Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 19 CareofPatientswithCardiacDisorders

CHAP

TER 19 CareofPatientswithCardiacDisorders

TERMINOLOGY

Cardiac Pathology

Directions: Match the pathology on the left with the disorder on the right.

1. ______ Structural defect in which chambers, septum, or large vessels are not normal (463)

a. Congestive heart failure

2. ______ Diseased valve is unable to close properly and blood flows backward into heart chamber (479)

b. Endocarditis

3. ______ Disturbance in hearts conduction system (464) c. Congenital heart disease

4. ______ Weakening and exhaustion of hearts pumping action (479)

d. Pericarditis

5. ______ Inflammation of inner lining of heart (470) e. Arrhythmias

6. ______ Excessive fluid restricts the filling and pumping of the heart (481)

f. Cardiomyopathy

7. ______ Inflammation of the sac surrounding the heart (483) g. Cardiogenic shock

8. ______ Causes left atrium to work harder to pump blood through the narrowed valve into the left ventricle (479)

h. Cardiac tamponade

9. ______ Circulatory failure due to the failure of the heart to pump sufficient blood (482)

i. Valvular insufficiency

10. ______ Cardiac degeneration unrelated to CAD, hypertension, structural disorders, or pulmonary disease (482)

j. Mitral stenosis

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 19 CareofPatientswithCardiacDisorders

LABELING

Identifying Parts of an EKG Pattern

Directions: Divide and label the waves in the EKG pattern below. Then answer the related questions. (471-473)M

illivo

lts

1. The normal P-R interval is ___________ seconds.

2. The normal QRS time is ______________ seconds.

3. Normal heart rate is ______________ beats per minute.

COMPLETION

Cardiac Disorders

Directions: Fill in the blanks to complete the statements.

1. When a synthetic valve is used (i.e., porcine or bovine) the patient must be on _____________________

therapy for the rest of his life. (481)

2. If the heart rate rises above ___________________ beats per minute, the patient has a dysrhythmia

known as tachycardia. (472)

3. Atrial fibrillation also predisposes the patient to _________________ formation in the atria. (472)

From Aehlert, B. (2002). EKGs Made Easy (2nd ed.). St. Louis: Mosby.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 19 CareofPatientswithCardiacDisorders

TABLE ACTIVITY

Drugs Used for Heart Failure

Directions: Fill in the table below with at least one example of the drug and briefly state the pharmacologic action of the drug. The first classification, betaadrenergic blockers, is done for you. (474-477)

Drug Classification Example Action

Beta-adrenergic blockers

metoprolol (Toprol XL) Used to slow the heart rate if tachycardia is causing the heart failure, thereby decreasing oxygen demand.

Angiotensin-converting enzyme (ACE) inhibitors

Loop diuretics

Digitalis

Venous vasodilators

NCLEX-PN EXAM REVIEW

Directions: Choose the best answer(s) for the following questions.

1. A patient reports being punched with a fist in the mid-sternal area during an assault. He is currently asymptomatic. Which of following complications is most likely to be associated with this type of blunt chest trauma? (483)1. Hemothorax2. Cardiac dysrhythmias3. Cardiogenic shock4. Cardiomyopathy

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 19 CareofPatientswithCardiacDisorders

2. The physiologic problem associated with atrial fibrillation is that the heart rate: (472)1. is too slow to supply oxygen to the body effectively.2. can be too fast to allow for adequate ventricular filling.3. is so irregular that it is difficult to count.4. is very erratic and can cause ventricular fibrillation.

CRITICAL THINKING ACTIVITIES

Scenario

Mr. Lee goes into cardiogenic shock 8 hours after surgery. (483)

1. How would you know that this complication is occurring? ____________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

2. Describe the usual treatment for cardiogenic shock. __________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

MEETING CLINICAL OBJECTIVES

1. Ask to be assigned to a cardiac step-down or telemetry unit. Obtain telemetry tracings of several EKG patterns. Interpret whether each EKG pattern is normal or abnormal. What is the rhythm? (Ask another nurse to assist you with abnormal patterns.)

2. Make a pocket diagram of the telemetry lead placements for the most common leads used on the unit. Practice hooking patients up to the telemetry monitor.

3. Learn how to set and reset the telemetry monitor units.

4. Care for a patient on digoxin (Lanoxin). Review the dosage, nursing implications related to administra-tion, and check the lab values for digoxin level and for serum potassium.