Initiate large-bore IV access. C. Auscultate for wheezing. This defect occurs as the result of a myocardial infarction, heart disease, and at times, as a complication of cardiac surgery. B. C. Sepsis Educate the client about the manifestations of dehydration, including thirst, decreased urine output, and dizziness, Educate the client about wearing seat belts and helmets, and the, use of caution with dangerous equipment, machinery, or, Advise the client to obtain early medical attention with evidence. Agonal rhythms can be caused by a myocardial infarction, trauma and predictable changes at the end of life and it is signaled with the lack of a palpable pulse, the lack of a measurable blood pressure and the complete loss of consciousness. Agonal rhythms most often occur when the efforts to save life with emergency medical measures are unsuccessful. Assess incison and dressing, Do not strain, do heavy lifting or hard exercise that The cardiac rate can range from 150 to 250 beats per minute, the rhythm can be irregular or regular, the PR interval is not measurable, and the QRS complex is widened with upward and downward deflections. PLEASE NOTE: The contents of this website are for informational purposes only. Alene Burke RN, MSN is a nationally recognized nursing educator. JGalvan ATI Basic Concept Stages and Phases of Labor. Sinus bradycardia has a cardiac rate less than 60 beats per minute, the atrial and the ventricular rhythms are regular, the P wave occurs prior to each and every QRS complex, the P waves are uniform in shape, the length of the PR interval is form 0.12 to 0.20 seconds, the QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds. Elevated PAWP measurements may indicate hypervolemia (fluid The classical features of torsades de pointes are a long QT interval in addition to a downward and upward deflection of the QRS complexes that are seen on the cardiac strip. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. D. Increased clotting factors. Regional enteritis. A. Hypotension Hypovalemic shock priorities; Hypopituitarism - ATI templates and testing material. The normal cerebral perfusion pressure, under normal circumstances, should range from 60 to 100 mm Hg. There are. From these findings, the Rationale: This client has two risk factors for the development of fluid volume deficit, or dehydration. When discharged eat a mechanical soft diet, infection. The atrial and ventricular cardiac rates are from 150 to 250 beats per minute, the cardiac rhythm is regular, the p wave may not be visible because it is behind the QRS complex, the PR interval is not discernable, the QRS complexes look alike, and the length of the QRS complexes ranges from 0.06 to 0.12 seconds. treated with the dialysis. Ventricular arrhythmias occur when the AV junction and the sinoatrial node fail to send their electrical impulses. Course Hero is not sponsored or endorsed by any college or university. A. B. Dyspnea Infection Trendelenburg to improve hemodynamic parameters in hospitalized patients with hypotension. The signs and symptoms of this cardiac arrhythmia can include syncope, dizziness, fainting, chest pain and a loss of consciousness. nurse should expect which of the following findings? ATI templates and testing material. Chronic cough A 2:1 second degree AV block type II has two P waves for every QRS complex and a 3:1 second degree AV block type II has three P waves for every QRS complex. C. Pulmonary vascular resistance (PVR) She got her bachelors of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. Become Premium to read the whole document. Which of the following clients is at greatest risk for fluid volume Asystole occurs most frequently when ventricular fibrillation is not corrected, but it can also occur suddenly as the result of a myocardial infarction, an artificial pacemaker failure, a pulmonary embolus and cardiac tamponade. A client has a pulmonary artery wedge pressure (PAWP) reading of 15 mm Hg. Begin the transfusion, and use a blood warmer if indicated. Changes in terms of all central nervous system functioning including alterations and impairments such as weakness, an altered mental status, restlessness, confusion, lethargy, impaired speech, decreased levels of consciousness and a lower Glasgow Coma Scale score, decreased pupil reaction to light, seizures, dysphagia, behavioral changes and paralysis can occur when the client is affected with impaired cerebral perfusion. Respiratory depression patients are repositioned. The esophagus is about 25cm long. Which classification of medications is likely to stabilize D. Atelectasis manifestations, such as angina. Created Date: infection. Positioning the patient properly assists fluid redistribution, wherein a modified Trendelenburg position is recommended in hypovolemic shock. Sinus bradycardia is a sinus rhythm that is like the normal sinus rhythm with the exception of the number of beats per minute. D. Gastritis. The definition of hemodynamics as the flow of blood as ejected from the heart to circulate throughout the body in order to effectively oxygenate the tissues of the body. The normal values for hemodynamic values are as follows: The psychomotor domain knowledge includes the nurse's ability to set up, maintain and collect data from a wide variety of invasive and noninvasive hemodynamic monitoring devices such as: Decreased cardiac output can lead to a number of physical, psychological and life style alterations, signs and symptoms. The signs and symptoms of decreased cardiac output include the abnormal presence of S3 and S4 heart sounds, hypotension, bradycardia, tachycardia, weak and diminished peripheral pulses, hypoxia, cardiac dysrhythmias, palpitations, decreased central venous pressure, decreased pulmonary artery pressure, dyspnea, fatigue, oliguria and possible anuria, decreased organ and tissue perfusion, and adventitious breath sounds like crackles, and orthopnea. Clients on telemetry, which is continuous monitoring and recording of the client's ECG strips, can be done by a telemetry technician who is an unlicensed staff member who is specially educated and trained to read and record telemetry and also to alert the nurse when an alarm occurs and/or when an abnormal rhythm is noticed on the telemetry monitor. Documentation and continued monitoring is an inadequate response to the medication is having a therapeutic effect? The risk factors associated with ventricular fibrillation include non treated ventricular tachycardia, illicit drug overdoses, a myocardial infarction, severe trauma, some electrolyte imbalances, and severe hypothermia. D. The client who has just been admitted, has gastroenteritis, and is febrile. The cardiac rates for the atria and the ventricles are different and the QRS complexes are wide and prolonged. Gastroenteritis is characterized by diarrhea and may also be associated with vomiting, so it can She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. Progressive increase in platelet production. Hemodynamic status is assessed with several parameters -Central venous pressure (CVP) -Pulmonary artery pressure (PAP) -Pulmonary artery wedge pressure (PAWP) -Cardiac Output (CO) -Intra-arterial pressure Mixed venous oxygen saturation (SvO2) indicates the balance between oxygen supply and demand. The interpretation of these rhythm strips is done according to the details provided above for many cardiac arrhythmias in the previous section entitled "Identifying Cardiac Rhythm Strip Abnormalities", such as the rate, the P wave, the PR interval and the QRS complexes. A. This abnormal sinus rhythm can occur secondary to hypothyroidism, some medications like a beta blocker or digitalis, increased intracranial pressure, hypoglycemia, hypothermia, preexisting heart disease and an inferior wall myocardial infarction which involves the right coronary artery. A. The treatment of atrial fibrillation includes the control of the cardiac rate with medications such as beta blockers, calcium channel blockers, or digoxin, intravenous verapamil when rapid cardiac rate reduction is necessary, cardioversion, supplemental oxygen, and antithrombolytic medications to prevent clot formation and pulmonary emboli. The nurse should recognize that the client is exhibiting symptoms of which condition? A. Redistribution of fluid. C. Colitis. B. positions the zero-reference stopcock line level with the phlebostatic axis. A nurse on a critical care unit is caring for a client who has shallow and rapid respirations, paradoxical pulse, CVP 4 PROCEDURE NAME ____________________________________________________________________ REVIEW MODULE CHAPTER ___________, Melyn Cruz The five types of sinus rhythms are: Normal sinus rhythms have a rate of 60 to 100 beats per minute, the atrial and the ventricular rhythms are regular, the P wave occurs prior to each and every QRS complex, the P waves are uniform in shape, the length of the PR interval is form 0.12 to 0.20 seconds, the QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds. Rationale: Tachycardia is more likely than bradycardia in a client who has anemia due to blood loss. should not be the treatment of choice. The esophagus is about 25cm long. fluid volume deficit. Rationale: A heart rate of 100-150/min is present in the compensatory stage of shock. University Del Mar College Course Heath Care Concept III (RNSG 1538) Academic year2021/2022 Helpful? As previously stated, the normal sinus rhythm is the only normal cardiac rhythm in terms of the cardiac rate, cardiac rhythm, its P waves, its PR intervals AND its QRS complexes. Rationale: This is associated with the diuresis phase of ARF. Esophageal disorders can affect any part of the esophagus. Rationale: Oliguria is present in hypovolemic shock as a result of decreased blood flow to the kidneys. They prevent reflux of food and fluid into the mouth or esophagus. The treatments for an idioventricular rhythm include a cardiac pacemaker, the administration of atropine, the administration of dopamine when the client is adversely affected with hypotension, and cardiopulmonary resuscitation when this cardiac arrhythmia leads to cardiac stand still and asystole. reading was elevated at 15 mm Hg. analgesics for pain. As a result of this failure, the ventricles take over the role of the heart's pacemaker. Rationale: The nurse should evaluate for local edema; however, this is not the priority intervention when Rationale: A wide QRS complex indicates a dysrhythmia that is an adverse effect, not a therapeutic effect. D. Bradypnea Skip to document. A client experiences anaphylactic shock in response to the administration of penicillin. Rationale: While some of the findings might indicate atelectasis, the combination of the clients signs and Rationale: Anemia from blood loss is unlikely to cause muscle cramps, although it can cause other painful Rationale: The PAWP is a mean pressure that is expected to range between 4 and 12 mm Hg. B. D. Petechiae As discussed in the previous section entitled "Evaluating Invasive Monitoring Data", intracranial pressure has an impact on the perfusion of the brain. Bundle branch block has wide QRS complexes and the delayed depolarization travels to either the right ventricle in an anterior manner or the left ventricle in a lateral manner, which are referred to as right bundle branch block and left bundle branch block, respectively. A CVP above 6 mm Hg indicates an increased right ventricular preload, typically from, Fatigue is an expected finding with a client who has anemia due to surgical blood loss. All trademarks are the property of their respective trademark holders. Sleep with your head and upper body elevated 30 Rationale: Narrowing pulse pressure is the earliest indicator of shock. The basic three types of pacemakers are the single chamber pacemaker, the dual chamber pacemaker and the biventricular pacemaker. Assessing the Client for Decreased Cardiac Output, Identifying Cardiac Rhythm Strip Abnormalities, Applying a Knowledge of Pathophysiology to Interventions in Response to Client Abnormal Hemodynamics, Providing the Client with Strategies to Manage Decreased Cardiac Output, Intervening to Improve the Client's Cardiovascular Status, Monitoring and Maintaining Arterial Lines, Managing the Care of a Client on Telemetry, Managing the Care of a Client Receiving Hemodialysis, Managing the Care of a Client With an Alteration in Hemodynamics, Tissue Perfusion and Hemostasis, Adult Gerontology Nurse Practitioner Programs (AGNP), Womens Health Nurse Practitioner Programs, Advanced Practice Registered Nurse (APRN), Performing and Managing the Care of the Client Receiving Dialysis, Identifying the Client with Increased Risk for Insufficient Vascular Perfusion, Physiological AdaptationPractice Test Questions, RN Licensure: Get a Nursing License in Your State, Assess client for decreased cardiac output (e.g., diminished peripheral pulses, hypotension), Identify cardiac rhythm strip abnormalities (e.g., sinus bradycardia, premature ventricular contractions [PVCs], ventricular tachycardia, fibrillation), Apply knowledge of pathophysiology to interventions in response to client abnormal hemodynamics, Provide client with strategies to manage decreased cardiac output (e.g., frequent rest periods, limit activities), Intervene to improve client cardiovascular status (e.g., initiate protocol to manage cardiac arrhythmias, monitor pacemaker functions), Manage the care of a client with a pacing device (e.g., pacemaker), Manage the care of a client receiving hemodialysis, Manage the care of a client with alteration in hemodynamics, tissue perfusion and hemostasis (e.g., cerebral, cardiac, peripheral), Make a conclusion about the cardiac rhythm on the rhythm strip, The normal sinus rhythm which has a cardiac rate of 60 to 100 beats per minute, Sinus bradycardia which has a cardiac rate of less than 60 beats per minute, Sinus tachycardia which has a cardiac rate of more than 100 beats per minute, A sinus arrhythmia which is an irregular heart rate that can range from 60 to 100 beats per minute, An idioventricular rhythm, also referred to as a ventricular escape rhythm, has a rate of less than 20 to 40 beats per minute, An accelerated idioventricular rhythm with more than 40 beats per minute, An agonal rhythm with less than 20 beats per minute, Ventricular tachycardia with more than 150 beats per minute, Second-Degree Atrioventricular Block, Type I, Second-Degree Atrioventricular Block, Type II. dysphagia, aspiration, or regurgitation. The most common causes of first degree heart block are an AV node deficit, a myocardial infarction particularly an inferior wall myocardial infarction, myocarditis, some electrolyte disorders, and medications like beta blockers, cardiac glycoside medications, calcium channel blockers and cholinesterase inhibitors. Ventricular tachycardia occurs when no impulses come from the atria; this life threatening arrhythmia will progress to ventricular fibrillation and then cardiac arrest and cardiac asystole unless emergency medical care is immediately rendered. Rationale: Pallor is a sign of hypovolemic shock. Weight loss Rationale: The nurse should expect a decrease, not an increase, in the clotting factors because the Negative inotropes. All phases must be. When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to Sinus tachycardia is a sinus rhythm that is like the normal sinus rhythm with the exception of the number of beats per minute. Assess laboratory values (e.g., platelet count less than 20,000 and hemoglobinless than 6 g/dL). At times these pacemakers are placed and implanted at the bedside and at other times they are placed in a special care area like a cardiac invasive laboratory or the operative suite. They prevent reflux of food and fluid into the mouth or esophagus surgeon will inserts a thin, tube-like instrument called an endoscope equipped with a light and camera into the mouth is used to make an incision in the wall that separates the diverticulum Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases is a right bundle branch block in combination with a left anterior fascicular block or a left posterior fascicular block. degrees, Obtain informed consent Regardless of who is monitoring the telemetry, it is the nurse caring for the client on the telemetry that is responsible and accountable for the accurate interpretation of the rhythm and the initiation of any and all interventions when interventions are indicated. How many micrograms per kilogram per Poor nutrition, Client education The goals of treatment in terms of the management of care for a client with an alteration in terms of their hemodynamics, tissue perfusion and hemostasis include the correction and treatment of any treatable underlying causes, and the promotion of improved tissue perfusion. B. taking the airway, breathing, circulation (ABC) approach to client care. Rationale: This CVP is within the expected reference range. Rationale: While some of the findings indicate cardiac tamponade, the urinary output and CVP distinguish After the implantation of a pacemaker, the nurse must be fully aware of the possible complications associated with pacemakers which include bleeding, inadvertent punctures of major vessels, infection, and mechanical failures, including battery failures, of the pacemaker. Rationale: A decreased volume of circulating blood and less pressure within the vessels results in weak Cross), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Give Me Liberty! The signs and symptoms of this cardiac dysrhythmia can include the loss of consciousness, shortness of breath, chest pain, shortness of breath and nausea. Which of the following blood products does the nurse Mechanical ventilation Rationale: ANS: 3PVR is a major contributor to pulmonary hypertension, and a decrease would indicate A nurse is assessing a client who has disseminated intravascular coagulation (DIC). All other rhythm strips are abnormal and some of these abnormal rhythms are relatively harmless and often immediately correctable and others can be life threatening when they are not treated promptly and effectively. D. DIC is a genetic disorder involving vitamin K deficiency. Post operative: Zenker's diverticulum 48, Know the esophagus is a muscular tube that leads from the throat to the stomach. ACE inhibitors. Right ventricular failure Obtain barium swallow test after the This abnormal sinus rhythm can occur secondary to hyperthyroidism, some medications, hypertension, hyperpyrexia, extreme stress and anxiety, the presence of pain, some electrolyte imbalances, preexisting heart disease and the intake of illicit substances like cocaine and the excessive intake of nicotine, alcohol and caffeine. Rationale: Petechiae characterize the progressive stage of shock. The treatment of this serious and highly life threatening dysrhythmia includes the initiation of CPR and the advanced cardiac life support (ACLS) protocols, if the client has chosen these life saving treatments. Rationale: This CVP is within the expected reference range. A. Fluid volume deficit Clients affected with bundle branch block may be symptomatic and asymptomatic. (Place the phases of acute kidney injury in the order that they occur. The risks and complications of atrial fibrillation include atrial clot formation, a pulmonary embolus, a cerebrovascular accident, and a significant and dramatic drop in cardiac output. D. The client must be lying flat in bed during the measurement procedure. telectasis Orthostatic hypotension Pressure Ulcers, Wounds, and Wound Management: prevention of Skin Breakdown Q2 turns Provide hydration and meet protein and caloric needs Remove drains and tubes that could cause skin breakdown Inflammatory Bowel Disease: Appropriate Diet Choices Avoid caffeine and alcohol Take multi-vitamin that contains iron Dietary supplements . RegisteredNursing.org does not guarantee the accuracy or results of any of this information. Hypertension Rationale: Hypotension is a sign of hypovolemic . C. ensures that the patient is supine with the head of the bed flat for all readings. Do not round off your answer. Reposition the client in bed at least every 2 hr and every 1 hr in a chair. After this premature p wave, there is a compensatory pause. indicate hypervolemia, left ventricular failure, mitral regurgitation, or intracardiac shunt. This includes neurogenic, septic, and anaphylactic shock Stages of Shock 1. D. Thready pulse The treatment of torsades de pointes, which can be life threatening, includes the initiation of CPR and ACLS protocols, the bolus administration of magnesium sulfate, cardioversion, and the correction of any underlying and causal factor or condition. Hemostasis can be categorized as cerebral, cardiac and peripheral hemostasis and it occurs as the result of vascular constriction and spasm, the clotting of blood and the formation of a platelet plug, all of which impede the free flow of blood throughout the body. Rationale: Hypotension is an early sign of shock, but it is not the earliest indicator. Rationale: ANS: 2A low CVP indicates hypovolemia and a need for an increase in the infusion rate. No treatments or interventions are typically indicated when the client is asymptomatic but intravenous isoproterenol or atropine may be given to the symptomatic client with this cardiac arrhythmia. This is not the correct analysis of the ABGs. A heart rate of 100-150/min is present in the compensatory stage of shock. The signs and symptoms related to the hypoperfusion of the peripheral vascular system include intermittent claudication, weak or absent peripheral pulses, aches, pain, coolness and numbness of the extremities, clammy and mottled skin, the lack of the same blood pressure on both limbs, edema and slow capillary refill times. Not an increase, in the infusion rate involving vitamin K deficiency, a! Of their respective trademark holders and symptoms of this information jgalvan ATI Basic Concept Stages and Phases acute! 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Priorities ; Hypopituitarism - ATI templates and testing material the diuresis phase of ARF take!