BNURS20 Nursing Assignment


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Questions 1 through 2 are about case study. Question 3 can relate to either case study or another question.

Questions clarification: Refer to the instructions file. Assignment details.

Answer to Question: BNURS20 Nursing Assignment

A particular case study caught my attention during my clinical rotation.

The case involved Mr. Curtis, a man.

He was 74-years old, and the man had been admitted following a routine operation to remove his cholecystectomy.

He had a history of high blood sugar and cardiac myocardial attacks over the last year.

As I was doing my routine observation using an electrocardiogram (ECG), I discovered that the patient had a irregular heart beat (HR).

This electrocardiogram shows that the patient is suffering from an irregular heartbeat.

A normal, or more irregular cardiac rhythm is characterised by a T wave, QRS, and a W wave.WAVE/INTERVAL


QT Interval0.36-0.44 Seconds.

P waveAmplitude:2-3 mm high

Deflection =+ in I,II.AVF,V2-V6


T wave

Amplitude – 0.5 mm for limb hillsDeflection:I,II,V3-V6

Duration:0.1-0.25 SecondsST segment0.08-0.12 seconds.

Complex QRSAmplitude:5-0 mm High

Deflection: + for I, II, III and IV.

Duration:0.06-0.1 second

PR Interval

0.012-0.2 seconds

The image and table below illustrate an average electrocardiogram.

According to the above results, it is possible that the patient has cardiac arrhythmia.

This condition is also known irregular heartbeat. It simply refers to a variety of heart conditions with irregular heartbeats.

You can have a heartbeat that is too slow or fast. Mr. Curtis’s test results show that his heartbeat has been very fast. This is characteristic of cardiac arrhythmia.

A fast heartbeat can be called tachycardia.

Cardia arrhythmia is a condition in which the electrical system of the heart fails.

The sinoatrialnode, a mass or tissue found in right atrium of the heart, is responsible for generating an electrical stimulus.

The sinus node creates an electric stimulus that travels through conduction channels downwards.

Arrhythmias can be caused by any alteration in the electrical system of your heart.

This includes stress, certain medications, nicotine, caffeine and other substances.

The treatment of cardiac arrhythmias can be avoided, but it should be sought if there are any significant or severe symptoms.

The condition should be treated if it is a potential health risk.

As we have discussed previously, cardiac arrhythmias could be slow heartbeats or fast.

However, the treatment options for both are similar.

The pacemaker is a device doctors use to treat slow heartbeats. This is because no studies have shown that medications can cause it to beat faster.

A pacemaker is a device that is implanted within the body, usually near the collarbone.

The pacemaker uses wires with electrodes that are placed in the blood vessels of the heart. Their purpose is to detect and send signals back to the heart to increase heartbeats if it slows.

The majority of doctors will prescribe drugs to counter cardiac arrhythmias.

Antiarrhythmics are drugs that treat cardiac arrhythmias.

Amiodarone, also known by the name Cordarone is the most well-known Antiarrhythmic.

Flecainide (also known as Cordarone), Procainamide and then finally, sotalol are all other Antiarrhythmics.

Two other drug classes include the Beta-blockers, Procainamide and finally the sotalol.

Toprol XL or metoprolol are examples of beta blockers.

These drugs decrease the heart’s rate.

Verapamil or calan, which reduce the heart rate, are calcium channel blockers.

Calcium channel blockers, and beta blockers, have different mechanisms.

Beta blockers prevent the release of adrenaline, epinephrine, or adrenaline.

Calcium narrows blood vessels. The calcium channel blockers block calcium’s actions, which means that blood vessels relax and become wider. This reduces heart beats.

There are many side effects to antiarrhythmic medication. These include blurry or blurry vision and dizziness.

Also, you might experience an increase in appetite and a metallic taste inside your mouth. You might also feel sensitive to light.

One can also experience diarrhea or constipation.Electrolyte Management

Heart arrhythmias are caused by disturbances in the electrolyte equilibrium.

In cardiac arrhythmia, potassium is the main electrolyte.

The blood plasma level of potassium should not fall below 3.5 mmol/L.

Keep the potassium levels in your blood plasma at 3.5 to 5.2 mmol/L. Any decrease or increase in potassium will cause damage to the myocardium, or heart muscles.Monitoring Patients.

A monitoring system is an additional method that can help detect and treat cardiac arrhythmias.

There are many monitoring procedures you can choose from.

These are just a few of the common monitoring methods that are used.

An event monitor, or device worn by the patient during daily activities, is an electronic device.

This device is used in monitoring cardiac arrhythmias which are less frequent.

It is equipped with electrodes, which are placed on the patient’s chest. After that, the wires of the electrodes are attached to the box. This box can then be worn on a belt.

The button activates recording when there are any symptoms.

The monitor would then take readings one minute before pressing the button and forty seconds after the arrhythmia occurs.

A Holter Monitor, another device that can be used for monitoring patients, is also available.

The device also includes electrodes that are worn on the chest.

The device records electrical impulses from the heart and stores them in the same place.

The patient is then instructed to keep track of his or her activities.

An Electrocardiogram (also used to monitor the electrical activity within the heart) is also available.

It is equipped with electrodes, which are connected to the machine via the arms, legs and chest.

Basic Interpretation The ABG results

Here were the results for Mr. Curtis.ABG

Normal rangePH7.327.35-7.45PaO264


35-45mmHgHCO3-2622-28 mmol/LSaO291%95-100%

The results clearly show that the blood pH is below normal levels.

The heart tends more to work, so the blood pressure will rise.

Pathophysiology of Acute pulmonary Edema

Below is a quick summary of the pathophysiology behind acute pulmonary edema.

McCance suggests that Acute Pulmonary Elema can be caused when there are abnormalities in hydrostatic, capillary, oncotic, and lymphatic pressures.

This could be caused by either diastolic (systolic) or systolic cardiac failure.

Systolic or left-sided heart failure refers a condition in the which the left ventricles weaken and become unable sustain adequate cardiac output.

Diastolic, or left-sided heart failure, refers to a condition that causes the left ventricles to fail to relax properly between contractions. This is also known as ventricular flooding. This can lead to decreased output.

There are many conditions or factors that can cause heart failure.

Cardiomyopathy, high blood pressure and heart disease are all common.

Reduced cardiac output from heart disease can cause reduced cardiac output.

Vasoconstriction is one example of the compensatory mechanisms.

Vasoconstriction can also be caused by inadequate oxygen in tissues. The sympathetic nervous systems is stimulated when there is a lack of noradrenaline.

Reduction in blood flow to the kidneys stimulates what’s known as the Renin Angiotensin System, which leads to systemic vascular constriction.

All of these factors contribute to an increase in cardiac output.

Vasoconstriction causes an elevated afterload that often makes the cardiac function weaker.

It is due to the obstruction of the fluids within the lungs that they are unable function properly in terms o gaseous exchange. This eventually leads to respiratory distress, or acute pulmonary edema.

Treatments for Acute Pulmonary Edema Patients: Nursing and Medical Interventions

Acute pulmonary edema refers to the treatment of a patient with pulmonary edema. The goal is to optimize the heart’s function by reducing the cardiac work and intravascular volume.

These treatments aim at reducing intrapulmonary pressures while allowing the lymphatic to drain fluids from the alveolar spaces.

Furosemide, Nitroglycerin and Nitroprusside are some of the most frequently used drugs to treat flash pulmonary embolism.

Furosemide works as both a diuretic (and a vasodilator).

However, Nitroglycerin acts as a vasodilator and reduces preload. If taken in large doses, it also increases afterload, improving the overall cardiac output.

The venous and arterial dilation of Nitroprusside reduces the preload as well as the afterload. Thus, it lowers blood pressure.

Morphine can reduce blood pressure and pulmonary swelling by venous dilation (Obrowski (2016)).

Morphine can cause respiratory depression and should therefore be used with great care.

Patients with acute pulmonary Edema will need to be titrated with oxygen using the nasal cannula. This is done in order for the oxygen saturation to remain within the 92-100% range per MD order.

The patient will also receive Lasix 60mg IVBID per MD order. Patients with acute pulmonary Edema will be weighed daily.

HDU components of patient assessment

HDU assessment has many components. These include breathing, circulation and disability.

Each of these components has established standards which nurses will need to compare with the patient so they can determine or learn how to manage the patient.

APO: Respiratory symptoms and why they occur

There are many signs and symptoms of acute respiratory embolism.

Common signs include irregular and rapid heartbeats, blue-tinged eyes, and cold and clammy skin. You may also experience wheezing or gasping to breathe.

Some patients feel like they are in danger of drowning, or will feel as if they are suffocating.

You may also experience a cough that produces sputum that’s frothy or has blood spots.

A common symptom is anxiety, restlessness and fear.

Dyspnea is another common problem. This condition worsens when the patient lies on their back.

Refer toKunisek, J. (2012).

Cardiac rhythmias can be influenced by Patern and left Ventricular Hypertrophy. Cardiac Arrhythmias – New Considerations. doi:10.5772/38133Obrowski, M. (2016).

High Altitude Pulmonary Disorders that are Deadly: Acute Mountain Sickness and High Altitude Cerebral Dementia (HAPE), Acute Mountain Sickness (AMS), Acute Mountain Sickness (AMS), and High Altitude Pulmonary Dysfunctions (HAPE). Clinical Review.

International Journal of Pulmonary & Respiratory Sciences. doi:10.19080/ijoprs.2016.01.555553