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The quick and easy way to master medical-surgicalnursing and use your knowledge in real-world situationsIf you're looking for a fun, fast review that boils medical-surgical nursing down to its most essential, must-know points your search ends here! You will learn about hallmark signs and symptoms, treatment, and nursing intervention so you have the knowledge to help your patients as a student and as a nurse once you start your career.
Studying is easy and effective with key objectives, important terms, brief overviews, tables and diagrams, andNCLEX-style questions throughout the book. This fast and easy guide offers: Learning objectives at the beginning of each chapter An NCLEX-style quiz at the end of each chapter to reinforce learning and pinpoint weaknesses Coverage of diagnostic tests and treatment options A final exam at the end of the book A time-saving approach to performing better on an exam or at work Simple enough for a beginner, but challenging enough for an advanced student, Medical-Surgical NursingDeMYSTiFieD is your shortcut to mastering this essential nursing topic.
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English Grammar Demystified Phyllis Dutwin. Quality Management Demystified Sid Kemp. Pericardiocentesis is done to remove fluid from the pericardial sac to relievepressure on the heart or for diagnostic testing. A long cardiac needle is insertednear the xiphoid process and fluid is aspirated during careful cardiac monitoring. Fluid builds up in the lungs as a result of ineffective pumping of blood by the heartas a result of left-sided heart failure, AMI, worsening of heart failure, or volumeoverload. The patient experiences hypoxia, which is insufficient oxygen supply totissues, caused by decreased oxygenation of the blood.
Several noncardiac issuesmay lead to pulmonary embolism. Immediate treatment of heart failure, while searching for underly-ing correctable conditions, is necessary. Mechanical ventilation may be necessary. Call physician if patient gains 2 lbs daily. Blood flow to the extremities decreases as peripheral arteries narrow fromvasospasm when exposed to cold or emotional stress.
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It usually occurs bilaterally, often sparing the thumbs, and beginsto resolve with warming of affected areas. This is more common in older men, usually involves thehands, and can have other complications. Symptoms may be controlled by avoid-ance or by medications. Rheumatic fever usually results from a prior upper respiratory infection withgroup A streptococcus.
It may lead to permanent valve disease and cardiac dam-age, with the mitral valve being more commonly affected. When progressive valve disease occurs in the mitral valve, it isimperative to recognize the early onset of atrial fibrillation, to ensure early initia-tion of anticoagulation to prevent emboli. Valve replace-ment may be necessary. If a fibrillation contracting of the heart is present, ensureadequate anticoagulation with an International Normalized Ratio between 2 and 3.
Rheumatic fever prophylaxis may be required; antibiotics are recommended forprevention of recurrent episodes.
Medical-Surgical Nursing Demystified
Throbmophlebitis is the inflammation of a vein as a result of the formation ofone or more blood clots thrombus. It is usually seen in the lower extremities,calves, or pelvis. This may be the result of injury to the area, may be precipitatedby certain medications or poor blood flow, or may be the result of a coagulationdisorder. Itmay move to the lung or brain, which can be life-threatening. Treatment consists of anticoagulation toprevent further occurrences. Monitor for therapeutic effect. Uncoordinated firing of electrical impulses in the wall of the atria upper chambersof the heart causes the heart to quiver instead of beating regularly, resulting in inef-fective contractions.
This is usually due to an abnormality in the electrical system ofthe heart. Blood is ineffectively pumped to the ventricles lower chambers of theheart and may result in not enough blood being pumped throughout the body. Usually the heart beats rapidly; however, this is not always the case. If left untreated or if it returns, there is a risk of stroke and othercomplications.
If theatrial fibrillation is less than 72 hours old, chemical or electrocardioversion isendeavored. Electrocardioversion, or shocking the heart, often restores normalsinus rhythm. If greater than 72 hours, anticoagulation is begun as the risk ofthromboembolism is great. Frequency depends on the type of pacemaker and the cardiologist.
Asystole is defined as no cardiac electrical activity. This causes ventricles to stopcontractions, leading to no cardiac output and no blood flow. Cardiac standstill is amedical emergency. Treatment must be started immediately, while simultaneouslyattempting to understand the etiology of a non-beating heart. Asystole is a criterionfor certifying that the patient is dead. Asystole may be caused by disruption in theelectrical conduction system, causing life-threatening arrhythmias, sudden cardiacdeath, hypovolemia, cardiac tamponade, massive pulmonary embolism, acutemyocardial infarction, metabolic disorder, or drug overdoses.
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In case of a drugoverdose—usually PEA pulseless electrical activity —reverse overdose or treat. The longer asystole continues,the more tissue is lost.
Talk to family members if they are present. Electrical impulses, that trigger the ventricles to contract, fire erratically. This causesthe ventricles to quiver and prevents regular effective contractions, resulting in thedisruption of blood flow to the body. The usual causes are ventricular tachycardia,electrolyte disturbances, myocardial infarction, electric shock, and drug toxicities. Speak to family. Abnormal electrical impulses within the ventricles cause the heart to contract morethan beats per minute. This results in inadequate filling of the ventricles with.
Recurrent V tach signals a poor prognosis. Leakage of the aortic valve causes blood to flow back into the left ventricle. Thisresults in increased blood volume in the left ventricle, causing it to dilate and be-come hypertrophic, thus reducing blood flow from the heart. The usual cause isincompetent cusps or leaflets of the valve, from endocarditis, valve structuralproblems, connective tissue disorders, rheumatic heart disease, hypertension, arterio-sclerosis, and other conditions. Leakage of the mitral valve causes blood to flow back from the left ventricle intothe left atrium.
As a result, blood might flow back into the lungs. Mitral regurgi-tation is due to an incompetent valve, damaged from rheumatic fever, CAD, orendocarditis. Others may require sur-gery, again, based on the symptoms. Ventricular damage may occur before symp-toms present, so frequent monitoring is indicated.
In mitral stenosis, scar tissue secondary to rheumatic fever forms on the mitralvalve. This causes it to narrow, increasing resistance to blood flow between the leftventricle and left atrium, which means the heart needs to pump harder to maintainblood flow.
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However, eventually symptoms may occur and progress, necessitating interven-tion. Medication may be enough, or surgical intervention may be necessary. When necessary, mitral replacement is indicated. Most of thesepatients need endocarditis antibiotic prophylaxis, which is administering anti-biotics to prevent a bacterial infection occurring before invasive procedures anddental cleaning. If atrial fibrillation occurs, anticoagulation is indicated. The mitral valve bulges back into the left atrium, allowing blood to flow back-wards from the left ventricle into the left atrium.
This is a common problem and isnot considered a serious condition. It is often congenital. Often it is an incidental finding on an echocardiogram. A large majority of pa-tients require no treatment other than endocarditis prophylaxis during dental andunsterile procedures. Some patients progress with their symptoms, developingarrhythmias and requiring medications.
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Severe MVP may require mitral valve repairor replacement. Most patientsrequire endocarditis antibiotic prophylaxis. Leakage in the tricuspid valve causes a backflow from the right ventricle into theright atrium. This results in increased pressure in the atrium and higher resistanceto blood flowing from veins, resulting in enlargement of the right atrium.
This mayoccur from an anatomic problem, but usually occurs from right ventricular over-load in turn caused by left ventricular overload. It may also occur due to an infe-rior myocardial infarction, or damage from endocarditis. If reso-lution does not occur, tricuspid valve repair or replacement may be necessary. The EKG is a graphic representation of the electrical activity of the heart in a non-invasive procedure.
It shows a three-dimensional perspective of the electricalfunction of the heart. There are four common uses of an electrocardiograph. Theseare 1 to measure the heart for a short time period such as during a physical or anassessment; 2 ongoing monitoring using telemetry while the patient is an inpa-tient; 3 ambulatory Holter monitoring for a hour period while the patientgoes about normal daily activities; 4 stress test. An electrical signal is generated each time the chambers of the heart contract.
Small pads containing electrodes are placed on the surface of the skin to detectthe hearts electrical signal. Each electrode is connected with wires to an electro-cardiograph, which draws up to 12 different graphical representation of theelectrical signal. Typically a technician will perform the electrocardiograph and a physician or anurse with advanced training will interpret the results of the test. The nurse should be able to recognize a normal sinus rhythm and abnormalrhythms that are life-threatening such as ventricular tachycardia and ventricularfibrillation.
The nurse should be able to reattach electrodes. Theflow of the radiopaque dye is viewed and recorded using a fluoroscope, enablingthe physician to determine obstructions to the flow and the structures of theheart. These are tests to determine kidney function. If so, notify the physician immediately because the patient might be also allergic to the radio- paque dye.
Risks and benefits of the test need to be explained to the patient before commencing. These are flushing of the face, nausea, urge to urinate, and chest pain, which are usu- ally reactions to the dye.
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If there is bleeding, apply pressure until bleeding stops. An ultrasound of the heart provides a noninvasive examination of intracardiacstructures and blood flow. Sound waves are directed to and deflected by the heart, causing an echo that isdetected by the echocardiograph, which is interpreted by a physician.