Question

Using ATI’s Active Learning Templates, each student will work on filling out the “System Disorder” template of the following: (Each template has to be handwritten. Templates that are typed will receive 0 points).

• Chapter 21
• Abnormal Heart Rhythms
  • PVCs
  • AFib
• Extra Heart Sounds
  • S3
  • S4
• Heart Murmurs
  • Aortic Stenosis
  • Pulmonic Stenosis

Answer 1

QUESTION

Using ATI’s Active Learning Templates, each student will work on filling out the “System Disorder” template of the following: (Each template has to be handwritten. Templates that are typed will receive 0 points).

· Chapter 21

Abnormal Heart Rhythms

PVCs

AFib

Extra Heart Sounds

S3

S4

Heart Murmurs

Aortic Stenosis

Pulmonic Stenosis

ANSWER

Active Learning Templates for “System Disorder”include:

DISORDER:

Alterations in Health (Diagnosis)

Pathophysiology Related to Client Problem

Health Promotion and Disease Prevention

ASSESSMENT

Risk Factors

Expected Findings

Laboratory Tests

Diagnostic Procedures

SAFETY CONSIDERATIONS

Complications

PATIENT-CENTERED CARE

Nursing Care

Medications

Client Education

Therapeutic Procedures

Interprofessional Care

1.DISORDER: AORTIC STENOSIS

Alterations in Health (Diagnosis)

Aortic stenosis

Pathophysiology Related to Client Problem

Narrowing of the aortic valve results in obstruction of blood flow from the left ventricle to the ascending aorta during systole.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remain physically active as per physian order.
• Consume a diet low in Na+ and restrict fluids
• Don't smoke
• Take medications as ordered

ASSESSMENT

Risk Factors

• Older age
• Certain heart conditions present at birth (congenital heart disease)
• History of infections that can affect the heart
• Chronic kidney disease
• History of radiation therapy to the chest

Expected Findings

• Abnormal heart sound (heart murmur) heard through a stethoscope
• Chest pain (angina) or tightness with activity
• Feeling faint or dizzy or fainting with activity
• Shortness of breath, especially when you have been active
• Fatigue, especially during times of increased activity
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Not eating enough (mainly in children with aortic valve stenosis)
• Not gaining enough weight (mainly in children with aortic valve stenosis)

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O
• Assess patient, labs values,etc
• Assess responses to medications
• Provide emotional support
• Provide client education

Medications

Medications as per risk factors .

• Antihypertensive drugs
• Diuretics
• Afterload-reducing agents
• Inotropicagents
• Betablockers
• Vasodilators
• Cholesterol lowering drugs
• Anticoagulants

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.

Therapeutic Procedures

• Heart valve repair
• Heart valve replacement

Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

2.DISORDER: DISORDER: PULMONARYSTENOSIS

Alterations in Health (Diagnosis)

Pulmonary stenosis

Pathophysiology Related to Client Problem

The aortic valve and pulmonary valve control the flow of blood as it leaves the heart and keep it flowing forward. They open to let blood move ahead, then quickly close to keep it from flowing backward. The pulmonary valve lets the blood flow forward to the lungs. It opens to let blood move ahead, then quickly closes to keep blood from flowing backward. In pulmonary stenosis ,the pulmonary valve is too small, too narrow, and can't open all the way. This causes the right ventricle to pump harder to send blood out to the lungs. Over time, this can cause thickening of the right ventricle and strain the heart.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remainphysically active as per physian order.
• Consume a diet low in Na+and restrict fluids
• Don’t smoke
• Take medications as ordered

ASSESSMENT

Risk Factors

• Older age
• Certain heart conditions present at birth (congenital heart disease)
• History of infections that can affect the heart
• Chronic kidney disease
• History of radiation therapy to the chest

Expected Findings

• In newborns, a bluish tint to the skin (called cyanosis) caused by blood that is low in oxygen
• Being very tired
• Poor weight gain
• Shortness of breath
• Palpitations (sensation of rapid or irregular heartbeat)
• Chest pain
• Fainting
• A swollen abdomen

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O
• Assess patient, labs values,etc
• Assess responses to medications
• Provide emotional support
• Provide client education

Medications

• Medications as per risk factors
• Antihypertensive drugs
• -Diuretics
• Afterload-reducing agents
• Inotropicagents
• Betablockers
• Vasodilators
• Cholesterol lowering drugs
• Anticoagulants

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.

Therapeutic Procedures

• Heart valve repair
• Heart valve replacement

Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

3.DISORDER: DISORDER: HEART MURMURS

Alterations in Health (Diagnosis)

Heart Murmurs

Pathophysiology Related to Client Problem

Murmurs of the cardiac system develop due to alterations in blood flow or mechanical operation. Depending on the cause, auscultation findings in pitch, volume, and rhythm may change. The development of murmurs is highly dependent on the etiology and is not always associated with a pathologic process. Benign murmurs are common in children and during pregnancy.

Murmurs develop from a multitude of mechanisms. Typical cases include low blood viscosity from anemia, septal defects, failure of the ductus arteriosus to close in newborns, excessive hydrostatic pressure on cardiac valves causing valve failure, hypertrophic obstructive cardiomyopathy, and valvular specific pathologies. Regardless of underlying etiology, all involve the creation of disturbed blood flow, which produces a murmur

Health Promotion and Disease Prevention

• Maintain an exercise routine to remainphysically active as per physian order.
• Consume a diet low in Na+and restrict fluids
• Don’t smoke
• Take medications as ordered
• Control risk factors

ASSESSMENT

Risk Factors

• Family history of a heart defect.
• Certain heart conditions present at birth (congenital heart disease)
• History of infections that can affect the heart
• Chronic kidney disease
• History of radiation therapy to the chest
• Certain medical conditions, including uncontrolled high blood pressure (hypertension)

Factors that increase your baby's risk of developing a heart murmur include:

• Illnesses during pregnancy. Having some conditions during pregnancy, such as uncontrolled diabetes or a rubella infection, increases your baby's risk of developing heart defects and a heart murmur.
• Taking certain medications or illegal drugs during pregnancy. Use of certain medications, alcohol or drugs can harm a developing baby, leading to heart defects.

Expected Findings

• Skin that appears blue, especially on your fingertips and lips
• Swelling or sudden weight gain
• Shortness of breath
• Chronic cough
• Enlarged liver
• Enlarged neck veins
• Poor appetite and failure to grow normally (in infants)
• Heavy sweating with minimal or no exertion
• Chest pain
• Dizziness
• Fainting

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O
• Assess patient, labs values,etc
• Assess responses to medications
• Provide emotional support
• Provide client education

Medications

• Medications that prevent blood clots (anticoagulants). An anticoagulant prevents blood clots from forming in heart and causing a heart attack or stroke.
• Diuretics. Diuretics can help treat other conditions that might worsen a heart murmur, such as high blood pressure.
• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors lower blood pressure. High blood pressure can worsen underlying conditions that cause heart murmurs.
• Statins. Statins help lower cholesterol. Having high cholesterol seems to worsen some heart valve problems, including some heart murmurs.
• Beta blockers. These drugs lower heart rate and blood pressure. They're used for some types of heart valve problems.

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.

Therapeutic Procedures

Valve repair

To repair a valve, your doctor may recommend one of the following procedures:

• Balloon valvuloplasty.
• Annuloplasty.
• Repair of structural support.
• Valve leaflet repair

Valve replacement

In many cases, the valve has to be replaced. Options include:

• Open-heart surgery.
• Transcatheter aortic valve replacement (TAVR).
• Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

4.DISORDER: PREMATURE VENTRICULAR CONTRACTIONS (PVCS)

Alterations in Health (Diagnosis)

Premature ventricular contractions (PVCs)

Pathophysiology Related to Client Problem

Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of heart's two lower pumping chambers (ventricles). These extra beats disrupt regular heart rhythm, sometimes causing to feel a fluttering or a skipped beat in your chest.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remain physically active as per physian order.
• Consume a diet low in Na+ and restrict fluids
• Don’t smoke
• Take medications as ordered

ASSESSMENT

Risk Factors

• Caffeine , tobacco, alcohol and illicit drugs
• Exercise — if you have certain types of PVCs
• High blood pressure (hypertension)
• Anxiety
• Heart disease, including congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)

Expected Findings

• Fluttering
• Pounding or jumping
• Skipped beats or missed beats
• Increased awareness of your heartbeat

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O,
• Assess patient, labs values,etc
• Assess responses to medications,
• Provide emotional support,
• Provide client education

Medications

• Beta blockers: which are often used to treat high blood pressure and heart disease , can suppress premature contractions.
• Calcium channel blockers
• Anti-arrhythmic drugs

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.
• Track y triggers.
• Modify substance use.
• Manage stress.

Therapeutic Procedures

Radiofrequency catheter ablation.

Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

5.DISORDER: ATRIAL FIBRILLATION

Alterations in Health (Diagnosis)

Atrial fibrillation

Pathophysiology Related to Client Problem

The heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remain physically active as per physian order.
• Consume a diet low in Na+ and restrict fluids
• Take medications as ordered
• Eating a heart-healthy diet
• Increasing your physical activity
• Avoiding smoking
• Maintaining a healthy weight
• Limiting or avoiding caffeine and alcohol
• Reducing stress, as intense stress and anger can cause heart rhythm problems
• Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.

ASSESSMENT

Risk Factors

• High blood pressure
• Heart attack
• Coronary artery disease
• Abnormal heart valves
• Heart defects you're born with (congenital)
• An overactive thyroid gland or other metabolic imbalance
• Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
• Sick sinus syndrome — improper functioning of the heart's natural pacemaker
• Lung diseases
• Previous heart surgery
• Viral infections
• Stress due to surgery, pneumonia or other illnesses
• Sleep apnea

Expected Findings

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest
• Weakness
• Reduced ability to exercise
• Fatigue
• Lightheadedness
• Dizziness
• Shortness of breath
• Chest pain

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O,
• Assess patient, labs values,etc
• Assess responses to medications,
• Provide emotional support,
• Provide client education

Medications

• Digoxin. This medication may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medications, such as calcium channel blockers or beta blockers.
• Beta blockers. These medications can help to slow the heart rate at rest and during activity. They may cause side effects such as low blood pressure (hypotension).
• Calcium channel blockers. These medicines also can control heart rate.
• Anticoagulants

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.
• Track y triggers.
• Modify substance use.
• Manage stress.

Therapeutic Procedures

• Catheter ablation
• Maze procedure
• Atrioventricular (AV) node ablation
• Left atrial appendage closure

Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

6.DISORDER: CARDIAC S3

Alterations in Health (Diagnosis)

Cardiac S3

Pathophysiology Related to Client Problem

This sound is normal in children, but when heard in adults it is often associated with ventricular dilation as occurs in systolic ventricular failure.Low frequency sound in early diastole, 120 to 180 ms after S2. It results from increased atrial pressure leading to increased flow rates, as seen in congestive heart failure, which is the most common cause of a S3. It is ssociated dilated cardiomyopathy with dilated ventricles also contribute to the sound.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remain physically active as per physian order.
• Consume a diet low in Na+ and restrict fluids
• Take medications as ordered
• Eating a heart-healthy diet
• Increasing your physical activity
• Avoiding smoking
• Maintaining a healthy weight
• Limiting or avoiding caffeine and alcohol
• Reducing stress, as intense stress and anger can cause heart rhythm problems
• Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.

ASSESSMENT

Risk Factors

• High blood pressure
• Heart attack
• Coronary artery disease
• Abnormal heart valves
• Heart defects you're born with (congenital)
• An overactive thyroid gland or other metabolic imbalance
• Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
• Sick sinus syndrome — improper functioning of the heart's natural pacemaker
• Lung diseases
• Previous heart surgery
• Viral infections
• Stress due to surgery, pneumonia or other illnesses
• Sleep apnea

Expected Findings

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest
• Weakness
• Reduced ability to exercise
• Fatigue
• Lightheadedness
• Dizziness
• Shortness of breath
• Chest pain

Laboratory Tests

Lab test will be done to rule out under risk factors or aggravating factors

eg:lipid profile

Diagnostic Procedures

• Echocardiogram.
• Electrocardiogram (ECG).
• Chest X-ray
• Cardiac computerized tomography (CT) scan
• Cardiac MRI.
• Exercise tests or stress tests
• Cardiac catheterization.

SAFETY CONSIDERATIONS

Complications

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

PATIENT-CENTERED CARE

Nursing Care

• Monitor daily weight and I&O,
• Assess patient, labs values,etc
• Assess responses to medications,
• Provide emotional support,
• Provide client education

Medications

• Medications as per risk factors
• Antihypertensive drugs
• Diuretics
• Afterload-reducing agents
• Inotropicagents
• Betablockers
• Vasodilators
• Cholesterol lowering drugs
• Anticoagulants

Client Education

• Regular follow-up
• Making healthy lifestyle changes and taking medications to treat symptoms.
• Track y triggers.
• Modify substance use.
• Manage stress.

Therapeutic Procedures

• surgery as per the cause.
• Catheter ablation
• Maze procedure
• Atrioventricular (AV) node ablation
• Left atrial appendage closure.
• Valve repair
• Valve replacement
• Open-heart surgery.

Interprofessional Care

Cardiology and pulmonaryservices, respiratoryservices, cardiac rehab,nutritional services

7.DISORDER: CARDIAC S4

Alterations in Health (Diagnosis)

Cardiac S4

Pathophysiology Related to Client Problem

The fourth heart sound occurs in late diastole just prior to the first heart sound.
The first heart sound is decreased in intensity and the second heart sound is increased in intensity.
The fourth heart sound is produced by an increase in stiffness of the left ventricle due to scar tissue formation. This may be a manifestation of coronary heart disease.
A fourth heart sound can also be caused by a greatly thickened left ventricular wall such as with essential hypertension or aortic stenosis. This is shown in the anatomy tab.
The fourth heart sound is a low frequency sound best heard with the bell of the stethoscope pressed lightly on the skin of the chest.

Health Promotion and Disease Prevention

• Maintain an exercise routine to remain physically active as per physian order.
• Consume a diet low in Na+ and restrict fluids
• Take medications as ordered
• Eating a heart-healthy diet
• Increasing your physical activity
• Avoiding smoking
• Maintaining a healthy weight
• Limiting or avoiding caffeine and alcohol
• Reducing stress, as intense stress and anger can cause heart rhythm problems
• Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.

ASSESSMENT

Risk Factors

• High blood pressure
• Heart attack
• Coronary artery disease
• Abnormal heart valves
• Heart defects you're born with (congenital)
• An overactive thyroid gland or other metabolic imbalance
• Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
• Sick sinus syndrome — improper functioning of the heart's natural pacemaker
• Lung diseases
• Previous heart surgery
• Viral infections
• Stress due to surgery, pneumonia or other illnesses
• Sleep apnea

Expected Findings

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest
• Weakness
• Reduced ability to exercise
• Fatigue
• Lightheadedness