early s/sx of your cardiac pts going bad?

[lifeLONGstudent]

Hi all:

I looked over the last 5-6 pages on this thread and didn't see this question, so forgive me if it is a repeat, but here goes:

What are some of the earliest (and later) s/sx that your cardiac patients are going bad?

What things make you nervous and how long did it take you to develop that "feel" -- how long were you a nurse before you could walk in the room and think "oh, crap......." before you even started your shift or before the stuff hit the fan.

Feel free to write about different scenarious.... s/sx are different for a fresh heart verses MI pt, etc...The more opinions & scenarios, the better.

Appreciate it,

LifeLONGstudent

[dorimar, BSN, RN]

Well, an early sign of CHF before the obvious signs,may be an S3 present in your assessment. I know all the books say this, but once you learn to listen for it, it truns out to be true. Now for the obvious: tachypnea,tachycardia, cool clammy skin, decrease in saturations, dyspnea, rales, anxiety,restlessness hypotension or hypertension, chest pain--any of these are warning something needs to be looked at. Of note, many patients on beta blockesrs will not exhibit the expected tachycardia. You should also be aware that many patients with poor EF cannot tolerate ANY hypertension. Sometimes if your patient is in flash pulmonary edema with chest pain and a BP of 200/110, it's hard to determine which caused which, but it is imperative to get the bp down. Also sometimes you can see ST elevation all of a sudden develope on your bedside moniter. It is important to know that you cannot diagnose ischemia or infarction with1 lead, and that a12 lead must be ordered,But if someone tells you that ST elevation on the bedside moniter means nothing, don't believe it. Always get a 12 ld. (patient may be asymptomatic during these changes as well). Don't ignore indigestion or back pain either.

Doris

[papawjohn]

Hey Student!!!

I have to say, I started to cruise on by this question because it's not very specific. I mean--you specify 'cardiac' Pt but how about the Open Chole in my SICU with a 'history' of CAD? You know--it's kinda hard to single out 'cardiac' Pts anymore.

But then I got to thinking, there's something here for lots of us NURSES WHO WATCH MONITORS. Heck, I started out like most of us--an nursing student working nights and found watching monitors fascinating and never lost the fascination. So maybe there's a good thing to say to nurses watching their Pts heartbeats.

Take the 'usual' cardiac Pt, ok? I'm taking stereotypes here. Moderately obese, probably diabetic, probably non-compliant hypertension, likely a cigarette smoker. Chest pain. Rule out MI. Cath lab. New meds. A little KVO IV fluid. Nobody we'd think seriously about, getting report.

Here's the thing--I expect this quy (probably a guy) to be hypo-dynamic. I want him snoozing and give po sedation whenever I have the chance. I want his heart beat slow and regular. I want his resp less than 20/min. I want his temp less than 99.0.

So the kinka things that get me into that room are signs of HYPER-dynamics. Fast heart rate, tachypnea, fever. If the heart rate goes from 60s to 70s and stays there, and then touches 80--I'm in there, checking out what's going on.

In the ICU--I want my cardiac Pt's LOW and SLOW.

Papaw John