CHF: Often times seen along with acute or chronic renal failure, look for BNP level to be done a BNP >100 is strongly indicative of CHF, look for an echocardiogram to be done and make note of what the ejection fraction is. Expect the patient to be on diuretic, beta blockers, and ACE inhibitors. Assess for adventicious lung or heart sounds, cyanosis, peripheral edema, elevated b/p or heart rate, chest pain, shortness of breath, dizziness, and low 02 sat. Expect to administer IV Lasix or Bumex if patient is newly diagnosed with CHF or is actively going into CHF. Keep an accurate and strict intake and output.
Hyperkalemia: Also often seen with acute or chronic renal failure, expect to administer Kayexalate either PO or Rectally, assess for muscle spasms or cramps, vertigo, palpitations, abnormal b/p or heart rate, and EKG changes.
Afib: A-fib can be considered a controlled or uncontrolled dysrhythmia, if the heart rate is greater than 100 it is usually considered uncontrolled. People with A-fib have a grossly irregular HR and it run very high >150. Often times elderly patients especially if they have COPD can develop uncontrolled A-Fib. A-fib'ers should be on telemetry, expect to administer IV amiodarone, cardizem, or digoxin. Assess once again for chest pain, shortness of breath, and dizziness, watch for hypotension and tachycardia as that combo can mean the patient is decompensating
GI bleed: expect a GI consult and an EGD or colonoscopy to be done depending un if it's a UGI or LGI bleed. Assess hemoglobin and hematocrit, generally if a hemoglobin is 9 or less I go ahead and notify the attending, assess for active bleeding, black tarry foul smelling stools, coffee ground emesis, tachycardia, hyper/hypotension, SOB, dizziness, cp. Keep pt on BR, keep an 18g IV in pt at all times in case of blood administration or if pt crashes so that you already have a large bore IV in.
syncope: depending what happened prior and during syncopal episode expect a neuro consult, assess b/p and orthostatics, heart rate, dizziness, place pt on fall precautions, assess if pt has had any medication changes, Also, I always keep an ammonia amp taped to my stethoscope comes in handy when you have a pt pass out or try to pass out.
Hope this helps!!