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Contact Customer and publisher do not warrant that all the mateopinions of its consultants erectile dysfunction blood flow generic priligy 60 mg without a prescription. Special rial in this publication is accurate and complete Letter is supported solely by subscription Web Site Classroom rates are available erectile dysfunction treatment phoenix purchase priligy with mastercard. The Editors and Publisher Site license inquires to: declare no conflict of interest erectile dysfunction drugs injection discount priligy online. The sinus node starts each heartbeat by generating a small amount of electricity impotence natural remedy purchase 60mg priligy otc, which spreads into the muscle cells of the atria drugs for erectile dysfunction ppt cheap 60 mg priligy free shipping. Next, the electrical activity moves into the junction between the atria and ventricles. It takes the signal coming from the atria, delays it slightly, then passes it into the ventricles, which causes them to beat. The brain tells the sinus node how fast to beat; it can speed up during exercise or in times of stress and slow down when resting or sleeping. Diagnosis Arrhythmias are abnormalities of the heart rate and rhythm (sometimes felt as palpitations). Some patients with otherwise normal hearts can have abnormal electrical pathways in their hearts that cause arrhythmias. Patients with underlying problems in the function and structure of the heart are more prone to heart rhythm problems. As patients who’ve had successful heart surgery live longer, doctors are diagnosing more heart rhythm abnormalities. A heart rhythm abnormality is evaluated in ways much like those used to evaluate other health problems. The history of your symptoms, including sensation of your heart beating fast, dizziness and fainting are very important. The fast heart rate — often over 150 beats a minute — starts in the heart’s upper chambers or in the upper part of the electrical conduction system. Symptoms include palpitations, chest pains, upset stomach, decreased appetite, lightheadedness or weakness. Straining, such as closing the nose and mouth and trying to breathe out, may work. Once the rhythm returns to normal, proper therapy with drugs can usually prevent future episodes. This is a fast heart rate that starts in the heart’s upper chambers and is conducted to the lower chambers. It’s common after surgery that involves the atria (upper chambers), especially the Mustard, Senning and Fontan operations and in conditions that cause the atria to enlarge (most commonly from leakage or blockage or the mitral or tricuspid valves inside the heart). Besides a fast heart rate, other symptoms are fatigue, dizziness, lightheadedness and fainting. Ventricular Tachycardia this is a fast heart rate that starts in the heart’s lower chambers. It usually results from serious heart disease and often requires prompt or emergency treatment. Treatment options include medication, radiofrequency ablation and implanting a device (defibrillator) that shocks the heart into a normal rhythm or surgery. Patients may have no symptoms or may have fatigue, exercise intolerance, dizziness or fainting. Complete Atrioventricular Block (complete heart block) Complete heart block occurs when the electrical signal can’t pass normally from the heart’s upper to lower chambers. These can’t cure an arrhythmia, but they can improve symptoms by preventing episodes from starting, slowing the heart rate during an episode or shortening how long an episode lasts. Many side effects aren’t serious and go away when the dose is changed or the medication stopped. Some side effects are very serious and may require that you be admitted to the hospital to start the medication. If the medicine must be taken to prevent fast heart rate problems, a pacemaker may be necessary. Because of the side effects, it’s very important to take the medicine exactly as the doctor prescribes it. One risk of chronic heart rhythm abnormalities is blood clots forming in the heart, especially its upper chambers. If a clot breaks off, it can be carried to other parts of the body, such as the lung or brain, and cause serious problems. Anticoagulants (medication to help prevent blood clots) are given to prevent this from happening. Radiofrequency Ablation Radiofrequency ablation is done during an intracardiac electrophysiologic procedure. Then the catheter’s tip is heated by radiofrequency waves to alter a small area of the heart. Its success is directly related to the cause of the arrhythmia and the complexity of the underlying congenital heart disease. In most patients with congenital heart disease, these procedures should be performed in centers with special expertise. This procedure is usually combined with surgery to correct other heart abnormalities. Pacemakers and Implanted Defibrillators A variety of rhythm disorders can be controlled with artificial pacemakers. The wires are inserted into the heart through veins in the shoulder and the pacemaker is placed under the skin just below the collarbone. Sometimes the wires must be placed on the outside of the heart through a small operation and the pacemaker generator placed in the abdomen. When a fast heart rhythm develops, the device detects it and shocks the heart to correct the rhythm. Your doctor can tell you if you need to avoid other electrical equipment and how to minimize your risk. The cardiac muscle tissue is similar to other tissue in its ability to contract (contractility). The generation of the + ++ + impulses results from the movement of electrolytes (Na, Ca and K) across the cell membrane leading to the depolarization of the cell. Tissues located in the ventricles (bundle branches and purkinje fibers) can also produce impulses at rates of 20 to 40 per minute. Conduction Times & Velocities Conduction times and velocities are important in that they co-ordinate the electrical system of the heart with its mechanical function of a pump. The diagram below shows that the movement of the impulses through the atria (right and left) is significantly slower that the movement through the ventricles. The larger mass of the ventricle requires the rapid flow of the electrical impulses resulting in the complete depolarization and contraction of the entire ventricle at almost the same time. This action results in the forceful contracting of the heart producing cardiac output. The delay provides sufficient time to allow the ventricle to fully fill with blood and stretch sufficiently prior to the impulses entering the ventricle producing the contraction. This movement results in the depolarization and subsequent repolarization of the cell with corresponding contraction of the heart muscle. When polarity of cell becomes less negative (-65 mV) the fast sodium channels open and the rapid influx of positively charged sodium enters the cell bringing the polarity of the cell to + 20 mV. Chloride channels open allowing negatively charged chloride to enter the cell, reducing the positive charge of the cell to neutral (0 mV). There is also a small efflux of potassium at this stage, hence the dip in the action potential. Phase 2: Plateau (Absolute Refractory Period) – calcium channels remain open allowing the influx of positively charged calcium ions to enter the cell. This period is slower allowing for the full depolarization and contraction of the tissue. Phase 3: Slope (Relative Refractory Period) – potassium ions (+ve) leave cell (efflux) reducing the intracellular polarity until it reaches – 85 mV again. The cell wall membrane of the pacemaker cell is permeable to sodium allowing for the slow influx of this ion from outside to inside the cell. It is also believed that ++ slow calcium channels are present allowing the movement of Ca inside the cell. The movement of the positively + ++ charged Na and Ca ions into the cell results in the slow depolarization of the pacemaker cell. It is the basis of this standard running speed that creates the large boxes with corresponding time frames. When the lead selection is made by turning the switch to a specific lead, the polarity of the leads changes amongst the white, red and black leads as noted above. Step 1: Rate < 60 Bradycardic 60 99 N ormal > 100 Tachycardic Step 2: Rhythm Regular Irregular Step 3: P-R Interval 0. Look for missing beats where you expect them to be, or added complexes where they weren’t expected. Note that an escape beat (compensatory mechanism) occurs when there is a missing complex. The impulse may follow the normal pathways in the atria but as it enters the ventricles it is blocked in either the left or right bundle branches. This results in one ventricle depolarizing just prior to the other ventricle depolarizing. Missing / Added: Nothing Identifying Features: Rate less than 60, otherwise normal. Indicative Missing / Added: Nothing of re-entrant focus or accessory bypass track Identifying Features: reg. Can be caused by Sick Sinus sequence Syndrome, hypoxia or electrolyte disturbances. An escape pacemaker Rhythm: Irregular generally resumes the function of pacing the P-R Interval: < 0. Sinus Arrhythmia Rate: 60 100 Sinus Arrhythmia is seen predominately in the pediatric Rhythm: Irregular age group. This is a benign Missing / Added: Nothing rhythm that is interpreted by watching the patients Identifying Features: Slowing of rhythm with breathing while simultaneously watching the changes in respiration heart rate. Can have a variable Identifying Features: Flutter waves replace P conduction pattern of 2:1, 3:1 or 4:1 or any combination waves as seen in the above strip. First Degree Heart Block Rate: May vary st Rhythm: Regular 1 Degree Heart Block is identified by the prolonged P-R Interval: > 0. The pacemaker depolarizes at a Rhythm: Regular regular rate between 20 to 40 per minute. Patients generally present with Missing / Added: P waves severe hemodynamic compromise. Antegrade conduction is stopped as it flows through ischemic or hypoxic tissue (A). Retrograde conduction flows through the tissue and stimulates a depolarization as it escapes the damaged tissue. Example “B” shows normal antegrade conduction as it flows through cardiac tissue (1) followed by the impulse slowing down through ischemic tissue (2). When the impulse breaks out of the ischemic zone, the surrounding tissue which was stimulated by the wave of electrical activity to depolarize, has reached the relative refractory period of repolarization and is ready to accept another impulse.

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Wikstrom M (2012) Assessment of stomach health by “chemical China: a randomized controlled trial impotence only with wife priligy 30mg for sale. Lomba-Viana R impotence causes and cures buy priligy 60mg with mastercard, Dinis-Ribeiro M erectile dysfunction drug overdose generic 60mg priligy overnight delivery, Fonseca F (2012) Serum Gastric cancer risk in chronic atrophic gastrits: statstcal pepsinogen test for early detecton of gastric cancer in a calculatons of cross-sectonal data tramadol causes erectile dysfunction cheap priligy 30mg line. Helicobacter pylori eradicaton has the (2012) Serological assessment of gastric mucosal atrophy in gastric cancer impotence versus erectile dysfunction order priligy with a visa. Oksanen A, Sipponen P, Mietnen A, Sarna S, Rautelin H (2000) Serum pepsinogen in screening for gastric cancer. Correlaton Serum pepsinogen as a new marker for gastric carcinoma among between gastric histology and serum levels of gastrin-17 and young adults. Telaranta-Keerie A, Kara R, Paloheimo L, Harkonen M, Sipponen (1991) Pepsinogen A/Pepsinogen C or Pepsinogen A multplied P (2010) Prevalence of undiagnosed advanced atrophic corpus by gastrin in the diagnosis of gastric cancer. Ital J Gastroenterol gastrits in Finland: an observatonal study among 4,256 23: 194-206. Benberin V, Bektayeva R, Karabayeva R (2013) Prevalence of Physiol Rev 78: 1087-108. Sipponen P, Vauhkonen M, Helske T, Kaariainen I, Harkonen M pangastrits with high risk of gastric cancer. Scand J (2004) Serum fastng level of gastrin-17 is low with longGastroenterol 186: 117-123. Sipponen P, Valle J, Varis K (1990) Fastng levels of serum gastrin Helicobacter pylori gastrits and serum pepsinogen levels in a in diferent functonal and morphological states of the antrohealthy populaton: development of a biomarker strategy for fundal mucosa. Vaira D, Gata L, Ricci C (2001) Helicobacter pylori: diseases, stomach of patents with gastrits and peptc ulceraton. Lehours P, Ruskone-Fourmestraux A, Lavergne A (2003) Which Opinion in Gastroenterology 11: 69-75. Sipponen P (2001) Update on the pathologic approach to the Antgen Test) as additonal tools in diagnosis of Helicobacter diagnosis of gastrits, gastric atrophy, and Helicobacter pylori pylori infecton in patents with atrophic body gastrits. Atrophic Gastrits in Patents Infected with CagA+ Helicobacter (2005) Gastric mucosa-associated lymphoid tssue lymphoma pylori. Parsonnet J, Hansen S, Rodriguez L (1994) Helicobacter pylori to detect eradicaton. Classifcaton the remarkable contradicton between histology and 14C urea and grading of gastrits. Kokkola A, Rautelin H, Puolakkainen P (1998) Positve result by human gastric juice and mucosa. Am J Gastroenterol 101: serology indicates actve Helicobacter pylori infecton in patents 1756-1761. Kokkola A, Rautelin H, Puolakkainen P, Sipponen P, Farkkila M, et bacteria in the stomach induce a false-positve reacton in a urea al. J Med with atrophic gastrits: comparison of histology, 13C-urea breath Microbiol 57: 814-819. Brandi G, Biasco G, Biavat B (1995) Bacterial colonizaton in juice and biopsies of the achlorhydric stomach. Brandi G, Pisi A, Biasco G (1996) Bacteria in biopsies in humans Caucasian populaton: A longitudinal nested case-control study hypochlorhydric stomach: A scanning electron microscopy study. Aliment Pharmacol Therapeut (2006) Urease-positve bacteria other than Helicobacter pylori in 20: 117-122. This study included 60 patients who were diagnosed as gastric cancer at the Endoscopy Unit of Education and Research Hospital and were operated at the General Surgery Department of Istanbul Education and Research Hospital. The patients were questioned about major complaints and duration of these complaints, cigarette smoking and tea drinking habits, family history, and previous gastrointestinal surgery. The localization, macroscopic appearance, histology, and extent of the tumor were determined. Endoscopy, biopsy and tomography examinations were used for the localization, shape and spread of the tumor in other patients. Keywords: Cancer, gastric, helicobacter pylori Introduction A recent study has reported that the prevalence of H. However, studies have concentrated Histological results were evaluated in the diagnosis of H. The number Material and Methods of publications in support of this relationship has increased steadily since 1989. At the end of the meeting in which the experienced this study included 60 patients who were diagnosed at the cancer specialists from 11 countries assessed available data with Endoscopy Unit of Istanbul Training and Research Hospital. The patients were questioned about major complaints and duration of these complaints, cigarette smoking and tea drinking the frst studies investigating the relationship between cancer type habits, family history, and previous gastrointestinal surgery. The samples taken from both the tumor and the surrounding mucosa in patients undergoing resection during the operation were frst fxed in 10% neutral bufered formalin. The parafn-embedded blocks *Coresponding Author: Aziz Ari, Istanbul Training and Research Hospital were then sectioned on a microtome at thicknesses of 4 to 5um. Of the patients with the samples taken from the surrounding mucosa were stained with antral involvement, 10 (30. Of the patients undergoing undergoing resection, tumor staging was performed according to tumor staging, 12 (54. Of the 10 (50%) patients undergoing to the General Surgery Outpatient Clinics of Istanbul Education tumor staging, 10 (100%) had difuse gastric cancer. Other patients lost weight 10 or undergoing resection were included in the evaluation. Statistical analysis could not be performed because the number of tumors localized in the cardia and corpus was very few. Distribution of gastric cancer according to anatomical localization Accordingly, there was no signifcant relationship between tumor type and gender distribution. Of the individuals with gastritis, 8 were difuseTotal 60 100 type, 2 were superfcial-type, and l was atrophic-type. There were 18 (45%) patients with intestinal-type, 18 (45%) patients with difuse-type, and 4 (10%) patients with Discussion mixed-type. The risk of developing some samples were taken from the tumor tissue in order to detect gastric cancer during life in H. However, its high even though it is studied in the surrounding tissue, not only role in gastric carcinogenesis is not fully understood because only in tumor tissue [16]. In some studies analyzing gastric tumor localization in relation to pylori infection have found that H. According to this model, it can be increase in risk is more pronounced in women and blacks [6]. Although the majority of studies have reported that there is no pylori is eradicated) > chronic atrophic gastritis > reduced diference in the seroprevalence of H. In our study, when the relationship between tumor type and Various studies using serological, histological and microbiological H. In our study, the relationship between tumor localization and the detection rate of H. The same In a study of Talley, an association could not be found between researchers retrospectively examined the histological slides of gastric cardia cancer and H. Widespread areas of intestinal metaplasia and tumors localized in the antrum and corpus. Accordingly, this study could gastric cancer can be grouped into three diferent groups. However, there have been a lot of studies showing that the relationship is not signifcant [19In the second group, serum samples were obtained years ago and 21]. It was compared between those who the largest epidemiological study supporting the relationship developed gastric cancer in the following years and those who did between H. The death from gastric cancer was 20 times higher in areas with high prevalence of H. In diagnosis of gastric cancer and compared with the control group Colombia, two cities with low and high prevalence of H. In one group, the histological was 4 times higher in the city with high prevalence of H. In addition, although the various publications from Brazilian patients with gastric carcinoma. Helicobacter pylori and gastric carcinoma: Serum antibody prevalance in populations with contrasting cancer risks. Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. Helicobacter pylori and gastric diseases, science, medicine and Competing interests future. Gastrik Kanserlerde Helicobacter pylori Financial Disclosure histolojik tip, lokalizasyon ve metaplazi arasfindaki iliskiler. Helicobacter Pylori and gastnc Before the study, permissions were obtained from local ethical committee. Helicobacter pylori genotypes are associated with clinical outcome in Portuguese patients and show a 21. Helicobacter pylori infection in a rodomly high prevalence of infections with multiple strains. Association between Helicobacter pylori and gastric carcinoma in city of Malmo, Sweden. It may also be used to check that the bacteria has been eradicated after treatment. However, any prescription medication other than those listed below can be taken with a sip of water. Exclusion Period Type of Medication Generic Name Trade Names Four Weeks Antibiotics All Antibiotics except Bactrim, Septrin, etc. You will then wait for 7 minutes, and then be instructed to take a deep breath, hold for approximately 10 seconds, and blow into a balloon until it is frm. The test results should be read 10-15 minutes after a specimen is applied to the sample well of the device. Any results interpreted outside of the 10-15 minute window should be considered invalid and must be repeated. It is intended to be used by device is stable through the expiration date printed on the sealed pouch. Do not freeze the kit professionals as a screening test and provides a preliminary test result to aid in the diagnosis or expose the kit to temperatures above 30°C. Alternative test method(s) Consider any materials of human origin as infectious and handle them using standard bioshould be considered to confirm the test result obtained by this device. Antibiotics in combination with bismuth compounds have been shown to be effective in may lead to an invalid test result. Step 3: Ensure that all inner grooves of the collection stick are filled with fecal specimen. Serologic antibody tests detect8 Step 5: Shake the stool collection device vigorously. The stool antigen test detects antigen present in the feces, which indicates an active H.

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Hypokalemia can precipitate toxicNursing Responsibilities ity even when the serum digitalis level is in the normal range erectile dysfunction doctors jacksonville fl cheap priligy 60mg without a prescription. Monitor • Monitor patients with renal insufficiency or renal failure and older hemodynamic parameters carefully erectile dysfunction caused by obesity cheap 60 mg priligy. Do not take • Inamrinone may be infused full strength or diluted in normal the digoxin if your pulse is below 60 bpm or if you are weak erectile dysfunction doctor nj order discount priligy on line, saline or half-strength saline erectile dysfunction treatment fruits cheap 60 mg priligy with visa. Do not mix this drug with dextrose fatigued erectile dysfunction cause best order for priligy, light-headed, dizzy, short of breath, or having chest solutions. Low serum potassium levels increase the risk of digitalis toxicity, as early manifestation of heart failure. Older adults are at parrest during acute episodes of heart failure to reduce cardiac workload ticular risk for digitalis toxicity. Digitalis levels may be affected by a number ate, progressive activity program is prescribed to improve myocardial of other drugs; check for potential interactions. Exercise should be performed 3 to 5 days per week, and Dysrhythmias are common in patients with heart failure. Surgery may be used to treat the underlying teaching regarding a sodium-restricted diet. Valve replacement is discussed later in this chapusing large skeletal muscles due to fatigue or dyspnea, is a common ter. The • Headache is a common adverse effect of this drug, particularly recommended dose is one to two tablets three times per day, although when first starting therapy. Headaches tend to subside with the dose may be as low as 1/2 tablet three times a day if side effects continued treatment. Bleeding is a maballoon pump or a left-ventricular assist device may be used when jor concern in the early postoperative period. Chest tube drainage is the patient is expected to recover or as a bridge to transplant (refer frequently monitored (initially every 15 minutes), as are the cardiac to Chapter 30). These devices (compression of the heart) can develop, presenting as either a sudwill serve either as a bridge to transplant or allow the myocardium to den event or a gradual process. More than 90% of patients is induced during surgery; postoperatively, the patient is gradually return to normal, unrestricted functional abilities following rewarmed over a 1to 2-hour period. The most frequently used transplant procedure leaves the ing and shivering is important to maintain hemodynamic stability posterior walls of the atria, the superior and inferior vena cavae, and and reduce oxygen consumption. Cardiac function is impaired in up the pulmonary veins of the recipient intact (Figure 31–6A •). The donor pulmonary artery and aorta are none may be required to support cardiac function and circulation. Care is taken Infection and rejection are major postoperative concerns; these to avoid damaging the sinus node of the donor heart and to ensure are the chief causes of mortality in transplant patients. Acute rejection usually presents within weeks of the transplant, developing when the Health Promotion transplanted organ is recognized by the immune system as foreign. Health promotion activities to reduce the risk for and incidence of heart Lymphocytes infiltrate the organ, and myocardial cell necrosis can be failure are directed at the risk factors. Acute rejection often can be treated using immuheart disease, the primary underlying cause of heart failure. Although immunosuppressive medications help prescreen patients for elevated blood pressure, and refer patients to a privent organ rejection, they impair the patient’s defenses against infecmary care provider as indicated. Early postoperative infections commonly are bacterial or fungal managing hypertension to reduce the future risk for heart failure. Multiple invasive lines, prolonged ventilator support, and Likewise, stress the relationship between effective diabetes manageimmunosuppressive therapy contribute to the transplant recipient’s ment and reduced risk of heart failure. Aggressive nursing care directed at prevention of infection is vital: limiting visitors with communicable diseases and Assessment practicing pulmonary hygiene measures, early ambulation, and strict See the Manifestations and Interprofessional Care sections for the asaseptic technique. Obtain both subjective and objective data when assessing the Lack of innervation by the autonomic nervous system affects the patient with heart failure. In ventricular reduction surgery (or partial ventriculectomy), a portion of the anteriolateral left versing, changing positions; apparent anxiety; vital signs including ventricular wall is resected to improve cardiac function. Hawthorn, a shrubby tree, contains natural cardiotonic ingredients in its blossoms, leaves, and fruit. Hawthorn should never be used without consulting an extreatment of the underlying process while providing care that supperienced herb practitioner and advising the physician. Nutritional ports the physical and psychologic responses to the disorder is a prisupplements of coenzyme Q10, magnesium, and thiamine may be ority of nursing care. Heart failure impacts quality of life, interfering with such daily activities as self-care and role performance. This includes providing rest and carrying out prescribed timately a terminal disease. The patient and family need honest distreatment measures to reduce cardiac work, improve contractility, cussions about the anticipated course of the disease and treatment options. It is important to discuss advance directives such as a living will and medical power of attorney, differentiating potential acute Evidence for Nursing Care events from which recovery would be anticipated. HosA selected resource that nurses may find helpful when planning pice services are available for patients with heart failure, and should evidence-based nursing care follows. Developing nursing expertise in caring for older advanced stage heart failure patients and their families—palliative stages of the disease. Canadian Journal of Cardiovascular Nursing, with frequent intravenous diuretics and continuous infusion of a 22(3), 12–17. Notify the physician if urine output is Nursing Care Plan for additional nursing diagnoses and intervenless than 30 mL/h. Diuretics may reduce circulating volume, producing hypovolemia despite persistent periphDecreased Cardiac Output eral edema. A fall in urine output may indicate significantly reduced As the heart fails as a pump, stroke volume and tissue perfusion cardiac output and renal ischemia. Expected Outcome: Patient will demonstrate adequate cardiac output • Record abdominal girth every shift. Note complaints of a loss of as evidenced by blood pressure and pulse rate and rhythm within appetite, abdominal discomfort, or nausea. Diastolic blood provide a means of monitoring the patient’s condition and response to pressure may initially be elevated because of vasoconstriction; in late treatment. Allow choices of fluid type and timing tion levels provide a measure of gas exchange and tissue perfusion. Offer ice chips and frequent mouth care; provide diminished if cardiac function is poor. Providing choices increases the patient’s an early sign of heart failure; atrial gallop (S4) may also be present. Ice chips, hard candies, and mouth care relieve dry Crackles are often heard in the lung bases; increasing crackles, dysmouth and thirst and promote comfort. As the disease progresses and cardiac sion: changes in mentation; decreased urine output; cool, clammy function is further compromised, activity intolerance increases. These low cardiac output and inability to participate in activities may hinder are manifestations of decreased tissue perfusion to organ systems. Expected Outcome: Patient will participate in physical activity as • Administer supplemental oxygen as needed. Elevate the head of the pressure, diaphoresis, pallor, complaints of chest pain, excessive bed to reduce the work of breathing. Provide a bedside commode, fatigue, or palpitations indicate activity intolerance. The failing heart is unable to increase carthese measures reduce cardiac workload. Assessing response to activities helps evaluate cardiac funcExcess Fluid Volume tion. Decreasing activity tolerance may signal deterioration of cardiac function, not overexertion. As cardiac output falls, compensatory mechanisms cause salt and water retention, increasing blood volume. This increased fluid volume places additional stress on the already failing ventricles, making them • Organize nursing care to allow rest periods. Encourage independence within predenced by weight loss and decreases in edema, jugular venous distenscribed limits. Consult with physical therapist on Declining respiratory status indicates worsening left heart failure. Acute pulmonary edema, a medical emergency, can develop rapidly, necessitating immediate intervention to preserve life. Chapter 31 • Nursing Care of Patients with Cardiac Disorders 935 Deficient Knowledge: Low-Sodium Diet • Desired and adverse effects of prescribed drugs; monitoring for Diet is an important part of long-term management of heart failure to effects; importance of compliance with drug regimen to prevent manage fluid retention. Understanding fos• Exercise recommendations to strengthen the heart muscle and ters compliance with the prescribed diet. Dietary planning and Provide referrals for home healthcare and household assistance teaching increase the patient’s sense of control and participation in (shopping, transportation, personal needs, and housekeeping) as disease management. Referrals to community agencies, such as local cardiac • Teach how to read food labels for nutritional information. Pulmonary edema is an abnormal accumulation of fluid in the • Encourage small, frequent meals rather than three heavy meals interstitial tissue and alveoli of the lung. Small, frequent meals provide continuing energy resources diac disorders can cause pulmonary edema. Cardiogenic pulmonary edema, the focus of this section, is a sign of seDelegating Nursing Care Activities vere cardiac decompensation. Risk factors are those associated with heart failure, and treatment Heart failure is a chronic condition requiring active participation focuses on maintaining oxygenation and improving cardiac function. In teaching for • Noncardiogenic pulmonary edema is a primary or secondary lung home care, include the following topics: disorder. Treatment focuses on maintaining • the disease process and its effects on the patient’s life oxygenation and the primary, underlying disorder. If you get tired during any activity, stop what you are doing Week 1 200–400 ft Twice a day, slow and rest for 15 minutes. Eat a high-fiber diet Weeks 3–4 1 mile 30 min, minimum and drink plenty of water to prevent constipation. Use laxatives of 3 times per week or stool softeners, as approved by your physician, to avoid conWeeks 4–5 1 1/2 miles 30 min, minimum stipation and straining during bowel movements. Walking is good exercise that Weeks 5–6 2 miles 40 min, minimum does not require any special equipment (except a good pair of of 3 times per week walking shoes). On discharge, he was started on a regimen of enalapril (Vasotec), • Administer oxygen per nasal cannula at 2 L/min. Monitor digoxin, furosemide (Lasix), warfarin (Coumadin), and a potassium oxygen saturation continuously. Jackson states that he has not been able to ferred activities and scheduled rest periods. Jackson met with the dietitian, who helped them decardiac impulse is left of the midclavicular line. He has crackles and velop a realistic eating plan to limit sodium, sugar, and fats.

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