Cardiovascular Disorders A 60-year-old male, 5 days post laparoscopic cholecystectomy, is getting ready to be discharged today and is going through the final assessment. When the assessment takes place, the nurse finds that patient has a pulse of a 110 beats per minute and irregular compared to his normal 86-90 beats per minute with a regular pulse that the patient has been having since post-surgery.
Since post-surgery, there has been an increase in patient’s pulse rate to110 beats/minute and the pulse is now irregular. This fact should raise a red flag. This finding would be documented after the nurse retakes the pulse to make sure that there was not an error. The nurse should call the physician immediately to inform him/her of the findings and get further instruction as to how to proceed with patient care.
Significance of an irregular pulse
The irregular pulse can show problems with the heart and its functions. It can be a sign of heart disease such as dysrhythmia. “Some dysrhythmias may be asymptomatic while others can cause death. The danger and symptoms depend on the extent that they reduce cardiac output.” (Story, 2012)
Assessment for post laparoscopic cholecystectomy.
The key components for a patient with five days post laparoscopic cholecystectomy is to do a physical assessment, monitor the patient’s vital signs and look for any abnormalities such as high fever, pain, abnormal heart rate, high blood pressure. Bowel movements have to be monitored to make
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Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.
Smith came in with the same complaint as before, but is now stating he is also having shortness of breath. His vitals were taken and there was an additional concern. Mr. Smith's blood pressure was taken manually with a blood pressure cuff and stethoscope and determined his blood pressure was currently at 160/100 mmHg. The 160 or top number is the systolic blood pressure which is the amount of pressure being pushed through the arteries to the rest of the body while the heart is beating. The 100 or the bottom number is the diastolic blood pressure which is the amount of pressure in the arteries while the heart is at rest. The normal range for an adult is 120/80 mmHg. Mr. Smith had an MRI completed at it revealed metastasis of prostate cancer to osseous tissue. He also had an abdominal CT and it showed an obstruction of the intestine due to nodular enlargement of the adrenal glands. He was again admitted to the hospital and had additional labs ordered. He had to repeat the complete blood count and blood and urine potassium check, a blood glucose test, and an adrenal stress test to include serum aldosterone, 24 hour urinary aldosterone, renin, adrenocorticotopic hormone(ACTH) and cortisol
Postoperative nursing care after a laparoscopic cholecystectomy includes monitoring for complications such as bleeding, making the patient comfortable, and preparing the patient for discharge. Assessment findings for poor wound healing include redness, tenderness, swelling, purulent drainage, pain, and fever. Monitoring white blood cell count is a way to see if there is a presence of a bacterial infection. Maintaining good fluid intake and nutrition promotes fast and good wound healing. The carbon dioxide can irritate the phrenic nerve
The patient tells me his last visit with Peter Dourdoufis, MD was just last week. I do not yet have a note from that visit. He says that he underwent an EKG and a stress test evaluation. To his knowledge, everything was okay, but he actually has an appointment tomorrow with Dr. Dourdoufis to review everything. No medication changes have been made per his report. He tells me that his blood pressures have been in a good range. Here today, his blood pressure is 126/76. He is not having problems with chest pain, shortness of breath, dyspnea on exertion or lower extremity swelling. He is still working
The heart in many cases does not have a correct beat and can cause symptoms like fainting, chest pain, heart fluttering, etc (WebMd.com). In some cases, Arrhythmia can be major as it can sometimes cause immediate heart failure or cardiac arrest (MedicineNet.com). The last main condition of cardiovascular diseases are strokes (Centers for Diseases Control and Prevention). A stroke is a point where the brain has an interruption of a blood supply (usually are blood clots). Strokes can block the blood that flows to the heart and can result in heart attacks, cardiac arrest, dizziness, slurred speech, etc (Centers for Diseases Control and Prevention). All of these conditions are the main aspects of cardiovascular disease (WebMd.com).
“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”
He underwent multiple cardiac related procedures, including a cardiac catheterization and stent placement. After discharge, he developed a fast heart rhythm (180-190 beats per minute -ventricular tachycardia) and other serious heart problems (cardiomegaly, valve regurgitation, and others) that required a cardiac defibrillator implant. He fatigued easily; his condition deteriorated and was hospitalized once more. The diagnoses listed included myocardial infarction (heart attack), acute on chronic respiratory failure, congestive heart failure (CHF), kidney failure, liver failure, hypertension, and anemia. His blood tests were abnormal.
Collaborate with your preceptor to interpret your patient’s EKG rhythm and list your patient’s rhythm. Discuss the implications this patient’s heart rhythm has for circulation. How does your patient’s specific rhythm impact the physical assessment findings? What if the rhythm changes: what would happen if the rhythm became slow, fast, or irregular? How could these changes manifest in the patient assessment and how would you, as the nurse, proceed?
Data gathered tonight includes electrocardiogram is unchanged from previous showing slightly low voltage, left anterior fascicular block. No definite ischemic changes. White count of 6.2, hemoglobin 11.00, platelets 117, glucose 90, BUN 43, creatinine 2.56, sodium of 138, potassium of 3.4, chloride 106, CO2 of 24.8, calcium of 8.2, bilirubin 0.92, alkaline phosphatase 307, ALT of 23, AST of 21, magnesium of 1.8, a troponin is 0.06, BNP is 2650. Labs done almost 24 hours ago had a lower BUN at 41, and a lower creatinine 2.23, a higher potassium at 3.7, BNP that was higher earlier at 3350, and a troponin that was slightly less at 0.04. Chest x-ray may have more congestion now than previous. Frontal view this morning was obtained the radiologist says the findings are concerning for minimal congestion versus atelectasis in lung bases and a stable mild to moderate cardiac
Postoperatively, pediatric patients typically exhibit low cardiac output. The study by Pediatric Cardiology provided temporary pacing to pediatric patients who underwent cardiovascular surgery with efforts to help enhance cardiac output postoperatively. 60 pediatric patients under the age of 18 consented to participate in the study. However, only 30 of the consenting patients were able to take part in the study. The 30 patients were unable to take part in the study largely because they became tachycardic at baseline postoperatively. Once temporary pacing was placed in the eligible patients, no benefit was determined. Cardiac output did no increase any faster than pediatric surgical patients who did not receive temporary pacing. Because the subjects in this study consisted of such a small subset, the author determined that even though temporary pacing was not beneficial for any of the patients in the study, temporary pacing will be beneficially to patients suffering from bradycardia postoperatively because the pacer will help maintain a normal sinus
A 45-year-old male comes into the emergency department with symptoms of acute dizziness, dyspnea, chest pressure, and palpitations. He states that he feels that his heart is “racing.”. He has a history of hypertension (HTN) and coronary heart disease (CAD) status post one bare metal stent. He is currently on clopidogrel, aspirin, metoprolol, and Llisinopril. His BP blood pressure is 87/60 mmHg, pulse heart rate 160–-170 beats/min, respirations rate 26 breaths/min, oxygen saturation 90% on room air, and afebrile. His physical exam has pertinent positive findings of diminished global breath sounds and rapid sinus heart sounds. He has no jugular venous distention (JVD), abdominal tenderness, nuchal rigidity, lower extremity swelling, or focal
The complication is determined by any existing medical problem and the postoperative management. The complication should be treated considering the patient medical history in mind to avoid further problems. Initial signs include but not limited to pain, fever, dehydration and confusion. Most complications happen within minutes of surgery or days after surgery. Late complication may be bowel obstruction due to patient lying in one position for a long time, infection on the wound, pneumonia, nausea and vomiting and insomnia. When nurses advocate for the patients and identify the symptoms might help from becoming worse. Complications may also be influenced by other various causes, comprising of pain, sleep disturbance, medication or metabolic disorders, Nausea and vomiting: analgesia, paralytic ileus, Fever, Secondary hemorrhage often caused by infection, Pneumonia, wound not healing well. Report to the surgeon who may treat and prevent further damage to the
During inspection of the heart assessment observe abnormal finding. Inspect the jugular vein and the carotid artery. Note pallor or cyanotic skin color, temperature, turgor, texture, and clubbing of finger. Observe for swelling, edema and ulceration. Clubbing is a sign of chronic hypoxia caused by a lengthy cardiovascular or respiratory. Poor cardiac output and tissue perfusion is noted by cyanosis and pallor. For dark-skinned, inspect his mucous membranes for pallor. Decreases or absent of pulse with cool, pale, and shiny skin, and hair loss to the area, and the patient may have pain in the legs and feet may indicate arterial insufficiency. Ulcerations typically occur in the area around the toes, and the foot usually turns deep red when dependent