*NURSING > HESI MED SURG > HESI MED SURG STUDY GUIDE COMPLETE GUIDE SOLUTION (All)
HESI MED SURG STUDY GUIDE COMPLETE GUIDE SOLUTION Med-Surg Study Guide 2021 Heart Failure (HF) (10) S/S left HF and S/S right HF Signs & Symptoms Left sided failure (blood backing up in l... ungs) Right sided failure (blood backing o up Venus system = edema) *Dyspnea, orthopnea (shortness of breath while *Jugular vein distention Lying down), nocturnal dyspnea *Ascending dependent edema (legs, *Fatigue ankles, sacrum) *Displaced apical pulse (hypertrophy) *Abdominal distention, ascites *S3 heart sound (gallop) *Fatigue, weakness *Pulmonary congestions (dyspnea, cough, *Nausea and anorexia Bibasilar crackles) *Polyuria at rest (nocturnal) *Frothy sputum (can be blood-tinged) *Liver enlargement (hepatomegaly) *Altered mental status and tenderness *Manifestations of organ failure, such as *Weight Gain Oliguria (decrease in urine output) Treatment o Diuretics o Ace inhibitors = Valsartan o ARB’s o CCB;s o Digoxin = strengthens heart o Beta Blockers o Vasodilators = Nitro o Warfarin, Plavix, blood thinner How to monitor HF – patient education o Daily weight o Diet = low sodium o Smoking cessation o Position: high fowlers o Monitor VS o Monitor lab work o Heart rate = below 60 do not administer digitalis = listen to apical for a full minute Nursing actions/interactions associated with monitoring HF o AROM o Fluid restriction o Low sodium diet o Weights o I & O o Medications = 2 | P a g e diuretics digitalis = increase myocardial contraction which slows conduction normal 0.5 -2 Ace inhibitors = biggest side effects = cough Dobutamine for severe heart failure Digoxin = decrease in potassium Toxic s/s = halos, vision changes, arrythmias, N/V Oxygen above 92% o Monitor labs o Administer medications Patient Education o Low sodium diet o Emotional support o Effective breathing techniques o Daily weight at same time everyday notify dr. if more than 2lbs in a day or 5lb in a week. o Report swelling of feet or ankles o Report shortness of breath o Common adverse effects of medication Key assessments with meds associated with HF o Respiratory assessment o Auscultation o Urinary output o Weight o I & O o Blood Pressure o Ascites Patient education on meds used to treat HF o Lisinopril Hypotension Increased serum potassium Worsening renal function Cough o Losartan Hypotension Increased serum potassium Worsening renal function o Hydralazine Hypotension o Metoprolol Decreased heart rate Hypotension Dizziness 3 | P a g e Fatigue o Diuretics Electrolyte imbalances Renal dysfunction Decreased BP I & O Daily weights Hypokalemia Hypernatremia o Spironolactone Hyperkalemia Hyponatremia o Digoxin Bradycardia Toxicity Hemophilia (6) Both types of hemophilia are inherited as X linked traits so mostly men are affected o Hemophilia A (factor VIII deficiency) measured by aPTT (intrinsic Pathway) o Hemophilia B (Christmas Disease, factor IX deficiency) measured by aPTT (intrinsic Pathway) Treatment o Replacement of the missing factor VIII or IX o Fresh frozen plasma o Recumbent (manmade) factor treatment o aPTT = 30 - 35 Nursing actions/interventions when caring for hemophiliac o Sign/Symptoms Lethargy Joint pain o Prevent bleeding o Safety precautions (fall precautions) o Avoid IM injections o Avoid meds that may encourage bleeding o Monitor for internal bleeding Coffee ground emesis Cola colored urine Tarry stools Patient education on [Show More]
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