Page 138 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 123

Nursing Interventions

Monitor the patient’s BP until stable; this may include intraarterial monitor-
ing to see if therapy is effective in lowering the BP 25% within 2 hours.

Monitor for signs/symptoms of stroke (numbness/tingling in extremities, pa-
ralysis or weakness, change in ability to talk). Stroke is a major complication
of acute hypertensive emergencies.
Initiate and monitor the effects of BP lowering medications to see if therapy
is effective.
Assess patient’s financial status, as money to buy medications is a big issue
in today’s economic crisis.
Teach the patient the importance of taking medications even if he or she
feels well. The patient may have high BP and not feel ill.
Teach the patient ways to modify risk factors to help lower the BP and give
a sense of control.

NURSING ALERT

In an acute hypertensive emergency, bringing the patient’s BP down too swiftly can Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
lead to cerebral or myocardial ischemia and hypoperfusion. Consult with the neu-
rologist to determine the BP to stabilize the patient without causing further damage.

Angina

What Went Wrong?
Angina is a term used to describe episodic chest pain or pressure. It is a symp-
tom of coronary artery disease or an overwhelming demand placed upon the
heart where the cardiac muscle is not perfused. It is different from an MI
because myocardial death does not occur in angina.
In coronary artery disease, the intimal lining (inner) of the arteries within the
heart develops atherosclerotic plaques. The plaques cause an obstruction in
coronary arteries, which causes a decrease in blood supply to the coronary
arteries. The decrease in blood supply can occur during periods of stress, exer-
cise, or any increase in demand upon the heart. The narrowed coronary arteries
lay the foundation for the formation of a complete blockage of an artery, which
can lead to an acute coronary syndrome (ACS).
The modifiable risk factors associated with angina include hypertension, high
cholesterol levels, smoking, obesity, physical inactivity, metabolic syndrome, and
diabetes. Nonmodifiable risk factors include heredity, aging, gender, and race.
Angina can be prevented by changing as many modifiable risk factors as possible.