• AMG School of Licensed Practical Nursing

• NURSING 241

Med Surg 2 Final Blueprint

Perfusion

Recognizing s/s of left vs right sided heart failure

● Right sided heart failure: peripheral edema, ascites, distended neck veins, hepatomegaly,

ascites

● Left sided heart failure: dyspnea, SOB, orthopnea, paroxysmal nocturnal dyspnea

Causes of hypo/hyperkalemia, effects on EKG + interventions

● Purpose: maintain heart & muscle contraction

● Hypokalemia

○ Causes:

■ Thiazide + loop diuretics

■ Corticosteroids

■ Sodium penicillin

■ Amphotericin B

■ Vomiting, suctioning

■ Resp/met alkalosis

■ ↑ aldosterone (causes excretion of K+)

■ Insulin

■ Low K+ diet

○ EKG:

■ Flat T waves, ST depression, prolonged PR interval

● Hyperkalemia - can lead to cardiac arrest

○ Causes:

■ ↓ renal excretion

■ Rapid administration of K+

■ Untreated kidney injury

■ Meds (heparin, ACE inhibitors, NSAIDs, beta blockers, spironolactone)

○ EKG:

■ Absent P waves, peaked T waves, wide QRS, ST depression

■ V-fib, Hypotension, bradycardia

RN responsibilities with digoxin

● Observe for ↓ HR + toxicity

● Toxicity can lead to PVC + V-tach

Recognizing s/s of digoxin toxicity

● Anorexia, n/v, visual disturbances, confusion, bradycardia

● Monitor K+ (hypokalemia causes toxicity)

● If renal function changes, toxicity can occur

Drug therapy for each dysrhythmia nursing responsibilities

● Sinus bradycardia (chest pain, hypotension, altered mental status)

○ Atropine (0.5mg) (can be repeated every 3-5 min until 3mg given)

● Sinus tachycardia

○ Identify + eliminate cause (no drug therapy)

● SVT - over 160

○ Adenosine (first dose 6 mg), IV beta blockers, calcium channel blockers

● A-fib

○ CCB, beta blockers, antithrombotic, flecainide, dofetilide (monitor QT

interval + renal function), propafenone, amiodarone, IV ibutilide

● A-flutter

○ Adenosine (IV rapid administration w saline flush + arm elevation)

● PVC *serious in pts w cardiac problems*

○ Amiodarone, beta blockers

● V-tach *lethal in pts with MI + ↓ EF*, *EMERGENCY*

○ Procainamide, amiodarone, sotalol, lidocaine

● First degree heart block:

○ Identify + eliminate cause (no drug therapy)

● Second degree type 1:

○ Identify + eliminate cause

● Second degree type 2:

○ Atropine (0.5mg)

● Third degree:

○ Pacemaker, Atropine

Explain effects of compensatory mechanisms

● ↓ urine output (nocturia as well)

● ↑ BP

● Tachycardia

● Altered digestion

● Dizziness, lightheadedness, confusion, restlessness, anxiety, dyspnea

● ↓ activity tolerance

● ↑ BNP - counter regulatory mechanism - released from overdistended cardiac chambers

S/s of tachyarrhythmias and bradyarrhythmias

● Sinus bradycardia: HR below 60

● Sinus tachycardia: HR above 100

● SVT: HR abov