QuestionAnswered step-by-stepCourse: NUR ____2025_____ Concept/Exemplar: ___Perfusion/ACS, Dysrhythm

QuestionAnswered step-by-stepCourse: NUR ____2025_____ Concept/Exemplar: ___Perfusion/ACS, Dysrhythmia, Pacemaker ___ Hours: __3_ Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.Scenario: Please use your Pearson book for referenceScenario Identify the Top 3 client areas for the nurse to assess.It is midmorning on the cardiac unit where you work, and you are getting a new patient.  G.P. is a 60-year-old retired businessman who is married and has 3 grown children.  As you take his health history, he tells you that he began feeling changes in his chest about 10 days ago.  He has hypertension (HTN) and a 3-year history of angina pectoris.  During the past week, he has had frequent episodes of mid-chest discomfort.  The chest pain responds to nitroglycerin (NTG), which he has taken sublingually about 8 to 10 times over the past week.  During the week, he has also experienced increased fatigue. He states, “I just feel crappy all the time.” A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery and 50% stenosis of the left anterior descending coronary artery. He tells you that both his mother and his father had coronary artery disease (CAD). He is currently taking amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and aspirin 81 mg/day. He is retired and says that he spends his days watching television, with some occasional yard work. He has gained 25 lb. (11.3 kg) since retiring and admits that he is overweight.                   1. What other information are you going to obtain about his episodes of chest pain?   2. What are common sites for radiation of ischemic cardiac pain?   3. There are several risk factors for coronary artery disease. For each risk factor listed, mark whether it is “M” modifiable or “N” non-modifiable.  4. Based on the history you have so far, circle the modifiable and non-modifiable risk factors in Question 3 that apply to G.P.a. ___ Age b. ___ Stress c. ___ Gender d. ___ Obesity e. ___ Smoking f. ___ Hypertension g. ___ Hyperlipidemia h. ___ Diabetes mellitus i. ___ Physical inactivity j. ___ Ethnic background k. ___ Excessive alcohol use l. ___ Family history of CAD5. Although the client has had a prescription for sublingual nitroglycerin (SL NTG) for a long time, the nurse wants to be certain he is using the medication correctly.  Which actions are correct when taking SL NTG for chest pain? Select all that apply.   What is the rationale for each answer- add comment in for each correct action? a. Call 911 immediately. b. Stop the activity and lie or sit down. c. Chew the tablet slowly then swallow. d. Place the NTG tablet under the tongue. e. Call 911 if the pain is not relieved after taking 1 SL tablet. f. Call 911 if the pain is not relieved after taking 3 SL tablets, 5 minutes apart.  6. The nurse reviews the use and storage of SL NTG with G.P.  Which statement by G.P. indicates a need for further education? Explain your answer next to your answer selection. a. “I carry the tablets with me at all times.” b. “I will keep the pills in their original brown bottle.” c. “I will not store other pills in the nitroglycerin bottle.”d. “I will discard any open bottle of nitroglycerin after a year.”  7. Complete Medication template for each of the following medications: (1) NTG SL, (2) Amlodipine, and (3) diltiazem IV.  Case Study ProgressWhen you first admit G.P., the nurse places the client on telemetry and observes his cardiac rhythm. The rhythm has periods of faster rates than below. 8. Identify the rhythm: (6 second strip) after answering the questions below to analyze the rhythm.Rate: What is the rate?Regularity: Is the rate regular or irregular? Measure regularity using R waves.P-Wave examination: Is there a P wave before each QRS?P to R interval: Measure P to R interval, is it within normal limits? Is it consistent?QRS width: Is the QRS narrow or wide? Measure the duration of the QRS complex. What is the rhythm?What are the nurse’s top 3 responses once the rhythm is confirmed? https://www.google.com/url?sa=i&url=http%3A%2F%2Fmyfamilymedicinepractice.blogspot.com%2F2017%2F04%2Fintroduction-to-atrial-fibrillation.html&psig=AOvVaw3SebAaEvsSatOG0wlIvE35&ust=1601487475700000&source=images&cd=vfe&ved=2ahUKEwi6qory847sAhVEIt8KHX-HD9QQr4kDegUIARDDAQ9. Explain the primary complication that could occur if this heart rhythm were not treated.     10. Review G.P.’s history. What conditions may have contributed to the development of this dysrhythmia?   11. The nurse reviews G.P.’s lab test results and notes that all of them are within normal range, including troponin and creatinine phosphokinase levels.  His potassium level is 4.9 mEq/L.  Given this and his current dysrhythmia, what is the likely cause of the symptoms he has been experiencing this past week?     Case Study ProgressWithin the hour, G.P. converts with intravenous diltiazem (Cardizem) to sick sinus syndrome with long sinus pauses that cause lightheadedness and hypotension.  Sick sinus syndrome is the inability of the heart’s natural pacemaker (sinus node) to create a heart rate that’s appropriate for the body’s needs. It causes irregular heart rhythms (dysthymias).  12. What risks does the new rhythm pose for G.P.? Explain the reasons for your answers    Case Study ProgressBecause G.P.’s dysrhythmia is causing unacceptable symptoms, he is taken to surgery and a permanent DDDR pacemaker is placed and set at a rate of 70beats per minute (BPM).  13. What does the code DDDR mean?   14. What is the purpose of DDDR pacing?    15. The pacemaker insertion surgery places G.P. at risk for several serious complications.  List 3 potential problems you would monitor when caring for him.   16. G.P. will need some education regarding his new pacemaker.  What information will you give him before he leaves the hospital?   17. Complete a concept map that identifies 3 priority problems and collaborative/nursing care. (Responding: Take action) (Deliverable) (see assignment instructions). 18. Describe the teach-back process and the top 3 priorities on living with a pacemaker?  19. G.P. and his wife tell the nurse they have heard that people with pacemakers can have their hearts stop because of microwave ovens and cell phones. Where can you help them find more information?  Name 3 resources.  Case Study ProgressAfter discharge, G.P. is referred to a cardiac rehabilitation center to start an exercise program.  He will be exercise tested, and an individualized exercise prescription will be developed for him, based on the results of the exercise test.  (NG NCLEX What outcomes demonstrate interventions are working? (Reflecting)  20. What information will be obtained from a graded exercise (stress) test?     21. What is included in an exercise prescription?   Case Study OutcomeG.P. returns in 1 month for a pacemaker check.  He reports that he and his wife go for a walk at least 3 times a week at the mall, and he is hoping to start volunteering soon. He has lost 8 lbs. (3.6 kg). Harding and Snyder: Perfusion CS 5 ACS, Dysrhythmia and pacemakerReflecting/AnCourse: NUR ____2025_____ Concept/Exemplar: ___Perfusion/ACS, Dysrhythmia, Pacemaker ___ Hours: __3_  Scenario Identify the Top 3 client areas for the nurse to assess.It is midmorning on the cardiac unit where you work, and you are getting a new patient.  G.P. is a 60-year-old retired businessman who is married and has 3 grown children.  As you take his health history, he tells you that he began feeling changes in his chest about 10 days ago.  He has hypertension (HTN) and a 3-year history of angina pectoris.  During the past week, he has had frequent episodes of mid-chest discomfort.  The chest pain responds to nitroglycerin (NTG), which he has taken sublingually about 8 to 10 times over the past week.  During the week, he has also experienced increased fatigue. He states, “I just feel crappy all the time.” A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery and 50% stenosis of the left anterior descending coronary artery. He tells you that both his mother and his father had coronary artery disease (CAD). He is currently taking amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and aspirin 81 mg/day. He is retired and says that he spends his days watching television, with some occasional yard work. He has gained 25 lb. (11.3 kg) since retiring and admits that he is overweight.                 Next GEN NCLEX: What matters most?  Noticing, Tanner’s Clinical Judgement model 1. What other information are you going to obtain about his episodes of chest pain?   2. What are common sites for radiation of ischemic cardiac pain?   3. There are several risk factors for coronary artery disease. For each risk factor listed, mark whether it is “M” modifiable or “N” non-modifiable.  4. Based on the history you have so far, circle the modifiable and non-modifiable risk factors in Question 3 that apply to G.P.a. ___ Age b. ___ Stress c. ___ Gender d. ___ Obesity e. ___ Smoking f. ___ Hypertension g. ___ Hyperlipidemia h. ___ Diabetes mellitus i. ___ Physical inactivity j. ___ Ethnic background k. ___ Excessive alcohol use l. ___ Family history of CAD5. Although the client has had a prescription for sublingual nitroglycerin (SL NTG) for a long time, the nurse wants to be certain he is using the medication correctly.  Which actions are correct when taking SL NTG for chest pain? Select all that apply.   What is the rationale for each answer- add comment in for each correct action? a. Call 911 immediately. b. Stop the activity and lie or sit down. c. Chew the tablet slowly then swallow. d. Place the NTG tablet under the tongue. e. Call 911 if the pain is not relieved after taking 1 SL tablet. f. Call 911 if the pain is not relieved after taking 3 SL tablets, 5 minutes apart.  6. The nurse reviews the use and storage of SL NTG with G.P.  Which statement by G.P. indicates a need for further education? Explain your answer next to your answer selection. a. “I carry the tablets with me at all times.” b. “I will keep the pills in their original brown bottle.” c. “I will not store other pills in the nitroglycerin bottle.”d. “I will discard any open bottle of nitroglycerin after a year.”  7. Complete Medication template for each of the following medications: (1) NTG SL, (2) Amlodipine, and (3) diltiazem IV.  Case Study ProgressWhen you first admit G.P., the nurse places the client on telemetry and observes his cardiac rhythm. The rhythm has periods of faster rates than below. 8. Identify the rhythm: (6 second strip) after answering the questions below to analyze the rhythm.Rate: What is the rate?Regularity: Is the rate regular or irregular? Measure regularity using R waves.P-Wave examination: Is there a P wave before each QRS?P to R interval: Measure P to R interval, is it within normal limits? Is it consistent?QRS width: Is the QRS narrow or wide? Measure the duration of the QRS complex. What is the rhythm?What are the nurse’s top 3 responses once the rhythm is confirmed? https://www.google.com/url?sa=i&url=http%3A%2F%2Fmyfamilymedicinepractice.blogspot.com%2F2017%2F04%2Fintroduction-to-atrial-fibrillation.html&psig=AOvVaw3SebAaEvsSatOG0wlIvE35&ust=1601487475700000&source=images&cd=vfe&ved=2ahUKEwi6qory847sAhVEIt8KHX-HD9QQr4kDegUIARDDAQ9. Explain the primary complication that could occur if this heart rhythm were not treated.     10. Review G.P.’s history. What conditions may have contributed to the development of this dysrhythmia?   11. The nurse reviews G.P.’s lab test results and notes that all of them are within normal range, including troponin and creatinine phosphokinase levels.  His potassium level is 4.9 mEq/L.  Given this and his current dysrhythmia, what is the likely cause of the symptoms he has been experiencing this past week?     Case Study ProgressWithin the hour, G.P. converts with intravenous diltiazem (Cardizem) to sick sinus syndrome with long sinus pauses that cause lightheadedness and hypotension.  Sick sinus syndrome is the inability of the heart’s natural pacemaker (sinus node) to create a heart rate that’s appropriate for the body’s needs. It causes irregular heart rhythms (dysthymias).  12. What risks does the new rhythm pose for G.P.? Explain the reasons for your answers    Case Study ProgressBecause G.P.’s dysrhythmia is causing unacceptable symptoms, he is taken to surgery and a permanent DDDR pacemaker is placed and set at a rate of 70beats per minute (BPM).  13. What does the code DDDR mean?   14. What is the purpose of DDDR pacing?    15. The pacemaker insertion surgery places G.P. at risk for several serious complications.  List 3 potential problems you would monitor when caring for him.   16. G.P. will need some education regarding his new pacemaker.  What information will you give him before he leaves the hospital?   17. Complete a concept map that identifies 3 priority problems and collaborative/nursing care. (Responding: Take action) (Deliverable) (see assignment instructions). 18. Describe the teach-back process and the top 3 priorities on living with a pacemaker?  19. G.P. and his wife tell the nurse they have heard that people with pacemakers can have their hearts stop because of microwave ovens and cell phones. Where can you help them find more information?  Name 3 resources.  Case Study ProgressAfter discharge, G.P. is referred to a cardiac rehabilitation center to start an exercise program.  He will be exercise tested, and an individualized exercise prescription will be developed for him, based on the results of the exercise test.  (NG NCLEX What outcomes demonstrate interventions are working? (Reflecting)  20. What information will be obtained from a graded exercise (stress) test?     21. What is included in an exercise prescription?   Case Study OutcomeG.P. returns in 1 month for a pacemaker check.  He reports that he and his wife go for a walk at least 3 times a week at the mall, and he is hoping to start volunteering soon. He has lost 8 lbs. (3.6 kg). Harding and Snyder: Perfusion CS 5 ACS, Dysrhythmia and pacemakerReflecting/Analysis Compare and contrast the assessment and care among the dysrhythmias.Using the information including this case, compare and contrast the findings, treatment and care among the dysrhythmias. (NG NCLEX What could it mean? (Noticing/Analyzing).Example: Under sinus bradycardia, you would check off bradycardia because bradycardia is an assessment finding for this dysrhythmia.    Client Assessment Findings (above) Sinus bradycardia Atrial fibrillation (AF) Ventricular Tachycardia  BradycardiaChest PainClammy skinConsciousness changeEdemaHypotensionPulse +1 TachycardiaWhat else would you assess for each rhythm? ???????? ????????? ?????????  Best treatment (medications) 1. 1. 1.   Name Top 2 nursing interventions for each    1.   2. 1.   2. 1.   2. alysis Compare and contrast the assessment and care among the dysrhythmias.Using the information including this case, compare and contrast the findings, treatment and care among the dysrhythmias. (NG NCLEX What could it mean? (Noticing/Analyzing).Example: Under sinus bradycardia, you would check off bradycardia because bradycardia is an assessment finding for this dysrhythmia.    Client Assessment Findings (above) Sinus bradycardia Atrial fibrillation (AF) Ventricular Tachycardia  BradycardiaChest PainClammy skinConsciousness changeEdemaHypotensionPulse +1 TachycardiaWhat else would you assess for each rhythm? ???????? ????????? ?????????  Best treatment (medications) 1. 1. 1.   Name Top 2 nursing interventions for each    1.   2. 1.   2. 1.   2.  Health ScienceScienceNursingNURSING 1015Share Question

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