Medical School, Nursing and Health Professionals – Learning Activity Sheet
|Typical signs and Symptoms of this disease process||Any labs and diagnostic tests. What results indicated the problem||Non-pharmacologic treatment that maybe ordered||Nursing responsibilities related specifically to this problem|
|Atrial fibrillation is a condition of heart’s atrial muscle quivering uncontrollably. Therefore, the blood doesn’t get pumped out effectively to the lower ventricular chambers and risk clotting in there. The atrium doesn’t contract normally during diastole and the fibrillation rhythm is irregular. The electrical impulses send by sinus node for a regular heartbeat is cut down by rapid abnormal electrical discharges taking place in the atria.
Common causes include stimulants such as coffee and tobacco, COPD, rheumatic fever, hyperthyroidism, atherosclerosis, acute heart failure, myocardial infarction and cardiac surgery.
|Irregular pulse, tachycardia, palpitations, activity intolerance, chest pain, SOB, edema, light headedness, weakness, confusion, and fatigue.
Two major complications of A-fib include stroke and heart failure.
|EKG: how fast and strong the heart is beating; chaotic beat above 350 is a-fib.
Holter Monitor: an electrode is placed on chest and records the heart activity for more than 24 hour period, including when doing activities.
Event Monitor: can record heart for more than a month but it is only records during specific times that are scheduled.
Echocardiography: sound waves are used to draw condition of the heart, including the shape, size, valves and how they are working. It is done through thoracic; the transesophageal (TEE) uses flexible tube send through esophagus.
Chest x ray, physical, blood and stress test can also be used.
|Reducing stress. Quit smoking. Low salt diet to control blood pressure. Avoid alcohol, caffeine and other stimulants that risks increasing heart rate. Maintain easy physical activities and eat healthy foods.||Any supplement or medications that contain stimulants need to be addressed.
If the patient is prescribed anti-coagulants for treat clotting problems currently, it may need to put on hold the day blood test is scheduled.
Assess signs for decreased tissue perfusion, including cool and clammy skin, weak and thready pulses, and slow capillary refill.
Monitor blood pressure and pulse frequently.
Record intake and output.
|CHF (Congestive Heart Failure) is a condition where heart is not able to pump enough blood to the rest of the body. It also causes a backflow problem, where the returning blood accumulates and causes congestion in the surrounding tissues.
Causes include narrowing the arteries, effect of myocardial infarction, HTN, heart valve disease, cardiomyopathy, arrhythmias and many other diseases affecting the heart.
|SOB, fatigue, swelling in the lower extremities, irregular heartbeat, weight gain, loss of appetite, cough, difficulty sleeping, palpitations, chest pain, and difficulty concentrating.||Physical examination of leg edema.
Chest x ray for pleural effusion.
Liver function test for inflammation possibly from liver swelling.
Fluid, electrolyte, and urinalysis test to find sodium imbalance.
Blood test for enzymes distorted by heart malfunctions.
Ejection Fraction, EF, to test how well the heart pumps with each beat.
Cardiac Catheterization to determine function and whether the heart is clogged.
ECG and EKG to track how well electrical impulses are travelling in the heart.
|Elevate the swollen legs and use pressure reducing mattresses.
Go on low salt diet, but continue eating fresh fruits and vegetables.
Get enough rest.
Don’t drink water more than you need to.
|Conserve patient’s energy by do simple non-strenuous exercises to prevent sob.
Assist with range of motion to promote circulation.
Position the client in semi-fowlers position.
Monitor vital signs frequently.
Asses for signs and symptoms of fluid overload, activity intolerance and mental status alteration.
|Deep Vein Thrombosis (DVT) is a blood clot that occurs in the deep vein of the body; often times it happens in the leg. Deep veins lie in group of muscles. This blood clot blocks vein that brings blood from lower part of the body to the heart causing pain, warmth and swelling. Blood usually forms small clots all the time, but our body breaks them down as they move along. There are many possible causes for DVT: immobility can lessen the blood circulation that can form clots; hypercoagulability due to smoking, thicker blood, medications, and cancer; damage to the vein via injury, procedure or simple bruising.||About half of people with DVT have no symptoms.
Swelling of the leg.
Increased warmth in the swelling area.
Redness or discolored skin.
|Ultrasound can determine whether clot exists or not.
Physical exam by assessing the shape, size and other characteristics of the lower extremities.
D-dimer test – measures a substance that is released when blood clot dissolves.
Venogram – an x-ray that helps track down the vein pathways and sometimes are clot are discovered.
MRI may help determine any venous valve turbulence.
|Wear elastic compression devices to prevent blood from pooling together at the site.
Walking or doing exercises to promote circulation.
Elevation of the affected leg.
Use heating pads 20-30 minutes daily to reduce pain and swelling.
Intermittent pneumatic boots.
|Exercise the lower calf muscles.
Vitamin K might complicate the anticoagulant purposes.
Monitor your diet and fluid intake.
Assess for any bleeding complications from blood thinning medications.
Monitor vital signs.
Use warm, moist pack on swelling to stimulate circulation and dissolute the clot but not dilate the vein too much at the same time.
|Pulmonary Embolism (PE) is a condition in which the arteries are lungs become blocked. Most commonly this blockage comes from smaller deep veins in legs and travels through the lung until it reaches a vessel that is too small to allow further movement. Other causes of PE include small masses of infectious material, fat released after injury or surgery into the bloodstream, and air bubble from trauma. All the risk factors for DVT are also risk factors for PE.||Sudden onset of chest pain and SOB. Coughing up bloody sputum. Rapid breathing and heart rate. Weak pulse. Palpitations, anxiety, sweating and fainting.||Lung scan test can study airflow and bloodflow in lungs.
CT scan can help prepare 2 dimensional image of lung without any invasive procedure.
Pulmonary angiongram is the most accurate way to determine PE because it provides clear picture of the blood flow in arteries of lungs.
MRI uses radio waves and magnetic field to produce detailed images of lungs to determine any abnormalities.
|Elastic compression stockings can prevent extension of thrombus. Exercise to keep the blood and fluid moving. Walk or flex your legs after sitting for long time. Use Intermittent Pneumatic Compression when in bed rest.||Monitor heart rate and respiration frequently.
Assess for swelling in the lower extremities.
Auscultate lung sounds.
Reassure to release anxiety and administer pain meds as necessary.
Administer oxygen as per physician’s order.
Reduce unnecessary movements to decrease oxygen demands.
Assist with ambulation or rang of motions.
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of Basic Nursing (9th ed., pp. 1218-1246).
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(2008). In Mosby’s Dictionary of Medicine, Nursing & Health Professions (8th ed.). St. Louis, MO: Mosby.