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Differentiate between acute & chronic CHF
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Differentiate between the pathophysiology and clinical manifestations of right-sided and left-sided congestive heart failure
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Analyze the pathophysiology, clinical manifestations, compenatory mechanisms, diagnostiv abnormalities, complications, therapeuric/nutritional,pharmacologic, and nursing management (including actue care, health promotions & maintenane ) of a patient with CHF
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Integrate the pathophysiology & clinical manifestation with the diagnostic abnormalities, therapeuticpharmacologic, and nursing management (including acute care, health promotion & maintenance) of a patient with CHF
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Relate the actions of medications used to treat CHF to the pahtophysiology of the condition
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Compare & contrast medications used to treat CHF
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Compare and contrast CHF as a primary disorder with CHF as a secondary disorder from pulmonary disease
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Discuss the physiological principles of hemodynamic monitoring i.e., pulmonary aretery catheter, intra-aortic balloon catheter (May be tested on again in this unit as it applie sto the subject matter)
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Descrive basic nursing care of a patient with hemodynamic monitoring ie pulmonary artery catheter, intra-aoric balloon catheter
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Discuss the rationale for use of the pulmonary artery catheter
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Discuss the rationale for use of the intra-aoric balloon pump for patients with CHF
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Compare cardiogenic (CHF) & non-cardiogenic pulmonary edema (ARDS)
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Analyze the pathophysiology, clinical manifestations, therapeutic, pharmacologic, and nursing management of a patient with pulmonary edema
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Interate the pathophysiology & clinical manifestations of pulmonary edema with the pahyophysiology of CHF
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Propose a nursing plan of care for a patient with CHF and pulmonary edema
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Breifly describe the pre-op & post-op care of the patient undergoing cardiac surgery
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Analyze the pathophysiology, clinical manifestation, diagnotic abnormalities, therapeutic, pharmacologic, and nursing managemtn (includeing acute care, health promotion & maintenance) of rheumatic fever & rheumatic heart disease
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Integrate the pathophysiology & clinical manifestation with the diagnostic abnormalities, therapeutic, pharmacologic and nursing management (including acute care, health promotion & maintenance) of thrumatic fever & theumatic heart disease
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Analyze the pathophysiology, clinical manifestation, diagnostic abnormalities, theraputic, pharmacologic and nursing mgt (including acute care, health promotion & maintenance) of valvular heart disease
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Compare & contrast the inflammatory hear conditions: pericarditis, endocarditis & myocarditis
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Analyze the pathophysiology, clinical manifestation, diagnostic abnormalities, therapeutic, pharmacologic, and nursing mgt of the inflammatory heart conditions
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Integrate the patho & clinical manifestation with the diagnostic abnormalities, theraputic, pharmacologic, and nursing mgt (including acute care, health promotion & maint) of the inflammatory heart conditions
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Analyze the patho & clinical manifestation, diagnostic abnormalities, therapeutic, pharmacologic, and nursing management of the following congenital heart conditions : acyanotic (ventricular septal defect (VSD), atrial septal defect (ASD), coarctation fo the aorta, patent ductus arteriosus, pulmonary stenosis, aortic stenosis); cyanotic (tetralogy of fallot, transportation of the great arteries, truncus arteriosus, hypoplastic left heart)
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Intefrate the pathophysiology & clinical manifestation with the diagnostic abnormalities, therapeutic, pharmacologic, and nursing mgt (including acute care, health promotion & maintenance) of the following congenital heart conditions ; acyanotic(centricular septal defect, atrial septal defect, coarctation of the aorta, patent ductus arteriosus, pulmonary stenosis, aortic stenosis) cyanotic (tetralogy of fallot, transportation fo the great arteries, trucus arteriosus, hypoplastic left heart
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Propose a plan of care foan infant or child with congenital heart defects
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Propose a plan of care for an infant or child with CHF
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Discuss the role of the nurse in assisting the child & family to cope with congenital heart disease
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Explain the mechanisms of action, uses, contraindications, normal doses, side-effects, and nursing considerations for medication used to treat the cardiac conditions discussed in the unit (ex. antidysrhythmics)
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Identify components of the EKG waveforms
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Calculate the rate and rhythm of ECG strips
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Analyze the significance of the ECG waveforms
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Alalyze the significance of the ECG waveforms
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Interpret the following ECG rhythm strips, NL sinus, Sinus Brady, Sinus Tach, Sinus Arrythmia, A-Fib, Premature Ventricular Contractions, V-Tach, V-fib- Asystole
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Integrate the pathophysiology & clinical manifestation with the therapeutic, pharmacologic, and nursing mgt of patients with the following dysrythmias : S Bradycardia, S Tachycardia. S Arrythmia, A-Fib, PVC, V-Tach, V-Fib, asystole
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Compare and contrast various methods of electrophysiologic therapy ie. pacemakers, cardioversion & defibrillation (implantable & external
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Discuss the therapeutic and nursing mgt of patients with pacemakers (temporary & permanent ) & implantable defibrillators
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Medication treament for dysrhythmias
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Three methods of Electrical Therapy - Defibrillation ,Cardioversion, Pacemakers, Implantable Defibrillator
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Goals in acute CHF
- Improve L ventical functions by:
- *Decreasing intravascular volume = Diuretics - Loop diuretics drugs of choice bec fast acting
- *Decreasing venous return = Hi fowler's position
- *Decreasing afterload = nitroprusside (Nipride) or morphine
- *Improving gas exchange = morphine
- *Increasing CO = digoxin (dobutamine {Dobutrex}, amrinone {Inocor}, milrinone {Primacor})= increase contractility w/o increase in O2 demand
- *Reducing anxiety = Morphine
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Medications of CHF
- (+) inotropics
- Diuretics
- Vasodilators
- Morphine
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Intra-aotric balloon pump (CHF)
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Inflammatory heart conditions
- Myocarditis = inflammation of the myocardium
- Pericarditis = inflammation of the pericardium
- Endocarditis= inflammation of the endothelial tussue of the hrt including hrt valves
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Rheumatic fever & hrt disease
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Sinus Bradycardia
- S&S : Syncope & CHF
- TX = Atropine or Isoproterenol : pacemaker may be needed
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Sinus Tachycardia
- S&S - Decreased CO = fatigue, dyspnea & dizziness
- Tx = Digoxin, beta blockers = propranolol (inderal) or diltiazem
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Atrail Fibrillation
- S&S - decreased CO = fatigue, dyspnea & dizziness
- TX = To decrease ventricular rate = diltiazem, digoxin, verapamil, quinidine, flecainide (Tambocor) beta blockers
- Slow ventricular response = atropine;
- -Other meds - propafenone (Rythmol), satalol (Betapace), & amiodarone (cardarone)= Careful monmitoring needed
- - Cardioversion = if meds do not work
- - Anticoagulants if pt in Afib greater than 24hrs - Coumadin
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Premature Ventricular Contractions
- S&S: Decreased CO
- TX - When; six or more PVC's/min : multifocal PVC's, Couplets or triplets ; R&T phenomenon : USE 1st drug of choice = lidocaine; 2nd drug of choice = procainamide (pronestyl)
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Ventricular Tachycardia
- S&S ; Decrease CO
- TX - lidocain - ofter first drug used - 2nd drug Procainamide - 3rd bretylium, Meds not working= if has a pulse = cardioverison -
- IF unconscious + no pulse = defibrillate
- - amiodarone may be used to surpress VT
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Ventricular Fibrillation
- S&S = unconscious, no pulse, apnea, seizures
- TX - Defibrillate & CPR
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Goals for TX of CHF -
- * Improve cardiac function = Digoxin & Ace inhibitors
- * Remove excess fluids & sodium = DDiuretic & low NA+ diet
- * Decrease cardiac demands = rest
- * Improve tissue exygenation & decrease O2 consumption
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Choice of Meds for CHF depends on:
- *Etiology of dysfunction
- *Need for acute or long-term management
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Digitalis Glycosides (+ Inotopics)
Action
- * Increases myocardial contractility (force of contraction) = C.O. ejection fraction
- * Reduces hrt, rate by slowing the rate of impulse through the conduction tissue (allows more filling of ventricles & enhances coronary circulation = decrease myocardial O2 demand = decreases supply of O2 & nutrients to myocardium)
- *Slows the conduction of impulses through the AV node & purkinje fibers & increases the AV nodal refractory period,
- * Diuretic effect dueto increased renal bld flow & filtration secondary to increased CO
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Digitalis Glycosides (+ Inotopics)
Use
- *Increased CO in acute & chronic CHF
- * Control atrial arrhythmias = slows transmission of impulses from atria protecting ventricles from over stimulation
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Digitalis Glycosides (+ Inotopics)
dosing
**** Caution It is commonly used ; Use is limited bec range between therapeutic & toxic doses is extremely narroTherapeutic Range 0.5-2ug/mlkids 0.8-2Watch for dig toxicity if K+ less than 3.0eq/l or serum magnesium is low
- Usual dose 0.125-0.25 mg Qd
- Available in elixir (0.05mg/ml) form ; infants - dose is calculated in micrograms (1000ug= 1mg)
- Give IV slowly over at least 5 min
- IM not advised
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Digitalis Glycosides (+ Inotopics)
Side effects and nursing care
- Nausea, vomiting, anorexia, bradycardia, dysrhythmias, visual disturbances (yellow borders around dark objects, flickering lights, blurry vision)
- Nursing care = Take apical pulse for 1min immediatly before giving med
- * Adults - if pulse is less than 60 hold med and call dr
- Infants and young children hold if pulse is less than 110 and older children less than 70
- Be sure to get a written order from the dr to hold the med.
- **** infants rarely receive more than 1ml in one dose always double check dose with another nurs
- Check K+ levels before giving and watch for signs of hypokalemia
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