EXPANDED! Abundant Safety Alerts focus on potential hazardous or high-risk issues. ers require very high doses. Pharmacogenetics is the study of how a person’s genes affect responses to med- ications. With scientific advances, genetic testing can now be used to determine responsiveness. In the case of warfarin, some patients are genetically fast metaboliz- ers, which can result in an increased risk of clotting and the need for higher or more frequent doses. In contrast, slow metabolizers have an increased risk of bleeding and require lower or less frequent doses. Patients who are fast or slow metabolizers may also respond similarly to other types of medications. Pharmacogenetic testing is not widely used due to availability, clinician knowledge, and regulatory and reimbursement issues, but it may be valuable. A more invasive surgical treatment is coronary artery bypass grafting (CABG) . With CABG, blockages in coronary arteries are bypassed using other arteries from the chest or arm or veins from the legs. In the traditional CABG, patients undergo general anesthesia. A large inci- sion through the sternum is made, and a cardiopulmonary bypass (CPB) is begun through large catheters in the vena cava or right atrium and aorta. A CPB provides continuous CONCEPTS a. Coronary artery disease b. Infective endocarditis a. Coronary artery disease b. Infective endocarditis
transluminal coronary angioplasty ( Pericardial effu Pericardiocent Pericarditis Prinzmetal’s/v angina Pulmonary ede Orthopnea Regurgitation Stable angina Stenosis Tamponade Transcatheter valve replace Unstable angin
Atherosclerosis Cardiac rehabilitation Compensatory mechanism Coronary artery bypass graft (CABG) Coronary artery disease (CAD) Ejection fraction Embolization Exercise stress test
nonobstructive CAD is being studied. Statins, angiotensin- converting enzyme (ACE) inhibitors, and beta blockers may be beneficial.
the workload on the heart and decrease myocardial oxygen consumption. • Administer beta blockers. Beta blockers decrease the sympathetic response (heart rate), thus reducing myocardial oxygen consumption. • Administer inotropic agents. Enhance contractility • Administer sodium glucose cotransporter 2 inhibitors (STGLC2i) Promote fluid excretion l Fluid and sodium restriction To prevent fluid overload ■ Teaching l Medication management Understanding and adhering to the medication treatment plan are essential for effective medication treatment. l Maintain activity as tolerated. Alternate rest and activity periods. To reduce muscle wasting and functional losses; to decrease workload on the heart l Low-salt diet To prevent fluid retention and exacerbation of HF l Daily weight at home at the same time each day, preferably in the morning after voiding Evaluate fluid retention and need to call provider l Cardiac rehabilitation Cardiac rehabilitation reduces mortality, improves functional status, reduces hospitalization, and improves quality of life. l Signs and symptoms of worsening HF checklist (edema, SOB, fatigue, and orthopnea) Knowing the symptoms can expedite treatment and reduce hospitalizations. l Immunization needs Patients with HF are vulnerable to communicable diseases such as influenza, COVID, and pneumonia. l Oxygenation l Perfusion Friction rub Heart failure Infective endocarditis (IE) Ischemia Aortic stenosis Atherosclerosis Cardiac rehabilitation Compensatory mechanism Coronary artery bypass graft (CABG) Coronary artery disease (CAD) Ejection fraction Embolization Exercise stress test Murmur Myocardial tissue Myocarditis Percutaneous transluminal coronary
plan should include frequent assessment, comprehensive patient education, and self-management. A well-managed patient has reduced dyspnea and fatigue, is able to actively participate in activities of daily living, and has reduced hospitalizations.
c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of: ESSENTIAL TERMS Acute coronary syndrome Angina
Medication Safety Alert: Nitroglycerin LEARNING OUTCOMES Content in this chapter is designed to assist in: 1. Describing the epidemiology of cardiac disorders 2. Correlating clinical manifestations to pathophysiological processes of:
Safety Alert
Making Connections
Nitroglycerin is a treatment for angina. Patients should be instructed to take this medication as prescribed, typically one tablet or spray under the tongue not to exceed three doses taken 5 minutes apart. If the symptom of angina (chest pain) is not relieved with three doses or if the pain worsens, they should be instructed to call emergency personnel. In addition, patients using medications such as sildenafil citrate (i.e., Revatio, Viagra) should be educated on the increased risk of hypotension with coadministration with nitroglycerin. a. Coronary artery disease b. Infective endocarditis
CASE STUDY: WRAP-UP Mr. Thompson’s ECG reveals atrial fibrillation with a heart rate of 130 to 140 bpm. His blood pressure continues to be high at 185/102 mm Hg. His respirations are still slightly labored and fast at 40 per minute. He continues on oxygen at 4 L/min via nasal cannula, with an oxygen saturation of 95%. The results of Mr. Thompson’s diagnostic tests reveal the following: • A chest x-ray indicates LV hypertrophy. • A transthoracic echocardiogram indicates an EF of 30%. • Cardiac biomarkers are negative for ischemia, with troponin I less than 0.1 ng/ml. • Renal function tests reveal borderline failure, with a creatinine of 1.5 mg/dL and a BUN of 30 mg/dL. • His BNP value is elevated to 500 pg/mL. Friction rub Heart failure Infective endocarditis (IE) Ischemia • Serum electrolytes reveal elevated potassium at 6.0 mEq/L. It is determined that Mr. Thompson is in HF, and he begins treat- ment. A diuretic is administered; an ACE inhibitor and a beta blocker are ordered. His SOB and color begin to improve. His transient chest pain resolves with treatment. Case Study Questions 1. The nurse has received the following orders for Mr. Thomp- son. Which order should the nurse implement first? A. Furosemide (Lasix) 40 mg IV B. Insert a Foley catheter C. Low-sodium, low-fat diet D. Apply sequential compression device 2. The nurse correlates which finding with Mr. Thompson’s atrial fibrillation with a heart rate of 120 to 140 beats per minute? A. Acute decompensation requiring immediate cardioversion B. Loss of atrial kick requiring fluid resuscitation C. Increased workload of the heart requiring beta blockers D. Cardiac ischemia requiring immediate cardiac catheterization 3. The nurse understands that Mr. Thompson’s sublingual nitro- glycerin decreases chest pain through which mechanism of action? A. Dilating the coronary arteries to improve blood flow B. Decreasing preload to relieve symptoms of dyspnea C. Decreasing heart rate to decrease cardiac workload D. Converting atrial fibrillation into sinus rhythm 4. Which statement by Mr. Thompson indicates that teaching about hyperkalemia has been effective? A. “The water pill makes my potassium level high.” B. “I should eat bananas because they make my potassium go down.” C. “My liver is not working, so it holds on to the potassium.” D. “My kidneys are not working, which makes my potassium high.” 5. The nurse providing care for Mr. Thompson should include which of the following in the discharge teaching plan? (Select all that apply.) A. Sodium restriction B. Daily weight C. Medication teaching D. Vigorous daily exercise E. Carbohydrate counting Making Connections to Clinical Judgment 1. Recognizing Cues: What clinical findings of heart failure does Mr. Thompson have? 2. Analyzing Cues: How do the physical findings relate to the pathophysiology of heart failure? 3. Prioritizing Hypotheses: What are the highest priority findings that need to be addressed? Why? 4. Generating Solutions: What interventions would best address Mr. Thompson’s respiratory needs? 5. Taking Actions: What are the nursing intervention priorities? 6. Evaluating Outcomes: What are the findings related to fluid balance that would indicate an effective response?
angioplasty (PTCA) Pericardial effusion Pericardiocentesis Pericarditis Prinzmetal’s/variant angina Pulmonary edema Orthopnea Regurgitation Stable angina Stenosis Tamponade Transcatheter aortic valve replacement Unstable angina
c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of:
Unfolding Case Studies help students make the connections to practice. Finding Connections introduces a patient related to the chapter content, and then students follow the scenario as it unfolds throughout the chapter. Making Connections provides a wrap-up of the case and concludes with questions that require students to apply their knowledge. c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardiac disorders 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with cardiac disorders
a. Coronary artery disease b. Infective endocarditis
l Caring l Infection l Inflammation c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardiac disorders 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with cardiac disorders
Percutaneous transluminal coronary angioplasty (PTCA) is the procedure most commonly performed to relieve symptoms caused by atherosclerotic changes in the coronary vessels. During this procedure, after the patient receives monitored anesthesia care (MAC), a catheter
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Unit VI Promoting Health in Patients With Circulatory or Perfusion Disord
5 rounding the h manifestation is include an elec cardiac comput resonance ima pain control w ties include pai of treatment an of pericardial e priorities includ heart attack to e appropriately w Valvular dise of the innermos heart valves ar transthoracic ec ing the presenc IV antibiotics. I biotic therapy c ment. Nursing especially for th of ongoing acut nance of good provider about procedure. Myocarditis dium most com mune diseases. dysrhythmias, d failure. Medica heart failure, d that may occur includes medica Pericarditis factors for CAD are used to rule ing CAD is a co with CAD is o ping the aggreg endothelium, (b of the endothel neous translum most commonly care priorities i and administeri factors and relie understanding t lifestyle to limit Infective end 05/
Finding Connections
05/04/23 4:58 PM being nonadherent with his meds because “I feel okay.” He reports he was in his usual state of health until about 3 weeks ago. At that point, he reports feeling short of breath and fatigued unrelated to physical activity. Over the past 3 weeks, his symptoms have pro- gressed to the point where he sleeps in his recliner every night. He is admitted to the step-down unit for further management.
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CONCEPTS
l Caring l Infection l Inflammation
l Oxygenation l Perfusion
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CASE STUDY: EPISODE 1 Follow this patient throughout the chapter.
Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to being nonadherent with his meds because “I feel okay.” He reports he was in his usual state of health until about 3 weeks ago. At that point, he reports feeling short of breath and fatigued unrelated to physical activity. Over the past 3 weeks, his symptoms have pro- gressed to the point where he sleeps in his recliner every night. He is admitted to the step-down unit for further management. ..
Finding Connections
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CASE STUDY: EPISODE 1 Follow this patient throughout the chapter.
Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to
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NEW! Making Connections to Clinical Judgment presents brand-new questions applying the six steps of the NCSBN Clinical Judgment Measurement Model to practice, using the patient from the unfolding case study.
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NEW! Making Connections to Clinical Judgment tables* provide a clinical judgment analysis of the chapter case study, visually connecting each step of the Clinical Judgment Measurement Model with the Making Connections to Clinical Judgment questions in book.
*Online in Davis Advantage
CHAPTER SUMMARY
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