascular graft

Question 11

8. PVC manifestations(slide 13)

Answer 11

• Pallor
• Nervousness
• Sweating
• Faintness
• “fluttering” sensation in chest

Question 12

9. Pacemaker insertion nursing actions

Answer 12

• Complication of pacemaker is dislodgement within several hours- avoid movement in affected arm.

Question 13

9. Pacemaker insertion client education(Slide 21)

Answer 13

• Accurate pulses every AM for one full minute on neck or wrist to ID variation
• Microwaves; radios etc. No restrictions
• Notify provider if increase fatigue, hiccups.
• Sexual activity after 6 weeks
• Will see a spike on future rhythm strips.
• Wear Medic Alert bracelet (use hand scan in airport)

Question 14

10. Ventricular dysrhythmias cause:

Answer 14

• Hypokalemia

Question 15

11. Maze procedure therapeutic response:

Answer 15

Surgical Management: Maze procedure for Cardiac Arrhythmias
• Restores the normal conduction pathway in the atria by eliminating the rapid firing of ectopic pacemaker sites using scar-forming techniques.

Question 16

12. Implantable cardiac defibrillator client ed(Slide 21)

Answer 16

Nursing considerations
• Electronic devices placed close to device could cause electromagnetic interference. NO MRIs

Question 17

13. Know the 3 rejection types for transplant. (Slide 13)

Answer 17

Types
• Acute: 1wk to 3 months
• Hyperacute: rare within a few minutes
• Chronic: any other time over lifetime

Question 18

13. Manifestations for transplant

Answer 18

Hyperacute, Acute or chronic rejection
• Fever, flu like symptoms
• Shortness of breath
• Chest pain
• Weight gain
• Fatigue
• Elevated blood pressure

Question 19

14. Know OPCAB

Answer 19

• Off-Pump Coronary Artery Bypass
• No use of cardiopulmonary bypass machine; adenosine (Adenocard) used to slow heart rate.

Question 20

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

Answer 20

• Will see spikes on ecg strips after permanent pacemaker put in

Question 21

17. Medical and Nursing actions for V Fib(Slide 16)

Answer 21

Rhythm of a dying heart
• PVCs or ventricular tachycardia can precipitate it; ventricles do not contract effectively; no cardiac output.
Treatment
• Cardiopulmonary resuscitation (CPR)
• Defibrillation