Question

Critical Thinking Questions: Cardiovascular Alterations

1. You are taking care of a 58-year-old post-MI patient brought back to the unit because of recurrent chest pain, shortness of breath, and the need for IV NTG.

            a. Prioritize your actions at this time.

            b. What assessment findings regarding MI would concern you?

            c. What pertinent information from the patient’s history would you want to obtain?

            d. What diagnostic tests do you anticipate?

2. Many patients now come into the hospital the same day that cardiac surgery is performed. Discuss methods for teaching patients effectively given this situation.

3. You are caring for a 63-year-old woman who has just returned to the cardiac care unit after PCI and stent placement to the right coro­nary artery. Her proximal right coronary artery had a 90% occlusive lesion. She has her arte­rial sheath in place to the right femoral artery. She is receiving IV NTG and eptifibatide (Integrelin).

            a. What type of dysrhythmia would you anticipate if her right coronary artery were to reocclude?

            b. Prioritize your actions on her arrival.

            c. What type of assessment would you perform regarding the sheath?

4. Mr. Phillips has been hospitalized three times in the past 2 months for chronic HF. What teaching and interventions can you implement to prevent rehospitalization after discharge?

Answer 1

1.a.Check for patency of airway and administer oxygen .Check his level of consciousness.Connect him to the monitor for analysing his vital signs and ECG.Provide him comfortable position like fowlers or orthopneic position. If his Blood pressure is stable administer medications ordered by physician.Ask for any bleeding disorders or alllergies. Gradual increase of dosage of IV NTG because it may lead to hypotension and even shock. So monitor BP and ECG closely.

b.Dizziness, variation in blood pressure, irregular heartbeat &rythm,elevated cardiac enzymes,ST segment elevation especially in posterior leads V7-V9.

c. Exact time when pain started, previous history of diabetes, hypertension. When he was previously admitted and discharge medications

d.ECG,Biochemical markers, ECHO, cardiac catheterisation.

2.Use technology for educating patients like customizing education materials into printouts about improving health related to heart.Analyse the learning style of patient and accordingly.Make patients understand the need for health education. Establish rapport, ask and answer questions, and consider specific patient concerns.Stimulate their interests about the condition.Question their understanding of the care, and plan for the next lesson.

3. a.Ventricular arrythmias,ST depression and ST elevation may be anticipated if her right coronary artery reocclude.

b. Administer oxygen and check airway patency.Make her remain in bedrest.Monitor vital signs.Observe for any bleeding and peripheral pulses. Administer medications especially antiplatelet drugs if recommended by physician.

c. Check peripheral pulses,temperature, skin colour and any sort of drainage