Lecture Notes: Cardiovascular Disorders - Priority and Delegations

Introduction

• Focus on cardiovascular disorders, particularly priority and delegation.
• Encouragement to like, subscribe, follow on social media (Nexus Nursing).

Priority Assessment

• Scenario: Nurse receives shift report from outgoing nurse.
  • Patient Prioritization: Assess first the client just brought from the emergency department with no complaints (choice 1).
    • Unassessed patients are assumed unstable until properly assessed.
    • Other patients have been assessed or their conditions are managed.

Medication Administration Priority

• Scenario: Nurse needs to administer medications after shift report.
  • Med Prioritization: Administer anti-dysrhythmic to client in V-fib (choice 3).
    • V-fib is a medical emergency.
    • Consider life-threatening conditions as priorities.

Telemetry Nurse Assessment

• Scenario: Tele-nurse assesses first after morning shift report.
  • Patient Assessment: Attend client with CHF and pink frothy sputum (choice 4).
    • Pink frothy sputum indicates pulmonary edema, a complication needing immediate attention.
    • Other symptoms in choices 1-3 are expected for their respective conditions.

Assigning Clients to New Graduate Nurse

• Scenario: Charge nurse assigns clients to a new graduate nurse.
  • Assignment Choice: 75-year-old scheduled for cardiac cath (choice 3).
    • Other patients have active or unstable conditions.
    • New grads should manage the most stable patients.

Staff Assignments on the Cardiac Unit

• Scenario: Assigning tasks among RNs, LPNs, UAPs.
  • Task Assignment: UAP should handle morning care (choice 3).
    • Avoid all-inclusive words (e.g., all sterile procedures to RN).
    • LPNs cannot write care plans, only follow them.

Coordination with Case Manager

• Scenario: Discussing client details with case manager.
  • Information Sharing: Provide info necessary for continuity of care (choice 2).
    • Case manager’s role is to ensure seamless post-discharge care.

Handling Erratic Telemetry Readings

• Scenario: Nurse observes erratic telemetry while conversing with client.
  • Action: UAP should check telemetry leads (choice 2).
    • Erratic readings often due to detached leads.

Floating Nurse to Emergency Department

• Scenario: Selecting nurse to float to emergency department.
  • Selection Choice: Nurse with critical care background (choice 2).
    • Critical care experience aligns with emergency department skills.

Dopamine Infusion and Hypertension

• Scenario: ICU client’s BP rises while on dopamine.
  • Intervention: Discontinue vasoconstrictor infusion (choice 1).
    • Stopping exposure to harmful agent is immediate priority.

Assigning Clients in Cardiac Critical Care

• Scenario: Assign clients based on nurse experience.
  • Assignment Choice: Most experienced nurse attends client with multifocal PVCs (choice 3).
    • Multifocal PVCs are life-threatening emergencies.

Medication Administration Considerations

• Scenario: Questioning medication administration.
  • Query: Client on calcium channel blocker drinking grapefruit juice (choice 1).
    • Grapefruit juice causes toxic interactions with certain medications.

Clients Requiring Immediate Intervention

• Scenario: Identify client needing urgent care.
  • Priority Patient: Client with arteriosclerosis showing slurred speech (choice 4).
    • Suspected stroke is a medical emergency.

Assignments Based on Experienced Nurse

• Scenario: Most experienced nurse assignment.
  • Assignment: Client with fulminant pulmonary edema (choice 3).
    • Pulmonary edema is critical, affecting breathing.

Unresponsive Client Response

• Scenario: Nurse and UAP find client unresponsive.
  • Task for UAP: Get the crash cart (choice 3).
    • Immediate CPR by RN while UAP fetches equipment.

DNR Order and Client Care

• Scenario: Client with DNR.
  • Intervention: Continue usual care for client’s needs (choice 1).
    • DNR status doesn’t affect routine care.

Conclusion

• Encouragement to engage with more cardiovascular content.
• Reminder of additional educational resources and social media connections (Nexus Nursing).