Pediatric
Alyssa Carter is a 7 year old female who was born at 32 weeks gestation and was diagnosed with a Ventricular Septal Defect (VSD) at one year of age. Alyssa has been medically managed and has not required operative intervention. Her development matches her chronological age. She is in the second grade in a public elementary school. She is up to date on all immunizations.
Alyssa presented to the emergency department twice over the past month with complaints of her “heart pounding”. Each time she was assessed and sent home without intervention.
Alyssa’s mother brings her to the emergency department today again and reports that she was outside playing and came into the house complaining of her heart pounding and feeling like she had just gotten off the merry go round. The mom reports she was pale and sweaty. Her mother had her lie down on the sofa for 30 minutes, but the lightheadedness and pounding in her chest did not dissipate.
The nurse places Alyssa on the cardiac monitor and notes a regular, narrow, complex rhythm with a rate of 174.
In your initial post, please address the following questions:
What physical assessment findings will the nurse expect?
Describe the three priority interventions and the rationale for these interventions the nurse will perform.
The vagal maneuvers are not successful and the ED physician has ordered Adenosine to be administered. Describe the pharmacologic action of Adenosine and the key nursing considerations of administering this medication.
Alyssa converts to an NSR at 90 beats per minute after two doses of adenosine. The physician discharges her with a prescriiption of oral digoxin. Develop patient/family medication education for Alyssa prior to discharge.
Adult
Brian Estes is a 52-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia. He is at the clinic today for a yearly physical examination at the urging of his wife. He is a mid-level manager at an electronics company and has been under considerable work stress in the past six months. He admits to being a “couch potato”. He was prescribed amlodipine (Norvasc) at his last physician appointment 15 months ago. He admits to taking his medication on “most days”.
His total cholesterol is 224 mg/dL; HDL 45 mg/dL; LDL 179 mg/dL; and triglycerides 200 mg/dL. He is 5’ 10” and weighs 201 pounds with a BMI of 28.8, He has a positive family history of CAD. His father had a myocardial infarction at age 54, and his grandfather died of a myocardial infarction at age 42.
His current vital signs are temperature 97.6 orally; pulse 86 and regular; blood pressure 178/96 mmHg; and respirations 14/min.
In your initial post, please address the following questions:
What are the three questions the nurse should ask to determine how the client feels about his current health status?
What are two possible nursing diagnoses for this client?
Develop a health teaching plan for Mr. Estes; include four nursing interventions and rationales to address his modifiable risk factors for CAD.
Geriatric
Gladys Jones is a 75 year old woman who was admitted to the telemetry unit from the emergency department with a diagnosis of new onset atrial fibrillation with rapid ventricular response. Her past medical history includes Type 2 DM and hypertension. She has a 40 pack-a-year smoking history but quit smoking one year ago.
She has a saline lock in the left forearm, is on oxygen at 2 liters per minute via nasal cannula, and is on a telemetry monitor. Current vital signs include temperature 97.2 orally; respirations 22/min; pulse 127 and irregular; blood pressure 90/62 mmHg; and oxygen saturations 91%.
The provider has written the following orders: Transesophageal echocardiogram today; Serum TSH, T3 and T4; liver function tests, CBC, and metabolic panel; Sotalol 10 mg po bid; Warfarin 5 mg po each evening; prepare for synchronized cardioversion tomorrow morning
What is the rationale for each of the orders written by the provider?
What are three potential nursing diagnoses for Mrs. Jones?
What are the nursing responsibilities in preparing the client for the transesophageal echocardiogram and potential synchronized cardioversion?
The physician has elected to perform synchronized cardioversion on Mrs. Jones. What are the essential nursing functions during the synchronized cardioversion and immediately following?
