Giving Beta Blockers to Someone with Mobitz Ii Heart Block

Early doctors were researching arrhythmia in heart beat as a result of unknown abnormal neuro-cardio mechanisms of the heart, one of theories was that SA and AV nodes were interfering with each other’s bio-electrical impulses another theory was that the right side of the septum was hypersensitive to electrical impulse, all were more else on the right track because we know now that SVT is a result of a faulty electrical connections of the heart.

For my seventh clinical shift at the Loma Linda Veterans Affairs Medical Center, my assigned preceptor Filipina Gumangan assigned me three patients on the 4NW unit. The unit where I precept is an intensive care step down unit. Filipina’s objective for giving me three patients this shift was to give me an opportunity to continue exercising my time management skills and to practice my reporting and charting skills, and wound care. This shift I was responsible for many clinical duties corresponding to the care of these patients. My patients this shift were Mr. B, a 72 year-old Vietnam War veteran newly diagnosed with colon cancer, Mr. S, a 65 year-old Vietnam War veteran in the hospital for complicated urinary tract infection, Mr. R, a 90 year-old Korean and Vietnam War veteran. Caring for these patients taught me more about the humanbecoming perspective of nursing and showed me about multidisciplinary coordination with peers, colleagues, and more.

Apical hypertrophic cardiomyopathy is a disease that mainly affects the apex of the heart and does not cause any obstruction. [1] These abnormalities in the heart muscle can cause a wide variety of symptoms. As the heart becomes stiff it increases the pressure in the left ventricle which can push blood back into the lungs, causing shortness of breath in exercise. Chest pain can occur as there is not enough oxygen available to the cardiac muscle due to insufficient blood supply. Palpitations and lightheadedness, along with other conditions can occur as a result of HCM. In addition to these discomforting symptoms, the patient may develop an arrhythmias that often goes unnoticed. An arrhythmia takes place as the electrical conduction of the heart is disturbed by the abnormal scattering of myocytes. The two most common arrhythmias are atrial fibrillation causing palpitations, and ventricular tachycardia that can be life threatening causing sudden death. Both conditions can be controlled with medication. [4]

✽ Note: Most HF admissions are R/T fl uid volume overload. Patients who do not require intensive

Individuals with this disorder further acquire congenital heart defects. It specifically blocks off the natural blood flow from the lungs and right chamber of the heart and/or causes an anomalous gap in the barrier that divides the heart chambers in two. Another symptom of this disorder are the problems involved in the digestive system. People who have this syndrome are

The patient's comorbidities include Hypertension, hyperlipidemia, CAD, and GERD. The patient had a CABG operation a few days back from admission day on 4-10-2017. In addition to the CABG surgery, other procedures such as TEE, cardiopulmonary bypass, vein harvest, and a thoracotomy with a chest tube and JP drain. Significant surgical procedures also include angioplasty and left and right knee arthroplasty.

I am a second year nursing student in my third week of the practicum placement on a surgical ward with my co-student and the morning shift registered nurses. We had just finished analysing the patients handover report (Levett-Jones & Bourgeois, 2015) and I had been assigned to work with the registered nurse. I was looking after Mrs. Brown (pseudonym) is 82 years old New Zealander was admitted to surgical ward on the 08/06/16 for multiple SCC removals from L) hand and L) foot with skin grafts.

is very pleased with the quality of care she recived during her stay, after further conversation with her I noticed a couple of things that would have improved the quality of care. there was a dicrepancy in the care she received in two different units. while in delivery unit all the call bells were answered on time and the nurses checked on her frequently, same couldn't be said about the nursing care in the recovery unit. A couple of incidences stood out that could have been handeled in a different manner. First one was that when S.D. received her meal and she wanted to confirm that it was a vegetarian meal. The nurse said that she was sure the meal ddn't have any meat in it because that’s what her chart said. but this response didn't satisfy the ptient and she decided not to eat the meal. Second incident was more of a safety concern compared to the first one. S.D. was advised to call for help before going to the bathroom because of pain and swelling around her stiches. But during one instnace while she rang the bell, a nurse came in and told the patient that because her husband was sleeping in the room he could help her to get to the bathroom. This incidence raises a serious safety concern for the pateint. If an untrained healthcare professional such as her husband helped her get in and out of the bed, he could have pulled on the stiches and caused a potential

Beta-blockers have been recently reported to decrease mortality in heart failure patients. Mortality and hospitalization rates for patients with the disease are high and continue to rise. Despite the magnitude of the problem, treatment of congestive heart failure is often inadequate. Primary care physicians care for most patients with heart failure. Beta-blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left ventricular systolic dysfunction. Unless contraindicated, beta-blockers should be considered a mainstay of therapy in these patients to improve symptoms and mortality and to decrease hospitalizations. Beta-blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.

Healthcare in the United States is changing which has given rise to new hurdles that must be overcome. One of the issues that we are currently facing in many tertiary facilities is the need for set criteria involving intensive care unit admissions and discharges. Throughout the country the total number of intensive care unit (ICU) beds are on the rise, but the current supply still outnumbers the demand (Cognet & Coyer, 2014). The cost of staying in an ICU is continuing to increase with technology, and there are limitations that insurance companies and the government have set forth to the number of days a patient can reside there dependent upon his diagnosis and condition. Intensive care units will continue to undergo strain due to high census, and decisions to discharge patients will be effected (Wagner, Gabler, Ratcliffe, Brown, Strom, & Halpern, 2013). Typically, the decision to have a patient occupy an ICU bed is based upon whether or not they are sick enough to be there or if they are well enough to be discharged to a progressive care unit (PCU) or medical surgical unit (Meyer, 2003). A progressive care unit is a step down from an ICU, but has stricter criteria for admission than a medical surgical unit based upon the patients medical status. Not all facilities offer a PCU, but the need for this level of care is continuing to rise with the number of ICU admissions increasing. Standardized guidelines for patient placement in

An elderly male with congestive heart failure was brought to a clinic because he was experiencing atrial fibrillation and had a ventricular response of 110 beats/min with palpitations and shortness of breath1. Medications that he was taking includes angiotensin-converting enzyme inhibitor, Lisinopril, Carvediol, Digoxin, and Furosemide1. His left ventricular ejection fraction has been reduced to 25%1. Further examinations showed that he had edema in his legs and crackles at the base of his lungs1. He was then told to increase the dosage of Furosemide by taking the drug twice daily instead of once, and doubling the dose per administration1. One week later, the electrocardiogram revealed that he had ventricular arrhythmias such as premature

12 lead EKG: It is one of the tools for initial evaluation of patients suspected of coronary syndromes such as MI. It as a sensitivity of 80% (Kreatsoulas et al., 2016). ST segment changes of elevation or depression, left bundle branch block, presence of Q waves, new onset of T wave inversion are suggestive of ischemic changes of heart. In this case, then Intervention for cardiac catheterization with stent placement may be required (McConaghy & Oza, 2013).

Define partial heart block, and describe how it was recognized in the laboratory. When the 1:1 ratio of atrial to ventricular

More recent cases and retrospective reviews suggested that the ST segment elevation or depression, T wave inversion and prolonged QT interval were commonly identified (Chin, Branch & Becker 2005; Malik et al. 2015; Shoukat et al. 2013; Waller et al. 2013). In addition, case studies claimed that these observed abnormalities predominantly occurred in the anterior and lateral leads (Franco et al. 2010; Waller et al. 2013), suggesting impaired ventricular repolarisation in a cardiac cycle. These ECG patterns are commonly seen in patients with acute myocardial infarctions. However, in the setting of SAH, the changes of ECG pattern were not associated with coronary obstruction (Banki et al. 2006), but rather the reflection of autonomic dysfunctions that are induced by the neurological insults.

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.