What is the initial intervention in a patient with sinus ...

[melly21297]

What is the initial intervention in a patient with sinus tachycardia with the following vital signs
 
  HR, 136 beats/min; BP, 102/60 mm Hg; RR, 24 breaths/min; T, 99.2  F; SpO2, 94 on oxygen 2 L/min by nasal cannula?
 
  a. Stat adenosine to decrease heart rate
  b. Identification and correction of the cause of the increased heart rate
  c. Sublingual nitroglycerine 0.4 mg
  d. Lidocaine 75 mg IV push

Question 2

Which of the following may be present in the patient with significant fluid volume overload? (Select all that apply.)
 
  a. S3 or S4 may develop.
  b. Distention of the hand veins will disappear if the hand is elevated.
  c. When testing the quality of skin turgor, the skin will not return to the normal position for several seconds.
  d. Tachycardia with hypotension may be present.
  e. Dependent edema may be present.

[kkenney]

Answer to Question 1

B
Sinus tachycardia can be caused by a wide variety of factors, such as exercise, emotion, pain, fever, hemorrhage, shock, heart failure, and thyrotoxicosis. Illegal stimulant drugs such as cocaine, ecstasy, and amphetamines can raise the resting heart rate significantly. Many medications used in critical care can also cause sinus tachycardia; common culprits are aminophylline, dopamine, hydralazine, atropine, and catecholamines such as epinephrine. This patient has a stable heart rate and SpO2; therefore, there is time to identify the cause of the sinus tachycardia. Lidocaine is indicated for ventricular dysrhythmias. Nitroglycerine is not indicated because the patient is not having chest pain at this time. Adenosine is usually not indicated unless the heart rate is greater than 150 beats/min.

Answer to Question 2

A, E
A gallop and dependent edema are indicative of fluid excess; the other signs are indicative of fluid volume deficit.

[melly21297]

TYSM

[aruss1303]

Gracias!