Page 555 - Cardiac Nursing

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C HAPTER 22 / Acute Coronary Syndromes 531
this imbalance by restoring the balance between myocardial oxygen usual activities of daily living are related to fear and anxiety, lack of
supply and demand. Interventions to meet each goal include: recall, non-use of information, misinterpretation, cognitive limita-
For Goal 1 tions, disinterest, lack of familiarity with available resources, or de-
nial of angina or acute MI; knowledge deficit is manifested by the
1. On admission, every 4 hours, and during chest discomfort, as-
patient being unable to describe the disease process, unable to ex-
sess, document, and report to the physician the following: ab-
plain the rationale behind the diagnosis, treatment, and prognosis
normal heart rate and rhythm; hypotension; narrowing pulse
of acute MI and CHD, unaware of activity limitations and pre-
pressure; abnormal respiratory rate and rhythm; decreased
scribed medications, unaware of cardiac risk factors in general, or
mentation; decreased urine output; increasing fatigue; and
unaware of specific risk factors and how to modify them.
moist, cool, cyanotic skin.
For Goal 2 Goals
1. Immediately reduce patient’s physical activity to the level of ac- 1. Early detection, reduction or elimination, and prevention of
tivity before occurrence of manifestations of decreased systemic the specific knowledge deficit and maintenance of heart-
tissue perfusion. healthy behaviors in the patient and family.
2. Administer oxygen and antiarrhythmic and other medications 2. Specific goals should be based on each identified knowledge
(positive inotropic, afterload-reducing, and preload-reducing deficit.
agents) as ordered, and continuously evaluate the patient’s re- Interventions
sponse to therapy. Development of a teaching plan to enables all nurses to provide
3. Provide a restful environment; and promote the patient’s physical standardized content to each patient.
comfort by elevating head of bed to 20 to 30 degrees or higher, or
by providing a cardiac chair (depending on BP response), and by 1. Teach patient to decrease activity and take NTG as prescribed
giving individualized basic nursing care. during periods of angina.
2. Teach patient to seek medical attention immediately if relief of
For Goal 3 chest discomfort has not occurred within 30 minutes; call the
1. Provide small portions of easily digested, low-sodium, low sat- physician if there is a change in the pattern of angina.
urated fat foods. Provide a restful environment; as needed, as- 3. Diagnostic procedures and interventions may be a source of
sist the patient in a supportive, calm, competent manner with anxiety and fear. Provide concrete information about proce-
activities of daily living. dures and describe sensory experiences that they may have. For
2. Teach patient to exhale with physical movement. example, “the dye (during cardiac catheterization) will make
3. Offer stool softeners and laxatives to prevent straining with you feel hot and flushed for about 15 seconds” or “the room
bowel movements. Teach patient to recognize precipitating fac- (cardiac catheterization laboratory) will be dimly lit and cool.”
tors of decreased systemic tissue perfusion and to alter behavior 4. Teach the patient and family the content necessary for them to
accordingly. modify their lifestyles. Provide information about modification of
risk factors such as elevated cholesterol levels, smoking, hyperten-
Outcome Criteria
sion, and physical activity. Advise the patient to adhere to the pre-
Goal 1 scribed therapeutic plan (diet, medication, and activity level).
Signs and symptoms of decreased systemic tissue perfusion are de- 5. Encourage active participation in cardiac rehabilitation programs.
tected early. 6. To prevent myocardial ischemia from progressing to infarction
Goal 2 or reinfarction, teach the patient to be aware of physiologic
(such as activity during cold weather, after a heavy meal, or
BP and pulse pressure are returning or have returned to baseline
with sexual intercourse) and psychological (such as anger or
level. Respiratory rate and rhythm are returning or have returned
grief) precipitating factors.
to patient’s baseline. Patient remains fully alert and oriented, with-
7. Teach the patient to reduce precipitating factors by taking pro-
out personality change. Urine output remains greater than 250 cc
phylactic NTG, reducing specific physical activity and psycho-
per 8 hours. Patient’s complaints of fatigue are reduced. Patient is
logical stress that often result in chest discomfort, and counter-
able to carry out activities of daily living within prescribed activity
ing emotional stress by regular physical exercise.
limits. Extremities remain warm, dry, and of normal color.
Goal 3 Outcome Criteria
Normal sinus rhythm without arrhythmia or conduction distur- The patient and family are able to describe the disease process and
bance is maintained. BP and pulse pressure are maintained at pa- explain the rationale behind the diagnosis, treatment, and prog-
tient’s baseline level. Respiratory rate and rhythm are maintained nosis of acute MI and CHD. The patient and family describe ac-
at patient’s baseline. Patient remains fully alert and oriented, with- tivity limitations and prescribed medications. The patient and
out mental status change. Urine output remains greater than 250 cc family list general and specific cardiac risk factors and describe
per 8 hours. Patient does not complain of worsening fatigue. Pa- strategies they will use to modify risk factors.
tient is able to carry out activities of daily living within prescribed
activity limits. Extremities remain warm, dry, and of normal color.
NURSING MANAGEMENT OF
Knowledge Deficit
PATIENTS WITH RV INFARCTION
Diagnosis
Knowledge deficit about acute MI and CHD, the medical or sur- An important initial nursing consideration is to suspect RV in-
gical management plan, risk factor modifications, or the return to farction in any person admitted to an intensive care unit with an