It is important to note that an (ICD) does have the potential to set of metal detector alarms at the airport. The staff should be notified to fact to make accommodations for the patient. A hand held may be used but should not be placed directly over the implanted device. 

Patients with heart failure after myocardial infarction often take many new medications. It is important to adequately educate these patients on each of the side effects and dosing schedules of each medication. Digoxin is a fundamental drug in the treatment of heart failure. The maintenance dose of digoxin is essential to maintain optimal cardiac functioning and should not be missed. Digoxin may induce nausea and vomiting, and this should be communicated to the primary care provider so it may be treated. Among other essential heart failure medications are vasodilators and inotropic agents, as well as antihypertensive medications such as diuretics, beta-blockers, and ACE inhibitors. Diuretics such as hydrochlorothiazide should be taken in the morning because they induce diuresis - this would disrupt sleeping if taken later in the day or at bedtime. Vasodilators such as nitroglycerin are essential to decrease afterload in the case of angina. Beta-blockers such as metoprolol are most effective when taken without food, such as before breakfast or at bedtime. Antihypertensive medications may also cause orthostatic hypotension, so it is essential for patients to change positions slowly.

The priority consideration for a nurse when a patient exhibits signs of a transfusion reaction include focus on the airway. Anaphylactic and hemolytic reactions diminish the ability of circulating blood to be oxygenated. The priority is to maintain a patent airway so circulating blood may remain oxygenated. After assessing the patient’s airway, the nurse should administer supplemental oxygen, stop the blood, give Benadryl (if it is an allergic reaction), and then notify the physician.

Weight gain is an early symptom of worsened congestive heart failure due to an accumulation of fluid in the vascular system that has not been diuresed. With fluid overload, the nurse should expect to see an increase in blood pressure, as well as tachypnea and tachycardia. Fluid overload may indicate a need for increased diuresis. Infants and children with congestive heart failure commonly demonstrate decreased appetites, so increased hunger would not be a negative sign.

Calcium channel blockers, such as amlodipine cause side effects that affect the conduction of the heart. Other side effects include nausea, headache, rash, and gingival hyperplasia. 

Thrombolytic therapy is commonly given to patients who have strokes to dissolve clots. This therapy is contraindicated in people who have recently had surgery due to the risk for hemorrhage. It is also contraindicated in currently pregnant women. Ibuprofen and beta blockers are not contraindications to thrombolytic therapy. Cardiac dysrhythmias are also not contraindicated with thrombolytic therapy.

Ventricular fibrillation is a potentially lethal rhythm. It is treated via defibrillation. This is an electrical shock that temporarily stops the heart in an attempt to have the natural pacemaker rhythm of the heart take over. Electrical therapy via defibrillation is the appropriate management of ventricular fibrillation.

Congestive heart failure tends to be precipitated by hypertension, type II diabetes, nutritional deficiencies such as thiamine, pulmonary disease, and chronic stress. Atrial fibrillation is not generally a causative factor in congestive heart failure, but these conditions are frequently seen together as they share an etiology. Vestibular irregularities are not generally observed in congestive heart failure.

The client describes pain at rest without a history of heart disease. This type of chest pain often describes prinzmetal's angina which is a spasm of a major coronary artery and can occur while at rest. Many times the client may have a history of other vasospastic conditions such as Raynaud's. It may be treated with a calcium channel blocker or nitrates. 

The first nursing action for a patient arriving in distress to the emergency department is always to begin with priority assessments including vital signs. It provides a baseline for the healthcare team to use when further assessment and treatment is implemented. An electrocardiogram may be used later but is not a priority action, and is ordered by the primary care provider and not the nurse. A thorough medical history and physical assessment will be useful but is not the first action the nurse must take. The physician should be notified but the nurse must assess vital signs first.