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In: Nursing

(1. )Prepare a table that compares the different types of pacemakers, their uses, possible complications, and...

(1. )Prepare a table that compares the different types of pacemakers, their uses, possible complications, and nursing implications.

(2.) Prepare a table that compares the pathophysiology, clinical manifestations, and treatment of coronary atherosclerosis, angina pectoris, and myocardial infarction.

(3. )Write a brief summary about the types of cardiac valve repair and replacement procedures used to treat valvular problems and care needed by patients who undergo these procedures.

(4. )Write a short report that describes the management of patients with heart failure (HF).

(5. )Using the nursing process framework, write a short report on the nursing interventions of care for patients with arteriosclerosis and atherosclerosis.

(6. )Write a short report on the risk factors for hypertension.
??this is the Second time I'm asking about the same question, please answer all the six question ?

Solutions

Expert Solution

1, PACEMAKER

Pacemaker Uses Possible complications Nursing Implications
1) According to the number of leads COMMON NURSING IMPLICATIONS OF PACEMAKERS
a. single chamber pacemaker helps to correct slow or irregular heart beat. sinus bradycardia, atrial flutter lead perforation, dyrrhythmias, infections
  • Instruct the client about the pacemaker including the programmed rate
  • Instruct the client the signs of fever, redness, swelling or drainage from the insertion site
  • Report signs of dizziness, weakness, fatigue, swelling of ankles, chest pain, shortness of breath
b. dual chamber pacemaker

helps to regulate the electrical activity of both the chambers

bradycardia, atrial fibrillation associated with bradycardia

lead perforation, dysrhythmias
  • keep a pacemaker identification card in the wallet and obtain and wear a Medic- Alert bracelet
  • Instruct the client to how to take the pulse, to take pulse daily and to maintain a diary of pulse rate
c. Bi- ventricular pacemaker

unsynchronized heart contraction

right and left ventricular failure

lead dislodgement, lead perforation, dyrhythmias
  • wear loose fitting clothing over the pulse generator site.
  • Instruct the client that if any unusual feelings occur when near any electrical devices to move 5 to 10 feet away and check the pulse
2. Pacemaker according to the programming
  • Instruct the client about the methods of monitoring the functions of device
a. Fixed rate pacemaker heart beats on regular rate regardless of hearts rate hematoma, dysrhythmias
  • emphasize the importance of follow up with the HCP
b. Pacemaker on demand heart beats according to the intrinsic rate of heart. infections, hematoma
  • Use cell phones on the side opposite the pacemaker
c. Rate responsive pacemaker increase heart rate accordingto metabolic needs dysrhythmias, infections, hematoma
  • Avoid contact sports

2. ATHEROSCLEROSIS, ANGINA PECTORIS, MYOCARDIAL INFARCTION

DISEASE CONDITION PATHOPHYSIOLOGY CLINICAL MANIFESTATION TREATMENT
Coronary Atherosclerosis It is a build up of plaue in the coronary artery. It cause decresed perfusion of myocardial tissue and an inadequate myocardial oxygen supply leading to hypertension, angina, dysrrhythmias, MI , heart failure and death. Development of collateral circulation takes place.

Chest pain

palpitation dyspnoea syncope cough and hemoptysis, excessive fatigue

Dietary management and treatment same as angina pectoris
Angina pectoris chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply. It is caused by the imabalnec between oxygen supply and demand.

Stable angina- chest pain aggravates with activity or emotional stress, relieved with rest or nitrogycerin

Unstable angina - pain not relieved by nitroglycerin

dyspnea, pallor, sweating, palpitation , tachycardia, dizziness and syncope, hypertension, digestive disturbance

  • Surgical procedures - PTCA, Laser angioplasty, Atherectomy, Vascular stent, CABG
  • Medications - Nitrates, Calcium channel blockers, Cholestrol lowering medications, Beta blockers
Myocardial infarction myocardial tissue abruptly deprived of oxygen leads to necrosis, and become blue and swollen. AFter 48 hrs infarct turns gray with yellow streaks developing as neutrophils invades the tissue. after 8 - 10 days, granulation tissue forms. over 2- 3 months, necrotic area develops as scar permanently changing the size and shape of the entire left ventricle Crushing substernal pain. radiating pain to the jaw, back, left arm unrelieved by rest or nitroglycerin, nausea, vomiting, diaphoresis, dyspnea, dysrhythmias, feelings of fear and anxiety, pallor cyanosis and coolness of extremity
  • fowlers position
  • oxygen
  • administer dysrrhythmics
  • administer thrombolytics
  • administer beta- blockers

3. Valve replacement procedure

a. Mechanical prosthetic valve : these are durable

b. Bioprosthetic valve - the risk of clot formation is small, long term anticoagulation is not indicated

Interventions - consult with the HCP regarding discontinuing anticoagulants 72hours before surgery, Monitor closely for signs of bleeding, cardiac output and signs of heart failure, administer digoxin as needed

4. MANAGEMENT OF PATIENT WITH HEART FAILURE

  • place the client in high fowlers position
  • administer oxygen
  • assess the clients lung sounds
  • prepare for the administration of diuretic and morphine sulphate
  • insertion of foleys catheter
  • Prepare for intubation and ventilator support if required

5. Nursing care for atherosclerosis and arteriosclerosis

Arteriosclerosis is the stiffening or hardening of the artery walls . atherosclerosis is the narrowing of the artery bacause of the plaque build up. atherosclerosis is a type of arteriosclerosis.

  • Increase the physical activity and there by raise HDL or good cholestrol
  • quit smoke or tobacco use
  • use of thrombolytic treatment as per doctors advice
  • dietary control
  • Assess the vitals at proper intervals
  • advice to monitor the pulse rate and educate them to assess
  • Identify the risk as early as possible
  • administer O2 therapy as needed and O2 saturation as needed
  • administer dyslipidemic agents and advice to check LFT at frequent intervals

6 Risk factors of hypertension

Non Modifiable risk factors - age , family history, african american race

Modifiable risk factors - obesity, smoking, stress, excessive alcohol , hyper lipedemia, increased intake of salt and caffeine

other disorders - cardiovascular disorders, renal disorders, endocrine system disorders, pregnancy, medications such as estogen, glucocorticoids, mineralocorticoids


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