Reference no: EM133853450
A nurse is assigned a patient who had a PLV (Partial left ventriculectomy) five days ago. The patient stayed in ICU initially, and is expected to come to the cardiac unit sometime during this morning.
PATHOPHYSIOLOGY
• DILATED CARDIOMYOPATHY - As a primary myocardial disorder, the myocardial dysfunction of dilated cardiomyopathy occurs in the absence of other disorders that can cause dilated myocardium, such as severe occlusive coronary artery disease or conditions that involve pressure or volume overload of the ventricle (eg, hypertension, valvular heart disease). In some patients, dilated cardiomyopathy is believed to start with acute myocarditis (probably viral in most cases), followed by a variable latent phase, a phase with diffuse necrosis of myocardial myocytes (due to an autoimmune reaction to virus-altered myocytes), and chronic fibrosis. Regardless of the cause, the myocardium dilates, thins, and hypertrophies in compensation (see figure Forms of cardiomyopathy), often leading to functional mitral regurgitation or tricuspid regurgitation and atrial dilation.
• CHAGAS DISEASE - Chagas disease is most commonly spread when a kissing bug bites an infected person or animal, then bites another person. While biting, infected bugs deposit feces containing metacyclic trypomastigotes on the skin. These infective forms enter through the bite wound or penetrate the conjunctivae or mucous membranes. The parasites invade macrophages at the site of entry and transform into amastigotes that multiply by binary fission; the amastigotes develop into trypomastigotes, enter the bloodstream and tissue spaces, and infect other cells. Cells of the reticuloendothelial system, myocardium, muscles, and nervous system are most commonly involved.
Patients with CCC may be asymptomatic or present with symptoms such as dyspnea on exertion, fatigue, palpitations, dizziness, syncope, chest pain (atypical or angina), and edema. Symptoms arise from heart failure (HF), cardiac arrhythmias, and thromboembolism caused by CCC.
1. What history data is important for this condition?
2. Using these signs/symptoms, and any description of condition provided above, create data that you would find on physical assessment if you were actually caring for this patient.
3. What special assessments/monitoring would be needed for this patient? What special care may be necessary?
4. Explain how the patient condition affects vital signs. How often should they be checked/documented?
5. What diagnostic tests (specific to condition) would you expect the physician to order for this condition? Describe how the test would be useful and the expected results. What patient preparation/teaching is necessary? What post-procedure care is necessary? What surgical procedures may be necessary?
6. List at least 5 medication that you would expect this patient to be taking for his current condition or his past medical history. Why? Therapeutic effects? Adverse effects to monitor for? (Answer these questions for each medication).
7. Assume for a moment that your patient has just arrived on your unit, what important data (relevant to this condition) is needed before you call the physician for orders?
8. What diet would you expected for this patient?
9. What activity level is expected for this patient?
10. What nursing diagnoses (at least 3) are appropriate for this patient?
11. Prioritize the diagnoses.
12. How did you determine the order of prioritization of the nursing diagnoses?
13. List at least 3 interventions for 2 of the nursing diagnoses?
14. Which interventions can you delegate to an unlicensed person?
15. You have cared for this patient for 2 days. You're taking report from the night nurse. Create the shift report information you would expect from your patient (w/ at least one complication).
16. The physician just came in and wrote discharge orders for this patient. What are the most important teaching instructions for this patient or family?