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Formula:
CO = SV X HR
= 70ml/beats X 72 beats/min
= 5040 ml/min (approximately 5L/min)
CO = 115L/min X 190bpm
= 21,850 ml/min (approximately 22L/min)
ystolic blood pressure – is the blood pressure caused by the
contraction phase or systole of the
left ventricle of the heart.
iastolic blood pressure- the pressure during the heart’s
relaxation phase, or diastole.
ulse pressure – the numerical difference between systolic an
diastolic.( normal 30 to 40 mm/hg).
nostic test
ivated partial thromboplastin time
- the test to measure the time required for
formation of a fibrin clot.
diac enzymes – test used to determine if cardiac tissue
been damage.
- normally present in high concentrations in
the heart, cardiac enzymes are released
into the blood stream from their normal
intracellular area during cardiac trauma.
• cardiac troponin test
- a blood sample is used to measure the cardiac
protein called troponin. This is the most precise
way to diagnose an MI.
Radiologic test
cardiac catheterization
- a diagnostic procedure in which a catheter is
inserted into a large vein and then threaded
through the vein to the patient’s heart.
angiocardiography – creates an x-ray of the heart and great
vessels after injection of contrast medi
into a blood vessels or one of the heart
chambers.
angiography – produces an x-ray of the blood vessels after
injection of radiopaque contrast medium.
Cardiac catheter
Cardiac
catheter
angiocardiography
angiocardiography
• radio nuclide scan – is a test that helps to measure heart
function and damage.
- during the test, a mildly radioactive
material is injected into the patient’s
blood stream. Computer generated
pictures are used to locate the radio-
active elements in the heart.
thallium stress test - helps diagnose coronary artery diseas
- the patients is given a thallium isotope
IV after a treadmill stress test.
rrhytmia - the lack of normal heart rhythm.
trial flutter - is an arrhytmia in which atrial rhythm
is regular, but the rate is 250 – 400 bpm.
radycardia - is a slow heartbeat, usually less than 60
beats per minute.
brillation - refers to an uncoordinated, irregular
contraction of the heart muscle, which may
originate in the atria.
eart block - describes an impaired conduction of the
heart’s electrical impulses, which commonly
leads to a slow heartbeat.
aroxysnal
trial tachycardia-is an arrhytmia in which the atrial and
ventricular rate are regular and exceeds
160 beats per minute.
achycardia - refers to a heartbeat greater than 100bpm
8. Atrial septal defect - is an opening between the 2 atria.
- because the left atrial pressure is
slightly higher than the right atria
pressure, blood shunts from the le
to the right.
9. Coartication of the
aorta - is narrowing of the lumen which
results in high pressure above and
low pressure below the stricture.
10. Endocarditis - is a bacterial or fungal infection of
the heart valves.
11. Myocarditis - is an inflammation of the heart
muscle that can be acute or long
term.
12. Pericarditis - is an inflammation of the
pericardium(protective sac)
3. Rheumatic fever - is a childhood disease caused by
streptococcal bacteria.
4. Aneurysm - occurs commonly in the aorta but
can happen in any vessels.
- ruptured bloodvessels
5. Stenosi - a thickening of valvular tissue that
result in narrow valve openings.
6. Coronary artery
disease - occurs when the arteries that serve
the heart are obstructed or narrowed.
7. Coronry artery bypass
graft - surgery restores circulation when
occluded coronary arteries prevent
normal blood flow to the heart muscle.
8. PTCA - percutaneous transluminal coronary
angioplasty.
- is a non-surgical alternative to CABG
- a guided catheter is thread to the
coronary artery and position @ site of a
occlusion.
9. Cardiac Tamponade – a life threatening complication
caused accumulation of fluid in the pericardiu
this fluid, which can be blood, pus, or air in th
pericardial sac, accumulates fast enough and
sufficient quantity to compress the heart and
restrict blood flow in and out of the ventricles
CARDIAC TAMPONADE
A build up of blood or other
fluid in the pericadial sac
puts pressure on the heart,
which may prevent it from
pumping effectively.
Fluid build up
within the pericardial
sac
sment:
process of data collection and inter-
tation.
es of data
tory
ysical examination
oratory testing
gnostic imaging
Principles
torical information, laboratory testing
nd physical findings directs appropriate
boratory and diagnostic testing.
Basic principles cont…..
2. Assessment data are used to formulate
clinical
diagnosis, established patients goals, plan
care and evaluate outcomes.
3. Patient condition and the purpose of the
encounter determine areas that are included
in an assessment.
4. Elements of the history and physical
elimination
are the same whether performed by a
physician,
nurse or other clinician.
Assessment of the cardiovascular system involves:
• incorporating data from history taking relating
the information to the physical examination
and diagnostic test.
• correlating the data with the underlying
pathophysiology.
istory:
a record of past events.
a systemic account of the medical and psychosocial
occurrences in a patient’s life and of factors in
family ancestors and environment that may have
a bearing on the patients condition.
alth history
the patients story of his or her diseases,
ymptoms, illness experiences and responses t
ctual and potential health problems.
dentifying information
primary data source - patient
secondary data source - family members
clinical record
: “significant cardiovascular data are obtained by assessme
of the following area’’
-risk factor analysis -current health/history of present il
-biographical -demographic data
-chief complaint -associated manifestation
k factor analysis:
- a factor that causes a person or a group o
person to be particularly vulnerable to a
unwanted, unpleasant or unhealthy even
Examples:
age and gender
women after menopause high risk
men older than 60y/0 high risk
family history of
increase BP
two or three or more
blood relatives
systolic 160 – 200
diastolic 90 – 110
cholesterol level
240 – 280 above high
risk
triglycerides level
200 – 499 high risk
above 500
highest risk
percentage of fat in diet
30 – 50% high
Above 50%
highest risk
frequency of recreational
exercise
no activity
highest
smoking
Biographical/Demographic data
• name
• age
• gender
• place of birth
• race
• marital status
• occupation
• ethnic background
note:
economic transition, urbanization, industrializatio
and globalization bring about lifestyle changes th
promote heart disease.
Current health/ History of present illness
documenting the progression of the first manifestatio
to the current complaints or problems helps organize
the history and reveals the sequence of events that le
the client to seek help.
CHIEF COMPLAINT
he reason why the person has sought health care
o establish priorities for interventions and to evaluate
how well the client understands the presenting condit
ommon clinical manifestations important/
mportant manifestations of cardiac disease.
chest pain irregularities of heart rhythm
cyanosis respiratory manifestations
fatigue syncope
hemoptysis weight gain
dependent edema
clubbing of fingers
te:
r the symptomatic patient obtaining the history of the
esent illness starts with a more detailed discussion of
ief complaint
mptom analysis
ubjective indication of a disease or a change i
ndition as perceived by the patient.
evaluate and clarify the chief complaint.
Chest pain
ne of the most important manifestations of
ardiac disease.
gina Pectoris
- is the true manifestation of coronary artery
disease.
- a paroxysmal thoracic pain caused most
often by myocardial anoxia as a result of
atherosclerosis of the coronary arteries
e:
words used to described chest pain.
related to exercise, emotional stress, exposure to
intense cold.
ification of Angina
able / Classic Angina
haracterized by transient episodes of substernal
hest pain or discomfort
te:
better quantify pain use a scale of 1 to 10 and should
corded as fraction.
ocation
describe the specific body location where the symptom
is experienced, include any area of location.
it provides additional information for determining its
cause.
Precipitating/Aggravating factor
-describe events that initiate symptom.
-describe what makes the symptom worse.
eg:
• emotional excitement
• position changes
• deep breathing
• eating/ deep sleep
chest discomfort that is reliably associated wit
activity is a specific indicator of cardiac ischem
orms of dyspnes
exertional dyspnea – most common of cardiac related
dyspnea.
- occurs during mild to moderate
exercise or activity and disappear
with rest.
- can limit activity tolerance
ask the client to describe the degree of activity
that typically precipitate the onset of dyspnea.
eg: walking one flight stairs
b. Orthopnea – difficulty of breathing except when
sitting or standing.
- result from increase hydrostatic pressur
in the lungs when the person is lying fla
and is relieved when the person assum
an upright or semiventrical position.
• hemoptysis–coughing up of blood
recurrent episodes of hemoptys
may result from mitral stenosis.
SSESSMENT
st health history ( ask the client about the following areas )
childhood and infectious disease
ask about the client’s experiences with rheumatic fever,
scarlet fever and severe streptococcal infections.
( conditions associated with structural/ mitral valve disease)
immunization
lients with chronic conditions, such as cardiovascular
disorder should be vaccinated yearly against influenze.
major illness and hospitalization
note conditions that influence the clients current cardio-
vascular performance
eg: diabetes mellitus, anemia, chronic obstructed lung
disease, kidney disease, hypertension, stroke, gout
. medications
-evaluate the use of prescription medications, over the
counter medications, herbals and recreational drugs.
- use brand names instead of generic names if possible
. family history
- purpose is to asses risk factors affecting the patients
current or future health.
• non-modifiable risk factor.
eg: age, gender, ethnicity, genes
• notations regarding the age and health status of ea
first degree family members.
• the possible or confirmed diagnosis or death.
psychosocial history
includes on data of lifestyle, household members, marital
status, children, relationship with significant others, education
military service or health habits.
ccupation
inquire about all occupations the client has had and the
duration of each job worked.
eographical location
nvironment
-the home, types of dwelling, no of steps
-mode of transportation
-access to public transport
-the neighborhood (noise, pollution)
-access to family and friends, store, pharmacy
xercise
ask about the type and amount of exercise routinely engaged
in during an average week.
sedentary lifestyle potentates the lethality of myo
cardial infarction and it is considered a significant
risk factor in the development of coronary artery
disease.
. nutrition
examine not only daily food habits but also attitudes
toward food, and resistance to therapeutic alterations
in diet.
note for special diet such as low sodium or low fat diets.
assess excess or deficit caloric intake and the clients
appropriate intake of food, high in sodium, cholesterol
saturated fat and caffeine.
its
caffeine or alcohol use, smoking habits, inquire the
duration/ pack per day.
hers
> perceived health and coping challenges
the patients perception of his or her current health
status as either good or bad.
being aware of patients goal in terms of health an
lifestyle are important in determining whether the
expectations are realistic.
eg: what do you see yourself doing 3 months from now
• health perception
• nutrition – metabolism
• elimination
• activity – exercise
• cognitive – perceptual
• sleep – rest
• roles and relationship
• sexuality
• coping – stress
• values - beliefs
Thank you!
PHYSICAL ASSESSMENT
hysical Assessment ( IPPA )
cardiac physical assessment should include an evaluation
f: [ things to consider]
The heart as a pump
> reduce pulse pressure
> cardiac enlargement
> presence of murmur/gallop rhythm
Filling volumes and pressure
> the degree of jugular venous pressure
> presence of crackles
> peripheral edema
> postural changes in blood pressure
Cardiac output
> heart rate >blood pressure
> pulse pressure >systemic vascular resistance
> urine output >central nervous system manifestation
. Compensatory mechanism
> increase filling volumes
> peripheral vasoconstriction
> elevated heart rate
e cardiac physical examination includes the following
a general inspection
assessment of BP, arterial pulse, jugular venous pulse
percussion, palpation and auscultation of heart
evaluation of edema
. GENERAL APPEARANCE
the patients appearance and response provide cues to the
cardiovascular status.
note general build, skin color, presence of shortness of
breath and distention of neck veins.
• does the client lie quietly, or is he restless or contin
moving about.
• can the client lie flat or is only an upright/erect
position tolerated.
• does the facial expression reflect pain or obvious
manifestation of respiratory distress.
• can the client answer questions without dyspnea
during the interviews.
• capillary refill/ edema presence
eg:
myocardial pain constant, moving
ently palpate for the carotid artery and note for the rate and
hythm and bruit sounds.
• ------------------ PMI
• -------------- STERNAL
ANGEL
45 degrees
bruit sounds are similar to cardiac murmurs that
occurs with turbulence of blood flow.
hest
bserve for size, shape and symmetry of movement and
vident pulsation.
Opening snap
result of high pitched sound with a snapping quali
it is heard early in diastolic @ the apex using a
diaphragm.
MURMURS
- a consequences of turbulent blood flow through the he
and large vessels.
- results of faulty valves.
- an incompetent valve fails to close tightly and blood
leaks through the valve when it closed.
diastolic murmurs is always abnormal.
eg: aortic or pulmonary valve insufficiency, mitral or
tricuspid insufficiency.
ericardial friction rub
characterized by scratchy, creaking or grating sounds
eg: pericarditis
-maybe present during the first week after myocardia
infarction.
-the roughed parietal and visceral layers of the peri-
cardium rub against each other during cardiac motio
0. Lungs
because the cardiovascular and respiratory system are
timately related, assessment of cardiovascular system must
clude evaluation of the respiratory system.
OMMON RESPIRATORY FINDINGS:
Tachypnea – rapid respirations is often associated with pa
anxiety accompanying myocardial ischemia.
Crackles - frequently signals left ventricular failure
etiology:
pulmonary capillary pressure increase because of back-
ward pressure of left ventricle pressure, fluids shift into
intra – alveolar spaces and crackles can be auscultated.
Blood tinged sputum – frank hemoptysis maybe associated
with pulmonary embolus.
Cheyne stroke respirations – characterized by abnormal peri
of deep breathing alternating with
period of apnea.
asically you have to assess for the rate, rhythm and effort.
1. ABDOMEN
abdominal obesity is highly correlated with metabolic ris
ctors that is an elevated body mass index.
spection and palpation may reveal abdominal distention or
ascites and enlarge liver, both indicates liver failure which ca
be sequel to right ventricular heart failure
an increase in jugular vein distention during and immediately
after liver compression indicates chronically elevated right
ventricular pressure
I. Diagnostic Test
a. Laboratory test
b. Graphical procedure
. Radiographic procedure
d. Hemodynamic Studies
a. Laboratory test
1. complete blood count
48 to 72 levels are
avoid IM injection prior to examination of ck and
ck-mb.
samples should be taken immediately on admissio
and every 6 to 8 hours for the 1st 24hrs.
smaller elevation maybe seen after reperfusion.
Myoglobin -Increase myocardial elevates 1
protein -return to N damage. to
found in in 12 to 30 useful marker 3 hrs. after
myocardium hrs of myocardial MI
& skeletal -great necrosis that
muscle that potential for is rapidly
is release from
false
released positive the
into circulation
test.
w/n 1 to
blood after
2hrs
cell injury
Lactic -peak w/n Increase w/n
dehydrogenase 48 to 72 14 to 24 hrs.
-plenty in hrs. after the
heart muscle -returns to onset of MI
normal
w/n
3 to 4
days
roponin ( cardiac enzymes )
components:
1. Troponin I – modulates the contractile states
2. Troponin C- binds to calcium
3. Troponin T – binds with I and C
roponi I and T
- although it is present in all striated muscle it has a diff
ammino acids sequence in cardiac muscle.
30 to 39 160 bpm
40 to 49 150 bpm
50 to 59 140 bpm
60 to 69 130 bpm
ctrophysiologic studies
hed light on the mechanism of dysrhytmias.
ifferentiate supraventricular and ventricular dysrhytmia
valuate SA/AV node dysfunction.
etermine the need for pacemaker
valuate the effects if antidysrhytmic agents.
ardiac diagnostic imaging
hest x- ray
help to determine size, silhoutte and position of the heart.
Magnetic resonance imaging
provide information on chamber size, wall motion, valvular
function and great vessel blood flow.
ositron emission tomography
physiologic and biochemical changes
detection of coronary artery disease
assessment of myocardial viability
assessment of progression of coronary artery disease
documentation of collateral coronary circulation
differentation of ischemia from dilated cardiomyopathy
chocardiography ( 2D echo )
non-invasive diagnostic procedure based on the principles
of ultrasonography/ structural and functional changes.
Transesophageal echocardiography
> yields a higher quality picture of the heart, than does
regular echocardiography.
Phonocardiography
> recording of audible vibrations from the heart and
great vessels.
> use to assess the timing of cardiac sounds and murm
. Myocardial scintigraphy
> use to measure function, motion and perfusion on the
myocardium
> involve IV injection of radioactive isotope to produce
radionucleoide image.
types:
> thallium 201
> dipyridamole thallium 201 test
> technitium 99m ventriculography
. Cardiac catheterization
> involves insertion of catheter into the heart and
sorrounding vessels to obtain detailed information
about the structure and performance of the heart,
the vessels, and circulatorysystem.
Right sided Left sided
Catheterization Catheterization
physicians insert a The catheter can be
radiopaque passed
catheter through the retrograde from the
antecu- brachial
bital or femoral vein. or femoral artery into the
aorta and then to the left
ventricle
exercise damage
emotions myocardium
anemia myocardial
digestion of hypertropy
large aortic stenosi
meal diastolic
hyperthyroidism hypertension
heavy exertion
art medications:
Digitalis - an extract of foxglove plants that slows and
strengthens contractions of the heart muscle.
Nitroglycerin – causes dilation of all of the veins and
arteries without an increased in heart
rate or stroke volume.
eta-adrenergic blocking agents
- reduce the rate and strength of cardiac muscle
contraction thus reducing the oxygen demand
of the heart.
Calcium channel blockers
- use to control the force of heart contraction
and reduce arrhytmia.
- dilate coronary blood vessels and increase blood
flow to cardiac muscle.
Adrenergics - help treat serious hypotension.
Angiotensin converting enzymes inhibitor
- are used to treat hypertension and heart
failure.
Cardiac glycosides
- are used manage heart failure and
certain types of arrhythmia.
Diuretics - treat edema and hypertension by reduc
circulating fluid volume.
Antihypertensive – reduce cardiac output or decrease
peripheral vascular resistance to
lower blood pressure.
hrombolytic therapy – is used to dissolve clots. Aspirin
therapy is one type of treatment.
uctural Cardiac Disorder
adequate tissue perfusion is essential to good health and
n to life. Perfusion to tissue is critical for their function,and
dequate tissue perfusion from cardiac disorder often leads
onfusion or anxiety related to the brain’s continual needs
glucose and blood and muscle pain resulting from the
scles’ continual need for blood. Failure to pump blood can
ult in adequate tissue perfusion.
CONTRIBUTING RISK
FACTORS
RESPONSE TO STRESS INFLAMMATORY
MENOPAUSE RESPONSE
HOMOCYSTEIN LEVEL
Angina Pectoris – is a term used to describe chest
pain resulting from
myocardial ischemia.
Etiology:
1. Condition that decrease blood or oxygen supply to
the heart.
> atherosclerosis > aortic stenosis or
insufficiency
> arterial spasm > anemia and
hypoxemia
> hypotension > polycythemia
2. Conditions that increase demands on the
myocardium
> exertion >
hyperthyroidism
> emotion > myocardial
damage
nical Manifestation:
> transient paroxysmal attacks of substernal or precordia
pain.
> dyspnea > pallor
> pallor > sweating
> palpitations
Medical Management:
> vasodilators – relaxes smooth muscle of coronary and
peripheral blood vessels, decreasing
work load of the heart and promoting
greater flow of blood and
oxygen to heart muscle.
eg: nitroglycerin / isosorbide dinitrate (isordil).
> beta – blocking agents – decrease myocardial
workload and oxygen demand by
decreasing contractility, heart rate,
and blood pressure.
eg: inderal, metoprolol, atenolol
Calcium channel blockers – reduce vascular smooth musc
tone by interfering with the ability of calcium ions
to initiate muscular contraction.
> eg: diltiazem, nifedipine, verapamil.
Analgesic –morphine sulfate is most commonly used as it als
reduces venous return ( preload) thereby
decreasing myocardial workload.
Dietary modifications – low fat, low cholesterol, low calorie
and high fiber diet.
rsing Management:
onitor cardiac rhythm > notify physician if c
rovide restful envirnment pain is not relieved by
dminister PRN analgesic 3 nitroglycerin tablets
dminister supplemental oxygen or ordered analgesics.
btain 12 lead ECG
onitor BP/nitroglycerin adm.
yocardial Infarction
also known as heart attack or coronary occlusion.
a formation of localized necrotic areas within the myocardium
usually follows the sudden occlusion of a coronary artery
and the abrupt cessation of blood and oxygen flow to
he heart muscle.
Clinical Manifestation:
Chest pain > hypotension
gray facial color > cold diaphoresis
weak pulse > peripheral cyanosis
tachycardia/bradycardia
lethargy > nausea and vomiting
great fear of death > apprehension
dyspnea/ orthopnea > palpitations
ECG changes
edical management:
the first 24 hours after an MI are the time of highest risk
for sudden cardiac death. The crucial time frame for the
salvage of the myocardium is the first 6hours.
pain control is priority.
continued pain is a sign of myocardial ischemia
pain also stimulates the autonomic nervous system and
increases preload, increasing myocardial demand.
compensatory mechanism
ventricular dilation
ventricular hypertrophy
sympathetic nervous system stimulation
cardiac decompensation occurs when the heart
despite these mechanism fails to meet the deman
Output upon it, and symptoms of CHF develop.
auses of congestive heart failure include:
congenital heart defects
systemic hypertension
pulmonary hypertension
myocardial infarction
valvular stenosis or regurgitation
cardaic tamponade
constrictive pericarditis
hypervolemia
cardiomyopathy
conditions that precipitate heart failure
- dysrhytmia - pulmonary disord
- physical or emotional stress
- infection
- anemia
- thyroid disorder
LEFT VENTRICULAR RIGHT VENTRICULAR
FAILURE FAILURE
Weakness Weight gain
Mental confusion Ankle or pretibial swelling
Insomia Abdominal distention
Anorexia Anorexia, nausea, gastric
Diaphoresis distress
Anxiety Pitting edema
Orthopnea Ascites
Cough
S3 and S4
edical management;
oxygen administration
digitalis therapy to improve contractility
Pre-load reduction
- diuretics – furosimide
- sodium and fluid restrictions (1000ml/24hrs.)
- high fowlers position>after load reduction
afterload reduction
- vasodilators
- physical/emotional stress reduction
notropic agents to facilitate myocardial contractility and
enhanced stroke volume.
dopamine, dobutamine
angiotensin converting enzyme – captopril
dietary modifications – low sodium, high potassium
water restriction.
ursing management:
Monitor intake and output
Maintain fluid restriction
Provide frequent oral care
Daily weights
Monitor laboratory results
Assess for sign and symptoms of decrease cardiac outp
Assess heart rate and rhythm
Auscultate heart sounds
Monitor blood pressure(diuretics and vasodilator drugs)
Assess for jugular vein distention, edema,pain
Administer oxygen therapy and monitor ABG
Maintain sodium restriction diet
Assess lung sounds
Monitor for signs of hypokalemia,lethargy,hypotension
muscle cramping.
NURSING DIAGNOSIS FOR CLIENTS WITH STRUCTURAL
CARDIAC DISORDER
activity intolerance
chronic pain
decreased cardiac output
imbalance nutrition: less than body requirements
impaired gas exchange
impaired physical mobility
risk for ineffective airway clearance
risk for ineffective therapeutic regimen
management: individual
risk for ineffective tissue perfusion: cerebral
risk for infection
NURSING DIAGNOSIS FOR CLIENT WITH FUNCTIONAL
CARDIAC DISORDER
• acute pain
• decreased cardiac output
• excess fluid volume
• impaired gas exchange
• ineffective airway clearance
• ineffective tissue perfusion
• risk for activity intolerance
• risk for anxiety
• risk for impaired skin integrity
• risk for infection
CONGENITAL HEART
DISEASES
ongenital means present at birth. Infants with
ongenital heart problems have structural defects o
e heart or its blood vessels.
al septal defects – is an opening between the two atrial.
because left atrial pressure is slightly higher than right
atrial pressure,blood shunts from left to right. This shun
causes an overload on the right side of the heart,
which enlarges to accommodate the increase volume.
majority asymptomatic..right ventricular hypertrophy, frequ
respiratory infection, feeding difficulties, dyspnea,fatigabilit
oartication of the aorta – is narrowing of the lumen (opening
of the aorta), which results in high pressure above and
low pressure below the stricture.
atent ductuc arteriosus – occurs when the ductus arteriosus
passage between the aorta and pulmonary artery tha
normally closes at birth remains open,sending oxygenat
blood back through the lungs.
mplications:
ulmonary infections -heart failure
erebral embolism -subacute bacterial endocarditis
rain damage
SAMPLE NURSING
CARE PLAN
ample Nursing Care Plan:
Chest discomfort
related to imbalance between myocardial oxygen supply
and demand.
oals:
To detect the early chest discomfort and associated ECG an
homodynamic changes.
To reduce or eliminate chest discomfort.
To prevent the occurrence of chest discomfort.
nterventions:
The balance between myocardial supply and demand can
be improved by intervention that decrease myocardial O2
consumption or increase coronary blood flow.
oal 1:
nstruct patient to report chest discomfort immediately @ on
of discomfort.
Assess and document the patient’s description of chest
iscomfort.
Assess blood pressure, heart rate, and rhythm and respirator
rate.
Assess the skin for temperature and moistness.
Obtain 12 lead ECG during discomfort.
Report the findings of these assessment to the physician.
- ck-mb
- troponin
Goal 2:
Immediately reduce patient’s physical activity
Administer oxygen.
Administer morphine sulfate, nitroglycerine or
other
medications as ordered.
- morphine sulfate ( 2mg to 4mg IV q 5 min.
max. 25mg to 30mg)
-relieves pain and anxiety and reduce
the patients
restlessness.
-dilates venous and arterial bed.
-decrease ventricular preload.
-reduces the activity of the symphathetic
nervous with a resultant decrease
in the oxygen consumption by a
decrease in heart rate and blood
Side effects:
respiratory depression, hypotension.
-nitroglycerine ( 12 to 14 hrs. followed by a free interval
of 10 to 12 hrs.).
- recommended for the first 24 to 48 hrs.
- decrease preload by peripheral vasodilation.
de effects:
Hypotension and increase intracranial pressure.
1
Monitor patient’s heart rate and rhythm
ssess and document cardiac rhythm every 1 to 4 hours
epending on the patient’s condition, before and after
ach dose of antiarrhytmic or vasoactive drug.
ssess blood pressure and obtain 12 lead ECG with changes
cardiac rhythm or if the patient complain of palpitations.
patient’s experience arrhythmias, perform a cardiovascular
hysical examination.
. Obtain venous blood for electrolytes, hemoglobin, arterial
blood for blood gas analysis and obtain a chest radiograph
as ordered by the physician.
. Assess, document and report to the physician the following
> new S3 and S4 (murmur/gallops)
> mitral regurgitation
> crackles
> reduce activity intolerance
Goal 2
- - - same in goal # 1
Out come criteria:
1. Arrythymias and conduction disturbances and signs and
symptoms of heart failure are detected at onset.