Page 149 - Critical Care Nursing Demystified

134 CRITICAL CARE NURSING DeMYSTIFIED

Administer and monitor nesiritide (Natrecor), a synthetic derivative of BNP
that helps reduce PCWP in the short term. Monitor closely for hypotension
and dysrhythmias.
Administer IV inotropics (dobutamine and milrinone) to improve effective-
ness of cardiac muscle.
Insert and monitor pulmonary artery catheter to monitor pressures on right and
left side of the heart. Pressures should decrease as therapy is effected.
Prepare and monitor for insertion of IABP to help reduce the afterload and
improve the blood supply to the coronary arteries.
Prepare for and monitor patient post insertion of implantable cardioverter
defibrillator (ICD) to help increase the heart rate when it is bradycardic and
shock the heart if it fibrillates (see Chapter 4 on rhythm disturbances).
Prepare for and monitor initiation of biventricular pacing to help improve
the synchronization of the heart, therefore increasing the cardiac output (see
Chapter 4).
Ensure that teaching and discharge instructions include information regarding
diet, weight monitoring, energy conservation techniques, and medication (ACE/
ARBs, digoxin, etc.) to prevent readmission, which frequently occurs with HF. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Teach and refer for smoking cessation advice/counseling to prevent further
damage to lungs/heart. For additional information on how to quit smoking
check out this web site: http://www.surgeongeneral.gov/tobacco/(last
accessed July 1, 2010).

NURSING ALERT

Daily weights are critical to monitor in a patient with a diagnosis of heart failure. A

gain of 1 kilogram = 1,000 cc of fluid retention.

Inflammatory Disease Process (Pericarditis,
Myocarditis, Endocarditis)

Inflammatory heart disease is classified into three different types of pathologies.
These include pericarditis, myocarditis, and endocarditis.

What Went Wrong?
Pericarditis Pericarditis is an inflammation of the pericardium or fibrous sac that
surrounds the heart. This more commonly occurs after MI but can occur after