Patient Data

Exhibits

Review H and P, and nurse’s note. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

The client is at immediate risk for developing Cardiac arrest, Anaphylaxis, and Arrhythmias.

Choice A: Peripheral Edema

Peripheral edema refers to the swelling of tissues, usually in the lower limbs, due to the accumulation of fluid. While peripheral edema can be a concern in patients with heart conditions, it is not an immediate risk in the context of the patient’s current situation. The primary concerns for this patient, given her history of symptomatic bradycardia and atrial fibrillation, are more acute and life-threatening conditions such as cardiac arrest, anaphylaxis, and arrhythmias. Peripheral edema is typically a chronic condition that develops over time and is not considered an emergent risk in this scenario.

Choice B: Renal Failure

Renal failure, or kidney failure, is a condition where the kidneys lose their ability to filter waste from the blood effectively. While renal failure can be a serious complication, it is not an immediate risk for this patient. The patient’s primary issues are related to her cardiovascular system, specifically her low heart rate and history of atrial fibrillation. The immediate risks in this scenario are more likely to be related to acute cardiovascular events rather than renal complications. Additionally, there is no indication in the patient’s history or current treatment that suggests an imminent risk of renal failure.

Choice C: Necrosis

Necrosis refers to the death of body tissue due to a lack of blood flow or infection. While necrosis can occur in severe cases of prolonged ischemia or infection, it is not an immediate risk for this patient. The patient’s current condition and treatment plan do not indicate a high risk of tissue necrosis. The more pressing concerns are related to her cardiovascular health, specifically the risk of cardiac arrest, anaphylaxis, and arrhythmias. These conditions are more likely to occur suddenly and require immediate medical intervention.

Choice D: Cardiac Arrest

Cardiac arrest is a sudden loss of heart function, leading to a cessation of blood flow to the body’s organs. Given the patient’s history of symptomatic bradycardia and atrial fibrillation, she is at a high risk of developing cardiac arrest. Bradycardia can lead to insufficient blood flow and oxygen delivery to vital organs, potentially resulting in cardiac arrest. Additionally, the stress of the upcoming procedure and the discontinuation of anticoagulants can further increase this risk. Therefore, cardiac arrest is a significant immediate risk for this patient and requires close monitoring and preparedness for emergency intervention.

Choice E: Anaphylaxis

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur rapidly. The patient is receiving vancomycin, which is known to cause hypersensitivity reactions, including anaphylaxis, in some individuals. Symptoms of anaphylaxis include difficulty breathing, swelling, hives, and a drop in blood pressure. Given the patient’s current infusion of vancomycin, she is at risk for developing anaphylaxis, which requires immediate medical attention to prevent severe complications or death. The nurse must be vigilant for signs of anaphylaxis and be prepared to administer emergency treatment if necessary.

Choice F: Arrhythmias

Arrhythmias are irregular heartbeats that can range from benign to life-threatening. The patient has a history of atrial fibrillation, a type of arrhythmia, and symptomatic bradycardia, both of which put her at risk for developing further arrhythmias. The stress of the upcoming procedure, changes in medication, and the underlying heart conditions all contribute to the risk of arrhythmias. These irregular heartbeats can lead to decreased cardiac output, syncope, or even progression to more severe arrhythmias like ventricular fibrillation, which can be fatal. Therefore, arrhythmias are an immediate risk for this patient and require continuous cardiac monitoring and readiness to intervene.

Captopril is an angiotensin converting enzyme inhibitor that works by vasodilation.

Choice A: Angiotensin Converting Enzyme Inhibitor

Reason:

Captopril is classified as an angiotensin converting enzyme (ACE) inhibitor. ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By inhibiting this conversion, ACE inhibitors reduce the levels of angiotensin II, leading to vasodilation, decreased blood pressure, and reduced workload on the heart. This mechanism is particularly beneficial in managing hypertension and heart failure. Additionally, ACE inhibitors like captopril help in reducing the progression of diabetic nephropathy by decreasing glomerular pressure.

Choice B: Aldosterone Agonist

Reason:

Aldosterone agonists are drugs that mimic the action of aldosterone, a hormone that increases sodium and water reabsorption in the kidneys, leading to increased blood volume and blood pressure. This is the opposite of what captopril does. Captopril, as an ACE inhibitor, actually reduces aldosterone secretion, leading to decreased sodium and water retention, which helps lower blood pressure. Therefore, captopril cannot be classified as an aldosterone agonist.

Choice C: Angiotensin II Receptor Blocker

Reason:

Angiotensin II receptor blockers (ARBs) work by blocking the action of angiotensin II at its receptor sites, preventing vasoconstriction and aldosterone secretion. While ARBs and ACE inhibitors both target the renin-angiotensin-aldosterone system (RAAS), they do so at different points. Captopril is an ACE inhibitor, not an ARB. ARBs include drugs like losartan and valsartan, which are used when patients cannot tolerate ACE inhibitors due to side effects like coug.

Choice D: Lowering the Heart Rate

Reason:

Lowering the heart rate is not the primary mechanism of action for captopril. This effect is more commonly associated with beta-blockers, which reduce heart rate and myocardial contractility to lower blood pressure and reduce cardiac workload. Captopril, on the other hand, primarily works through vasodilation by inhibiting the formation of angiotensin II. While it may have some indirect effects on heart rate by reducing blood pressure, this is not its main mechanism.

Choice E: Reducing Inflammation

Reason:

Reducing inflammation is not a primary action of captopril. Anti-inflammatory effects are typically associated with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. While there is some evidence that ACE inhibitors may have minor anti-inflammatory effects due to their impact on the RAAS, this is not their primary function. Captopril is mainly used for its vasodilatory effects to manage hypertension and heart failure.

Choice F: Diuresis

Reason:

Diuresis, or increased urine production, is not the primary mechanism of action for captopril. Diuretics, such as furosemide or hydrochlorothiazide, are specifically used to promote diuresis by acting on different parts of the renal tubules to increase the excretion of sodium and water. While captopril can lead to mild diuresis by reducing aldosterone levels, this is not its main therapeutic action.

Choice G: Vasodilation

Reason:

Vasodilation is the correct mechanism of action for captopril. By inhibiting the conversion of angiotensin I to angiotensin II, captopril reduces vasoconstriction and promotes vasodilation. This leads to a decrease in blood pressure and an overall reduction in the workload on the heart. Vasodilation is a key therapeutic effect of ACE inhibitors, making them effective in treating conditions like hypertension and heart failure.