Assignment: Cardiac and leadership 1

Assignment: Cardiac and leadership 1

Nursing Teaching for PAD includes:-

❖ Educate the client to

maintain aseptic technique.

❖ Instruct the client on how

to administer IV antibiotics.

❖ Have the client record

temp daily for six weeks.

❖ Encourage oral hygeine for

six weeks with a soft bristle

toothbrush 2x daily.

❖ Have the client clean any

skin lacerations and apply

antibiotic ointment.

❖ Client should inform all

HCP’s of hx of

endocarditis.

❖ Client should use

prophylactic antibiotics for

oral procedures.

❖ Tech the client the signs

and symptoms of emboli

and HF.

Medical treatment for PAD includes:-

❖ Arterial bypass with

autogenous vein or

synthetic graft.

❖ Endarterectomy.

❖ Patch graft angioplasty.

❖ Amputation.

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A patient is being discharged following insertion of a permanent pacemaker. The nurse determines that the patient requires further instruction on safety precaution after the following statement:

 

Overview

A new pacemaker requires limitation of physical activity, including no lifting, pulling, or pushing more than 5 pounds, so the patient will need to be educated further if they speak of lifting something greater than 5 pounds.

Learning Outcomes

A new pacemaker requires limitation of physical activity, including no lifting, pulling, or pushing more than 5 pounds. Other limitations include limiting tasks like sweeping in repetitive motions, keeping the area free from pressure (such as tight clothing or suspenders), and not raising the arm on the affected side above the level of the heart for the first few weeks. The pacemaker insertion site may be bruised, swollen, tender, and instructions may include gentle washing of incision site, and not applying lotion or powder.

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Heparin

64. A client with atrial fibrillation who is receiving maintenance therapy of

warfarin sodium has a prothrombin time (PT) of 35 seconds. On the basis of

these laboratory values, the nurse anticipates which prescription?

1. Adding a dose of heparin sodium

2. Holding the next dose of warfarin

3. Increasing the next dose of warfarin

4. Administering the next dose of warfarin

64. Answer: 2

Rationale: The normal PT is 11 to 12.5 seconds (conventional therapy and SI

units). A therapeutic PT level is 1.5 to 2 times higher than the normal level. Because

the value of 35 seconds is high, the nurse should anticipate that the client would not

receive further doses at this time. Therefore, the prescriptions noted in the remaining

options are incorrect Assignment: Cardiac and leadership 1

68. A client is receiving a continuous intravenous infusion of heparin sodium to

treat deep vein thrombosis. The client’s activated partial thromboplastin time

(aPTT) is 65 seconds. The nurse anticipates that which action is needed?

1. Discontinuing the heparin infusion

2. Increasing the rate of the heparin infusion

3. Decreasing the rate of the heparin infusion

4. Leaving the rate of the heparin infusion as is

68. Answer: 4

Rationale: The normal aPTT varies between 30 and 40 seconds (30 and 40

seconds), depending on the type of activator used in testing. The therapeutic dose of

heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 (45 to

60) and 2.5 (75 to 100) times normal. This means that the client’s value should not be

less than 45 seconds or greater than 100 seconds. Thus, the client’s aPTT is within the

therapeutic range and the dose should remain unchanged.

Test-Taking Strategy: Focus on the subject, the expected aPTT for a client

receiving a heparin sodium infusion. Remember that the normal range is 30 to 40

seconds and that the aPTT should be between 1.5 and 2.5 times normal when the

client is receiving heparin therapy. Simple multiplication of 1.5 and 2.5 by 30 and 40

will yield a range of 45 to 100 seconds. This client’s value is 65 seconds.

Activated partial thromboplastin time (aPTT)

1. The aPTT evaluates how well the coagulation

sequence (intrinsic clotting system) is functioning by

measuring the amount of time it takes in seconds for

recalcified citrated plasma to clot after partial

thromboplastin is added to it.

2. The test screens for deficiencies and inhibitors of all

factors, except factors VII and XIII.

3. Usually, the aPTT is used to monitor the

effectiveness of heparin therapy and screen for

4. Normal reference interval: 30 to 40 seconds

(conventional and SI units [International System of

Units]), depending on the type of activator used.

5. If the client is receiving intermittent heparin therapy,

draw the blood sample 1 hour before the next

scheduled dose.

6. Do not draw samples from an arm into which heparin

is infusing.

7. Transport specimen to the laboratory immediately.

8. Provide direct pressure to the venipuncture site for 3

to 5 minutes.

9. The aPTT should be between 1.5 and 2.5 times normal

when the client is receiving heparin therapy.

10. Elevated values occur in the following: Deficiency of

one or more of the following: factor I, II, V, or VIII;

factors IX and X; factor XI; and factor XII; hemophilia;

heparin therapy; liver disease

If the aPTT value is prolonged (longer than 100 seconds or per

agency policy) in a client receiving IV heparin therapy or in any client at

risk for thrombocytopenia, initiate bleeding precautions.

E. Prothrombin time (PT) and international normalized ratio (INR)

1. Prothrombin is a vitamin K–dependent glycoprotein

produced by the liver that is necessary for fibrin clot

formation. Assignment: Cardiac and leadership 1

2. Each laboratory establishes a normal or control value

based on the method used to perform the PT test.

3. The PT measures the amount of time it takes in

seconds for clot formation and is used to monitor

response to warfarin sodium therapy or to screen for

dysfunction of the extrinsic clotting system resulting

from liver disease, vitamin K deficiency, or

disseminated intravascular coagulation.

4. A PT value within 2 seconds (plus or minus) of the

control is considered normal.

5. The INR is a frequently used test to measure the

effects of some anticoagulants.

6. The INR standardizes the PT ratio and is calculated in

the laboratory setting by raising the observed PT ratio

to the power of the international sensitivity index

specific to the thromboplastin reagent used.

7. If a PT is prescribed, baseline specimen should be

drawn before anticoagulation therapy is started; note

the time of collection on the laboratory form.

8. Provide direct pressure to the venipuncture site for 3

to 5 minutes.

9. Concurrent warfarin therapy with heparin therapy can

lengthen the PT for up to 5 hours after dosing.

10. Diets high in green leafy vegetables can

increase the absorption of vitamin K, which shortens

the PT.

11. Orally administered anticoagulation therapy

usually maintains the PT at 1.5 to 2 times the

laboratory control value.

12. Normal reference intervals

a. PT: 11 to 12.5 seconds (conventional

and SI units)

b. INR: 0.81 to 1.20 (conventional and SI

units)

13. For both the PT and INR, elevated values occur in the

following: deficiency of one or more of the following:

factor I, II, V, VII, or X; liver disease; vitamin K

deficiency; warfarin therapy

If the PT value is longer than 25 seconds and the INR is

greater than 3.0 in a client receiving standard warfarin therapy (or per

agency policy), initiate bleeding precautions.

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Thiazide diuretics (Box 53-7)

1. Description

a. Thiazide diuretics increase sodium and

water excretion by inhibiting sodium

reabsorption in the distal tubule of the

kidney.

b. Used for hypertension and peripheral

edema

c. Not effective for immediate diuresis

d. Used in clients with normal renal

function (contraindicated in clients

with renal failure)

e. Thiazide diuretics should be used with

caution in the client taking lithium,

because lithium toxicity can occur, and

in the client taking digoxin,

corticosteroids, or hypoglycemic

medications. Assignment: Cardiac and leadership 1

2. Side and adverse effects

a. Hypercalcemia, hyperglycemia,

hyperuricemia

b. Hypokalemia, hyponatremia

c. Hypovolemia

d. Hypotension

e. Rashes

f. Photosensitivity

g. Dehydration

3. Interventions

a. Monitor vital signs.

b. Monitor weight.

c. Monitor urine output.

d. Monitor electrolytes, glucose, calcium,

blood urea nitrogen (BUN), creatinine,

and uric acid levels.

e. Check peripheral extremities for edema.

f. Monitor for signs of digoxin or lithium

toxicity if the client is taking these

medications.