Mega Code Case Study

Describe the preoperative and postoperative care of a client having PTA/cardiac catch. What complications can occur post cardiac catch? The goal of EPIC (precancerous Translational intervention) is to open the blockage in the coronary artery. By opening the area that is blocked, it will help to refuses the myocardium. The faster this is done will help limit the amount of damage. This procedure should be done within minis of the patient arriving in the DEED.

Operatively, the nurse will need to ensure that the patient understands the procedure and has signed a consent form. The nurse will also need to gather a medical and medication history and any reactions to medications. The nurse will also check for labs, such as blood urea nitrogen and crestfallen levels. The patient will need an IV placed. The arterial pulses In both legs (femoral, politely, dorsal peddles, and posterior tibiae) should be checked and documented using a scale of O to 4.

The nurse should also explain what the patient will be experiencing during the procedure.

The patient will be awake but will receive analgesics and sedatives. They may feel some chest pain when the balloon is inflated. During the procedure, the nurse will monitor vital signs and assess for chest pain, shortness of breath, s/s of bleeding, changes in cardiac rhythm and presence of SST segment or T wave abnormalities. The patient should also be checked for neurological changes and their peripheral vascular status should be checked.

Post operatively, the patient should be monitored for s/s of myocardial schemas , thrombosis and bleeding.

The patient should be assessed for chest pain, SST segment changes and shortness of breath. Vitals should be monitored and attached for a drop In oxygen saturation, a drop In blood pressure or a decrease or increase in heart rate. The patient needs to be assessed for signs of bleeding at the catheter insertion site, as well as other body orifices. A hematite at the catch site can be a sign of internal bleeding. Vitals can also indicate signs of internal bleeding.

Hemoglobin, homoerotic and platelet level should be monitored.

The collagen sheath is a secure method of allows for homeostasis after a femoral artery puncture so that the patient may ambulate and discharge from the hospital earlier. The patient must also have their pulses checked to be sure that there is no schemas or thrombosis. The patient must keep leg straight and be on bed rest from four to six hours until homeostasis occurs. Complications that can occur post operatively include: myocardial Schemas, thrombosis, bleeding from catch/sheath site. When discharging the patient, teach them to monitor for of MI or angina, Infection, bleeding.

This Includes fever, swelling, oozing or bruising around catch site. The patient should also report numbness, tingling or pain in the leg used for the procedure as this might medication (aspirin or Coolidge) a satin and a beta blocker. The patient should also be taught to avoid pressure on the catch site, avoid lifting things heavier than boobs for two weeks and not to drive for a few days after the procedure. 2. Describe pharmacological management for the client with a myocardial infarction.

What is the difference between a STEM’, MOISTEN and Q wave myocardial infarction?

Pharmacological management for an MI patient includes: aspirin, oxygen, intro, loppers(beta 1 blocker), morphine sulfate (lowers BP). A normal EGG will show the SST segment level with the sclerotic line. Any deviation of the SST segment from the collectors line will determine how much damage is done to the heart muscle. STEM’ is an SST elevation that is above the sclerotic line. Any severe of prolonged elevation of the SST segment or new Q waves indicates a STEM’.

A EINSTEIN is most often associated with unstable angina. Q wave is a transferal MI that goes through the entire thickness of the heart. 3.

Describe pharmacological management for the client with a Heart failure. State the mechanism of action for the following medications utilized in heart failure: Primacy, Deputation, Nippier, Ace inhibitors, Anteater, Morphine sulfate? Pharmacological treatment for a patient with heart failure includes medications to improve pump function and reduce cardiac workload. These medications include diuretics, ACE inhibitors/negotiations receptor blockers, Dioxin, and Beta-blockers, and BAN.

Deputation is a Bal adrenaline agonies, and helps strengthen cardiac contractions. Primacy is a potent vacillator and improves cardiac contractions.

Nippier has potent vacillating effects in arterioles and venues. In the heart, nitric oxide reduces both total peripheral resistance as well as venous return, thus decreasing both preloaded and afterworld. For this reason, it can be used in severe carcinogenic heart failure where this combination of effects can act to increase cardiac output.

ACE inhibitors ACE inhibitors inhibit negotiations-converting enzyme, which is a component of the blood pressure- regulating rennin-negotiations system, thereby decreasing the tension of blood vessels and blood volume, which ends up lowering the blood pressure.

Anteater is a recombinant form of human a-type intrauterine peptide (hip), a naturally occurring hormone secreted by the ventricles, and helps relieve shortness of breath. Morphine leaflet causes peripheral vacillation, increasing venous capacitance and decreases venous return by depressing the responsiveness of alpha-adrenaline receptors. Since it decreases both preloaded and afterworld it can decrease myocardial oxygen demand. 4. What are the symptoms of Beck’s Triad in Cardiac Tampons and what is the treatment?

Cardiac Tampons is an emergent medical condition where there is an excess of fluid or blood in the pericardia sac.

This causes the heart to lose its ability to expand and contract properly resulting in insufficient blood flow to the body. Cardiac Tampons can be a complication from a number of conditions such as a thoracic dissecting aortic aneurysm, end-stage lung cancer, acute myocardial infarction, heart surgery, pericardium, wounds to the heart, etc. Early recognition of this syndrome is important.

Cardiac Tampons can be identified by Beck’s Triad which describes the three main clinical manifestations seen. These symptoms and symptoms include unstable angina, dispense, tachycardia, syncope, pallor, tachyon, absent or weak peripheral pulses and edema. Treatment includes immediate precariousness’s which is a procedure where the excess fluid or blood in aspirated using a needle from the pericardia sac.

The patient also may receive oxygen to decrease the workload of the heart, fluids to maintain a normal blood pressure, and eavesdroppers to increase blood pressure until precariousness’s can be performed.

A surgical periodicity’s or pericardia window may also be performed which includes removing part of the pericardium in order to drain the excess fluid or blood in the pericardia sac. 5. List the American Heart Association 2050 guidelines for CPRM in an Adult in Established order. What is the CPRM sequence? How many compressions to breaths, how many compressions per minute, depth? What is the management for a client in Systole utilizing these guidelines? A client in Systole would be unresponsive and not breathing with a flat line on the EGG monitor if one was applied.

One member of the health care team should get the DEAD defibrillator while another member checks the clients pulse and defines whether one is present or not within 10 seconds. If no breathing, pulse or it is irregular, the health care member should begin cycles of 30 compressions at a rate of at least 100/ min and at a depth of 2 inches (5 CM). They should allow for complete chest recoil after each compression. The airway should then be opened by tilting the clients head back slightly and two breaths should then be delivered while avoiding excessive ventilation.

The acronym to use for this sequence is C-A-B (chest compressions, airway, and breathing). This sequence should be performed, alternating between health care providers in order to deliver maximum quality chest compressions for two minutes and until the DEAD/defibrillator arrives.

The health care provider should then place the pads on the client’s bare, hairless chest. The client’s chest should be dry. One pad should be placed on the right center of the client’s chest above the Apple. The other pad should be placed slightly below the client’s other nipple to the left of their ribcage.

The pads should be placed at least inch away from any metal piercing or devices implanted in the client’s body.

Allow the machine to analyze the client’s rhythm and see if there is a shock-able rhythm. If there is a shock-able rhythm deliver 1 shock and resume CPRM immediately for 2 minutes. If the rhythm is not shock-able the health member should immediately resume CPRM for two minutes. The client’s rhythm should be assessed every two minutes. This should be continued until ALLS providers take over or the client begins to move. Name the appropriate treatment in sequence for each of the following rhythms V-Attach * With a pulse Treatment- Cardiologist (consultation), Synchronized carnivores (sedation, sync mode, 50-100 Joules on the r wave) * Without a pulse Treatment- CPRM, Defibrillator, Epinephrine or Possessing, Emendation * V-Fib * Treatment: CPRM, Defibrillator, Epinephrine 1 MGM or Possessing units, Emendation MGM followed by MGM (followed by continuous infusion if client converts) * 1st degree HUB * Occurs when? PR interval is >5 boxes, but regular Treatment- Nothing, Just watch it * 2nd degree HUB I * Occurs when? – Either SIRS gets wider, wider, wider then drops OR there are more P waves than SIRS * Treatment- If patient is asymptomatic then no treatment is necessary; If patient is symptomatic than drugs that may be contributing to this are discontinued, pacemakers may also be considered * 3rd degree HUB * Occurs when? The atria’s and ventricles are not communicating * Treatment- Pacemaker * Pulses Electrical Activity (PEA): This is a rhythm on the monitor and no pulse * Cause: Hypoxia, Hyperthermia, Hypothermia, Acidosis (H ions), Hypo/Hyperemia, Tablets (overdose), Tampons (cardiac), Tension pneumonia, Thrombosis (coronary or pulmonary) * Treatment- Treat the cause, CPRM, Epinephrine or Possessing 6.

Describe the mechanism of action, half-life, contraindications and dosing for the following medications: A) Emendation- * Mechanism of Action: Slows the sinus rate; Increases PR and CT intervals; Decreases peripheral vascular resistance (Vacillator) * Half-life: 13-107 days * Contraindications: Carcinogenic shock, severe sinus node dysfunction resulting in sinus brickyard, second or third degree therapeutically block, or symptomatic inns brickyard in the absence of an adequately functioning pacemaker.

Dosing: For pulses V Fib/V Attach MGM IV push, may repeat once after 3-min with MGM IV push B) Epinephrine- * Mechanism of Action: Fractionation; Maintenance of blood pressure and heart rate; Localization/prolongation of local/spinal anesthetic * Half-life: Unknown * Contraindications: Hypersensitivity to adrenaline amines, Cardiac arrhythmias, Some products may contain faculties or fluorocarbons and should be avoided in patients with known hypersensitivity or intolerance * Dosing: 2-2. OMG C) Possessing- Mechanism of Action: Alters the permeability of the renal collecting ducts, allowing reapportion of water. Half-life: 10-20 minutes * Contraindications: Chronic renal failure with increased BUN, Hypersensitivity to beef or pork proteins * Dosing: Pulses V Attach Fib, Systole, or PEA units as a single dose D) Adenosine- * Mechanism of Action: Restores natural sinus rhythm by interrupting re-entrant pathways in the VA node; Slows conduction time through the VA node; Coronary artery vacillation * Half-life: This dose may be repeated (single dose not to exceed MGM) E) Atropine- * Mechanism of Action: Inhibits action of acetylene’s at postcolonial sites located in smooth muscle, secretors glands, CANS; Increased heart rate; Decreased GIG and respiratory secretions; Reversal of musicians effects * Half-life: 4-5 hours * Contraindications: Hypersensitivity, Angle-closure glaucoma, Acute hemorrhage, Tachycardia secondary to cardiac insufficiency or trichinosis’s, Obstructive disease of the GIG tract * Dosing: Brickyard- 0.

1 MGM, may repeat as needed every 5 * Mechanism of Action: Peripheral vasoconstriction and as an entropic stimulator of the heart and dilator of coronary arteries; Constricting the blood vessels and increasing blood pressure and blood glucose levels * Half-life: 1-2 minutes * Contraindications: Hypertension due to blood volume deficit * Dosing: 8 to 12 mug/min -titrate to BP (Usual target: SUB: 80-100 or MAP=80). Usual maintenance: 2 to 4 mug/min 7. The nurse is caring for a client that presented to the emergency room in symptomatic brickyard.

The client was placed on a transmutations pacer and .NET to the cardiovascular international lab for a pacemaker.

How will the nurse know when receiving the patient in recovery if the pacemaker is working? A nurse is caring for a client coming to recovery after being placed on a pacemaker. The nurse would be able to tell that the pacemaker is working when the patient’s heart rate is equal to or greater than 60 beats per minute, the client denies any chest pains or shortness of breath, and the clients vital signs are within normal limits. The client’s LOC and pulses will be within normal limits.

The nurse would also be able to monitor the EGG. Trial and ventricular pacing can be seen on the electrocardiogram (EGG) as a pacing stimulus (spike) followed by a P wave or SIRS complex, respectively. The EGG has the ability to show normal and abnormal pacemaker function.

Other issues the nurse needs to be aware of are failure to capture and failure to sense. Define the following elements: Failure to Capture- Failure to capture (Nomenclature) happens when the pacemaker fires, but the chamber (atria, ventricles, or both) in which is being paced do not deplorable.

It can been seen on the EGG strip as a pacer spike that is not followed by a P-wave or SIRS complex. Common reasons failure to capture happens is because of escapement of the pacing wires or the energy level is set too low. This patient may become hypertensive and brickyard. Failure to Sense- Failure to sense (Under sensing) happens when the pacer does not recognize or sense the hearts natural electrical activity.