Comprehensive

• Hypovolemia Early Indicator:


  Increasing pulse & decreasing blood pressure
• clients who are vitamin c deficiency

  • Scurvy
  • bleeding gums
• Vitamin D foods

  Fatty fish, eggs, fortified products (cereal, milk, orange juice)
• Calcium foods


  Dairy, broccoli, kale, fortified grains
• Sodium foods


  Table salt, added salts, processed foods
• Vitamin A foods


  Fatty fish, egg yolks, butter, cream, dark yellow/orange fruits & vegetables (carrots, yams, apricots, squash, cantalope)
• Vitamin E foods


  Vegetable oils & certain nuts
• What actions to take for Hirschsprung’s Disease?

  prepare the family for surgery.

  need surgery to remove the affected segment of the intestine.
• Plaster of Paris casts

  Heavy, not water-resistant, can take 72 hours to dry
• Handling a plaster cast

  Use palms, not fingertips, until the cast is dry to prevent denting
• Elevating the cast


  Prevents edema during the first 24-48 hours, elevate above heart level
• Inspecting the cast


  Every 8-12 hours
• Relieving itching under the cast


  Blow a hair dryer into the cast, use plastic if needed to avoid raising urine or feces
• Reporting issues with the cast

  Pain, "hot spot", drainage, warmth, odor (infection), change in mobility, skin breakdown, constipation
• Ball and socket joint


  Found in the shoulders and hips
• Sources of non-pharmacological pain relief following a Cesarean birth

  • Patterned breathing exercises
  • Relaxation
  • Biofeedback therapy
  • TENS
  • Music
  • Use of natural parks
  • Subdued lighting
  • Back rubs
  • Massage
  • Walking
  • Sacral pressure
• Foods high in potassium


  • Oranges
  • Dried fruits
  • Tomatoes
  • Avocados
  • Dried fruit
  • Meats
  • Broccoli
  • Dairy products
  • Whole grains
  • Potatoes
• Providing postmortem care for a client who practiced Islam

  Position the head toward Mecca
• Providing gastrointestinal care for a child with a gastrectomy enteral tube

  1. maintain nutrition, utilize a 9-tip to clean around the gastrostomy tube

  2. Tube insertion with mild suction and water, no lotions, creams or ointments

  3. Hydrogen peroxide, keep skin dry
• Heart failure


  Occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion. The heart is unable to maintain adequate circulation to meet tissue needs.
• Causes of heart failure

  • Acute or chronic cardiopulmonary problem, such as systemic hypertension, myocardial infarction (MI), pulmonary hypertension, dysrhythmias, valvular heart disease, pericarditis, or cardiomyopathy
• Pulmonary edema


  A severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure
• Causes of left-sided heart (ventricular) failure


  • Hypertension
  • Coronary artery disease, angina, MI
  • Valvular disease (mitral and aortic)
  • Smoking
• Causes of right-sided heart (ventricular) failure

  • Right ventricular MI
  • Pulmonary problems (COPD, pulmonary fibrosis)
• Causes of high-output heart failure

  • Increased metabolic needs
  • Septicemia (fever)
  • Anemia
  • Hyperthyroidism
• Causes of cardiomyopathy (leading to heart failure)

  • Coronary artery disease
  • Infection or inflammation of the heart muscle
  • Various cancer treatments
  • Prolonged alcohol use
  • Heredity
• Expected Findings


  • The presence of other chronic illnesses (lung disease, kidney failure) can mask the pre
• Symptoms of left-sided failure

  • Dyspnea, orthopnea (shortness of breath while lying down), nocturnal dyspnea
  • Fatigue
  • Displaced apical pulse (hypertrophy)
  • S3 heart sound (gallop)
  • Pulmonary congestion (dyspnea, cough, bibasilar crackles)
  • Frothy sputum (can be blood-tinged)
  • Altered mental status
  • Manifestations of organ failure, such as oliguria (decrease in urine output)
  • Nocturia
• Symptoms of right-sided failure


  • Jugular vein distention
  • Ascending dependent edema (legs, ankles, sacrum)
  • Abdominal distention, ascites
  • Fatigue, weakness
  • Nausea and anorexia
  • Polyuria at rest (nocturnal)
  • Liver enlargement (hepatomegaly) and tenderness
  • Weight gain
• 1. type natriuretic peptides (BNP)


  In patients who have dyspnea, elevated BNP confirms a diagnosis of heart failure rather than a problem originating in the respiratory system. BNP levels direct the aggressiveness of treatment interventions.
• BNP levels


  • Less than 100 pg/mL indicates no heart failure
  • Greater than 400 pg/mL indicates heart failure
  • BNP increases with the severity of the heart failure
• Hemodynamic monitoring


  • Used to identify the client's cardiac function and response to treatment. A catheter is inserted into a central vein into the right side of the heart and pulmonary artery. This can measure the client's central venous pressure, pulmonary artery pressures, and cardiac output.
• Ultrasound

  • Two-dimensional or three-dimensional ultrasound (also called cardiac ultrasound or echocardiogram) is used to measure the systolic and diastolic functioning of the heart.
• Left ventricular ejection fraction


  The volume of blood pumped from the left ventricle into the arteries upon each beat. Expected reference range is 55% to 70%.
• Right ventricular ejection fraction


  The volume of blood pumped from the right ventricle to the lungs upon each beat. Expected reference range is 45% to 60%.
• Transesophageal echocardiography (TEE)


  • Uses a transducer placed in the esophagus behind the heart to obtain a detailed view of cardiac structures. The nurse prepares the client for a TEE in the same manner as for an upper endoscopy.
• Chest x-ray


  • A chest x-ray can reveal cardiomegaly and pleural effusions.
• ECG, cardiac enzymes, electrolytes, ABGs

  To identify factors contributing to heart failure and/or the impact of heart failure. Monitor potassium level closely if the client is taking diuretics.
• Beta adrenergic blockers (beta blockers)


  Medications such as carvedilol and metoprolol can be used to improve the condition of the client who has sustained increased levels of sympathetic stimulation and catecholamines. This includes clients who have chronic heart failure.
• Nursing Actions for beta blockers

  1. Monitor blood pressure, pulse, activity tolerance, and orthopnes.

  2. Check orthostatic blood pressure readings.