observe findings of hypotension, bradycardia, diaphoresis, dizziness; give atropine and lay the client flat•monitor serum creatinine•client and family teaching•risk-factor modification•teach the risk factors for coronary artery disease (CAD)•encourage client to lose excess weight; review low-fat, low-cholesterol diet, resume activity gradually as tolerated orencourage participation in cardiac rehabilitation program•encourage smoking cessation- acute coronary events are strong motivation for many clients to successfully quit smoking•teach side effects of drugs for CAD•stress - teach stress reduction techniques•avoid•activities known to cause angina•physical activities for two hours after meals•very cold and very hot weather•alcohol and caffeine drinks•stimulants such as diet pills, nasal decongestants, or any remedy that can raise heart rate or blood pressure•use•nitroglycerin tablets and carry at all times•1 tablet every 5 minutes up to 3, if no relief call 911•report•new anginal pattern- if it occurs with less activity, or at rest•If multiple doses of nitroglycerin or more frequent use is neededD. HYPERLIPIDEMIADefinition:an elevation of lipids (fats) in the bloodstream, e.g., cholesterol, cholesterol esters (compounds), phospholipids,triglycerides•Etiology: dietary, heredity•Pathophysiology: increased lipids and cholesterol leads to atherosclerosis, leading to coronary heart disease•Diagnostic studies•total cholesterol - increased•LDL - increased•HDL - decreased•triglycerides - increased•Management•diet•choose healthier fats and eliminate trans fats•limit cholesterol in food•whole grains•eat foods rich in omega-3 fatty acids
•exercise•medications•statins: atorvastatin, rosuvastatin, simvastatin•bile acid sequestrants: colestipol, cholestyramine•niacin•Nursing interventions•encourage screening for at risk children with family history•teach dietary guidelines or refer to dieticianCARDIAC ARRHYTHMIASDefinition:disturbance in heart rate or rhythm•Types ofdysrhythmia•A. Supraventricular:sinus, atrial, and junctional (originates outside the ventricles, usually in atria) - immediateintervention may be required with very fast or slow rates that are symptomatic•1. sinus tachycardia2.sinus bradycardia3. Sinus arrythmia4.premature atrial complexes5. atrial tachycardia6. atrial flutter
7. atrial fibrillation- very common, may cause thrombotic stroke due to lack of atrial contraction, requiring anticoagulation8. premature junctional complex9. junctional tachycardiaB. Ventricular:immediate intervention may be required with very fast or slow rates that are symptomatic; very seriousrhythms indicated by emergent care1. premature ventricular contraction2. ventricular tachycardia- emergent care with defibrillation needed, may have pulse or no pulse - includes Torsade dePoints3. ventricularfibrillation- emergent care with defibrillation needed - incompatible with life4.
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