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