Page 238 - Cardiac Nursing

0/0
6/2
0/0
3
3
6/2
1
0:4
1
009
009
1-2
44.
1-2
21
21
44.
xd
xd
q
q
q
0:4
A
p
A
14
14
p
ara
ara
t
p
t
M
Pa
M
6 A
6 A
Pa
e 2
e 2
g
g
g
K34
0-c
10_
LWB K34 0-c 10_ p p pp211-244.qxd 30/06/2009 10:46 AM Page 214 Aptara
LWBK340-c10_
LWB
214 P A R T III / Assessment of Heart Disease
■ Exactly how often does the chest discomfort occur? Family History
■ How many minutes does it usually last? The major purpose of the family history is to assess risk factors af-
■ Can you point to the exact location where it starts? fecting the patient’s current or future health. Notations regarding
■ Does the discomfort move anywhere else? the age and health status of each first-degree family member are
■ If so, can you trace its path with your fingertip? made: living and well, deceased, and the possible or confirmed di-
■ What words would you use to describe how the discomfort feels? agnosis now or at death. Family occurrences of diabetes, kidney
■ What do you do when you have the chest discomfort? disease, tuberculosis, cancer, arthritis, asthma, allergies, mental ill-
■ Quantify your discomfort on a 1-to-10 scale. ness, alcoholism, and drug addiction are included. A family his-
■ Where were you when the discomfort occurred? tory of coronary heart disease, myocardial infarction, or sudden
■ If the chest discomfort has occurred before, have you always death would be included in the history of present illness for a pa-
been in the same place? tient presenting with chest discomfort.
■ Were you alone at the time or with someone?
■ Did you notice any other symptoms that occurred at the same
time? Personal and Social History
■ If yes, does this other symptom ever occur by itself? The personal and social history includes important and relevant
■ What can you do to make the chest discomfort better? information about the patient as a person. A person’s response to
■ What can you do to make it worse? illness is determined in part by his or her cultural background, so-
■ Are you taking any medication, botanical medications, sup- cioeconomic standing, education, and beliefs about the illness.
plements, foods or home remedies to improve your chest dis- Major elements include health habits, home situation, and sup-
comfort? ports and resources. Occupational history may be included here
■ If yes, what is the medication, botanical medication, supple- or in the past history. Health habits include alcohol, drug, or to-
ment, food, or home remedy? bacco use; nutrition; sleep; and physical activity. Use of alcohol
■ Does any medication you are taking affect your chest discomfort? and the amount per time period (day, week, year) should be
■ If yes, what is the medication? recorded. The use of recreational drugs, especially cocaine and its
■ What time of day do you prefer to take your medication? derivative “crack,” should also be assessed. The cigarette smoking
■ Are you doing anything else to improve your chest discomfort, history should be recorded as the number of pack-years (packs per
for example yoga or meditation? day multiplied by the number of years) the patient has smoked.
■ What activities have you given up because of your chest dis- For ex-smokers, approximate quit date should be recorded. Other
comfort? tobacco use, such as pipe or cigar smoking or chewing tobacco,
■ What do you think this chest discomfort means? should be recorded. Special diets, such as low-sodium, low-fat,
■ Do you know anyone else who has had this kind of discomfort? low-carbohydrate, or high-protein diets, should be identified, and
the patient’s usual eating pattern should be described. The usual
number of hours the patient sleeps and circumstances that impair
Past History or facilitate sleep should be assessed.
The past history includes past illnesses and interventions not di-
Current Living Circumstances. These circumstances in-
rectly related to the present illness. For a patient with chest dis-
clude marital status, number of children, occupation, financial re-
comfort, the history of a previous myocardial infarction, coronary
sources, and hobbies.
artery bypass surgery, or cholecystectomy belongs in the history of
present illness, whereas a remote appendectomy does not. Major Perceived Health and Coping Challenges. The patient’s
elements of the past history include childhood and adult illnesses, perception of his or her current health status as either good or bad
accidents and injuries, current health status, current medications, is helpful in assessing how he or she views its effect on daily living.
allergies, and health maintenance. Always ask about major ill- For example, a 42-year-old man with an old anterior myocardial
nesses such as chronic obstructive airway disease, diabetes mel- infarction is seen in the clinic. His chief complaint is extreme fa-
litus, bleeding disorders, and acquired immuno deficiency tigue that prevents him from working a full day at the office. Ini-
syndrome (AIDS). tial investigation focuses on ruling out any new process affecting
Allergic reactions (e.g., to drugs, food, environmental agents, or the adequacy of cardiac output, such as a left ventricular aneurysm.
animals) also should be noted. Always ask if the patient has an al- Nonpathophysiologic causes for fatigue must be considered also,
lergy to penicillin or to commonly used emergency drugs, such as such as fear of overstressing his heart and sudden death, changes in
lidocaine hydrochloride and morphine sulfate. Allergy to shellfish the work situation, family difficulties, or depression.
suggests iodine sensitivity and is important because agents used in Being aware of patients’ goals in terms of health and lifestyle is
cardiac diagnostic tests may contain iodine. Both the allergen and important in determining whether their expectations are realistic.
the reaction should always be noted, because some patients con- “What do you see yourself doing 3 months from now?” is a good
fuse an allergic reaction with a drug’s side effect. way to ask the patient to define the goal. Another approach is as-
Medication history includes all prescription and over-the- certaining what changes the patient would be willing to make in
counter drugs, including botanical medicines, supplements, life if the goal could not be achieved.
and home remedies. Over-the-counter preparations, botanical Assessing the patient’s and family’s expectations of health care
medications, and supplements that increase heart rate or after- has implications for teaching. For example, is the patient with un-
load may precipitate or worsen symptoms. If the patient has stable angina pectoris who has been admitted after “cardiac
brought medications with him or her, these should be reviewed catheterization” able to explain what the test was and why it re-
by the nurse and then sent home or to the appropriate area for sulted in admission? Communication among the health care team
safekeeping. members is essential before planning any teaching.