Diagnostic Procedures, Assessment and Management of - Timing – early diastole

Cardiac Disorders - Location – apex (LV) or LLSB (RV) PITCH: faint and
low pitch
ASSESSMENT OF CV DISORDER
RISK FACTORS S4 – ATRIAL Diastolic Gallop – vibration resulting from
 NON-MODIFIABLE – age, gender, race, heredity resistance to late ventricular filling during atrial asystole
 MODIFIABLE – stress, diet, exercise, sedentary  Timing – late diastole (before S1)
lifestyle, smoking, alcohol, hypertension,  Location – apex (LV) or LLSB (RV) PITCH: low
hyperlipidemia, DM, obesity, type A personality, (use bell)
contraceptive pills
HEART MURMURS – sounds other than the typical “lub-
CHEST PAIN dub”; typically caused by disruption in flow
 Pressure, fullness, burning tightness
 Knife-like/stabbing INCOMPETENT VALVE – swishing sound just after the
 Crushing or searing chest pain normal lub-dub; valve does not completely close, some
 Radiating to back, neck, jaw, shoulders, one or regurgitations of blood
both arms
EDEMA STENOTIC VALVE – high pitch swishing sound when
 Ascites blood should be flowing through valve, narrowing of
 Hydrothorax outlet in the open state
 Anasarca
 Bilateral pedal edema PERICARDIAL FRICTION RUB- It is an extra heart sound
originating from the pericardial sac
Other Clinical Manifestations  Mechanism: originates from the pericardial sac as
 PALPITATIONS it moves
 HEMOPTYSIS  Timing: with each heartbeat
 FATIGUE  Location: over pericardium; upright position,
leaning forward
 SYNCOPE AND FAINTING
 Pitch: high pitch and scratchy. Sound like
 CYANOSIS
sandpaper being rubbed together
 ABDOMINAL PAIN
 Significance: inflammation, infection, infiltration
 CLUBBING OF FINGERS
 JAUNDICE

CLASSIFICATIONS OF CLIENTS WITH

Physical Assessment
AUSCULTATION DISEASES OF THE HEART (FUNCTIONAL CAPACITY)
S1  CLASS I – patients with cardiac disease but
- due to closure of the AV (mitral/tricuspid) valves without resulting limitations of physical activity
- Timing: beginning of the systole
 CLASS II – patients with cardiac disease
- Loudest at the apex
resulting to slight limitation of physical activity
 CLASS III – patients with cardiac disease
S2
resulting in marked limitation of physical
- due to closure of the semilunar (pulmonic/aortic)
activity. They are comfortable at rest.
valves
- Timing: diastole
- Loudest at the base

S3 Ventricular Diastolic Gallop

- vibration resulting from resistance to rapid
ventricular filling secondary to poor compliance
  CLASS IV – patients with cardiac disease  Normal value: 0-7 U/L or males 50-35 mu/ml;
resulting in inability to carry on any physical females 50-250 mu/ml
activity without discomfort
2. Lactic Dehydrogenase (LDH)
 An established marker for the late diagnosis of
myocardial infarction
 Elevates in MI in 24 hours, peaks in 48-72 hours
returns to normal in 10-14 days.
 Normal value is 70-200 IU/L (100-225 mu/ml)

3. Myoglobin
 Rises within 1-3 hours
 Peaks in 4-12 hours
 Returns to normal in a day
 Not used alone as a cardiac marker
 Muscular and renal disease can also have
elevated myoglobin
BLOOD STUDIES  NORMAL VALUE: 0-85 ng/ml
RBC count – women – 4.2-5.4M/mm3; men – 4.7-
6.1M/mm3 4. TROPONIN I and T
 I is usually utilized for MI
HEMOGLOBIN – women -12-16g/dl; men – 13-18 g/dl  Elevates within 3-4 hours, peaks in 4-24 hours
and persists for 7 days to 3 weeks.
HEMATOCRIT – women 36-42 %; men – 42-48%  Early and late diagnosis can be made with
troponin; NO IM injections before blood sample!
RBC INDICES – MCV (mean corpuscular volume); MCH  Normal value TROP I - <0.6 ng/ml
(mean corpuscular hemoglobin); MCHC (mean TROP T –<0.4 ng/ml
corpuscular hemoglobin concentration)
B. COAGULATION SCREENING TEST 4. SERUM LIPIDS
 BLEEDING TIME – measures the ability to stop  Lipid profile measures SERUM CHOLESTEROL,
bleeding after small puncture wound. TRIGLYCERIDES and LIPOPROTEIN LEVELS
 NORMAL VALUE – 2.75-8 mins  Cholesterol = 200 mg/dl
 TRIGLYCERIDES = 40-150 mg/dl
 PARTIAL THROMBOPLASTIN TIME - used to  LDL = 130 mg/dl
identify deficiency of coagulation factors,  HDL = 30-70 mg/dl
prothrombin and fibrinogen; monitors heparin  NPO post midnight (usually 12 hours)
therapy.
 NORMAL VALUE – 60-70 Seconds A. CARDIAC MONITORING / ELECTROCARDIOGRAPHY
B. HOLTER MONITORING
 PROTHROMBIN TIME – determines activity and  A non invasive test in which the client wears a
interaction of the PT group clotting factors; Holter monitor and an ECG tracing recorded
used to determine dosages of oral anti- continuously over a period of 24 hours
coagulant  Instruct the client to resume normal activities
 NORMAL VALUE – 12-14 seconds and maintain a diary of activities and any
symptoms that may develop
C. ERYTHROCYTE SEDIMENTATION RATE (ESR) C. CARDIAC STRESS TEST
 -it is a measurement of the rate at which RBCs  Non invasive test that studies the heart during
settle out of anticoagulated blood in an hour activity and detects and evaluates CAD
 It is elevated in infectious heart disorders or  Exercise test, pharmacologic test and emotional
myocardial infarction tests
 Non specific inflammatory test  TREADMILL testing is the most commonly used
 NORMAL VALUES: men: 15-20 mm/hr; women:  Used to determine CAD, chest pain causes drug
20-30 mm/hr effects and dysrhythmias in exercise
D. CARDIAC PROTEINS AND ENZYMES PRE-TEST:
1. CK-MB (creatine-kinase)  Consent may be required, adequate rest, eat a
 Most cardiac specific enzymes light meal or fast for 4 hours and avoid smoking,
 Accurate indicator of myocardial damage alcohol and caffeine
 Elevates in MI within 4 hours, peaks in 18
hours and then declines until 3 days
DURING TEST A. CARDIAC CATHETERIZATION (CORONARY
 Secure electrodes to appropriate location on ANGIOGRAPHY/ARTE-RIOGRAPHY)
chest, obtain baseline BP and ECG tracing,  PRE-TEST: fasting for hours; check for allergies
instruct client to exercise as instructed and (iodine, seafood); provide medications to allay
report any pain, weakness and SOB, monitor BP anxiety
and ECG continuously.  INTRA-TEST: inform patient of a fluttery feeling
POST TEST as the catheter passes through the heart;
 Instruct client to notify the physician if any inform the patient that a feeling of warmth and
chest pain, dizziness or shortness of breath metallic taste may occur when the dye is
occurs. administered.
 Instruct the client to avoid taking a hot shower  POST-TEST: monitor VS and cardiac rhythm.
for 10-12 hours after test  Monitor peripheral pulses, color and warmth
D. PHARMACOLOGIC STRESS TEST and sensation of extremity distal to the
USE OF DIPYRIDAMOLE insertion site.
 Maximally dilates coronary artery  Maintain sandbag to the insertion site if
 Side effect: flushing of face required to maintain pressure.
 PRE-TEST: 4 hours fasting, avoid alcohol,  Monitor for bleeding and hematoma formation
caffeine B. NUCLEAR CARDIOLOGY
 POST TEST: report symptoms of chest pain  Are safe methods of evaluating left ventricular
E. ECHOCARDIOGRAM muscle function and coronary artery blood
 Non invasive test that studies the structural and distribution.
functional changes of the heart with the use of  CLIENT PREPARATION: obtain written consent,
ultrasound. explain procedure, instruct client that fasting
 CLIENT PREP: instruct the patient to remail still may be required for a short period before exam,
during the test, secure electrodes for assess for iodine allergy.
simultaneous ECG tracing, explain that there  POST PROCEDURE: encourage client to drink
will be no pain or electrical shock; lubricant is fluids to facilitate the excretion of contrast
placed on the skin which will be cool. material, assess venipuncture site for bleeding
E. PHONOCARDIOGRAM or hematoma
 A graphic recording of heart sound with TYPES OF NUCLEAR CARDIOLOGY
simultaneous ECG MULTIGATED ACQUISITION (MUGA) or Cardiac Blood
 A plot of high fidelity recording of the sounds Pool Scan
and murmurs made by the heart  Provides information on wall motion during
 Provides a recording of all the sounds made by systole and diastole, cardiac valves, and ejection
the heart during a cardiac cycle. fraction
CARDIAC CATHETERIZATION (CORONARY SINGLE PHOTON EMISSION COMPUTED
ANGIOGRAPHY/ARTERIOGRAPHY) TOMOGRAPHY (SPECT)
 Insertion of a catheter into the heart and  Used to evaluate the myocardium at risk of
surrounding vessels infarction and to determine infarction size
 Is an invasive procedure during which physician POSITRON EMISSION TOMOGRAPHY (PET) Scanning
INJECTS a dye into the coronary arteries and  Uses two isotopes to distinguish viable and
immediately takes a series of x-ray films to nonviable myocardial tissue
assess the structures of the arteries.
 Determines the structure and performance of PERFUSION IMAGING WITH EXERCISE TESTING
the heart valves and surrounding vessels.  Determines whether the coronary blood flow
 Used to diagnose CAD, assess coronary artery changes with increased activity
patency and determines extent of  Used to diagnose CAD, determine the prognosis
atherosclerosis in already diagnosed CAD, assesses the
physiologic ignorance of a known coronary
lesion, and assess the effectiveness of various
therapeutic modalities such as coronary artery
bypass surgery, percutaneous coronary
intervention, or thrombolytic therapy.
A. CENTRAL VENOUS PRESSURE
 Reflects the pressure of the blood in the right
atrium
 Engorgement is estimated by the venous
column that can be observed as it rises from an
 imagined angle at the point of manubrium  Hypothyroidism
(angle of Louis)  Diet: increased saturated fats
 With normal physiologic condition, the jugular  Type A personality
venous column rises no higher than 2-3 cm Signs and Symptoms
above the clavicle with the client in a sitting  Chest pain
position at 45 degree angle.  Dyspnea
 Measurement of:  Tachycardia
 Cardiac efficiency  Palpitations
 Blood volume  Diaphoresis
 Peripheral resistance

RIGHT VENTRICULAR PRESSURE

 a catheter is passed from a cutdown in the
antecubital, subclavian jugular or basilica vein
to the right atrium and attached to a prescribed
manometer or transducer
 NORMAL VALUE – 2-8 cm H20 or 2-6 mmHg
 DECREASE indicates decreased circulating
volume; INCREASE indicates increase blood
volume or right sided heart failure
To Measure: patient should be flat with zero point
of manometer at the same level of the RA which
corresponds to the mid-axillary line of the patient or
approx. 5 cm below the sternum.
Fluctuations follow patients respiratory function
and will fall on inspiration and rise on expiration
due to changes in intrapulmonary pressure.
 Reading should be obtained
at the highest point of fluctuation.
B. PULMONARY ARTERY PRESSURE (PAP)

CARDIOVASCULAR DISORDERS
CORONARY ARTERY DISEASE
- Results from the focal narrowing of the large
and medium sized coronary arteries due to the
deposition of atheromatous plaque in the vessel
wall.

Predisposing factors
 SEX: Male
 RACE: Africans, African Americans, Pacific
Islanders
 Smoking
 Obesity
 Hyperlipidemia Treatment
 Sedentary lifestyle Percutaneous Transluminal Coronary Angioplasty and
 Diabetes Mellitus Intravascular Stenting (PTCA)
  Mechanical dilation of the coronary vessel wall  Race: Africans, African-Americans, Pacific
by compressing the atheromatous plaque. Islanders
 It is recommended for clients with single vessel  Smoking
coronary artery disease  Obesity
 Prosthetic intravascular cylindric stent maintain  Hyperlipidemia
good luminal geometry after balloon deflation  Sedentary lifestyle
and withdrawal.  Diabetes Mellitus
 Intravascular stenting is done to prevent  Hypertension
restenosis after PTCA  CAD: Atherosclerosis
For SAPHENOUS VEIN SITE:  Thromboangitis Obliterans
 Wear support stockings 4-6 weeks post op  Severe Anemia
 Apply pressure dressing or sand bag on the site  Aortic Insufficiency: heart valve that fails to
 Keep leg elevated when sitting
open and close efficiently
 Hypothyroidism
OBJECTIVES OF CABG
 Diet: increased saturated fats
 Revascularize myocardium
 To prevent angina Increase survival rate  Type A personality
 Done to single Occluded vessels
 If there is 2 or more occluded blood vessels, PRECIPITATION FACTORS: 4 E’S OF ANGINA
CABG is done  EXCESSIVE PHYSICAL EXERTION: heavy
exercise, sexual activity
COMPLICATIONS OF CABG  EXPOSURE TO COLD ENVIRONMENT:
 Pneumonia: encourage to perform deep vasoconstriction
breathing coughing exercises and use of  EXTREME EMOTIONAL RESPONSE: fear,
incentive spirometry anxiety, excitement, strong emotions
 SHOCK
 EXCESSIVE INTAKE OF FOODS or heavy meal
 THROMBOPHLEBITIS

Nursing Management SIGNS AND SYMPTOMS

 Nitroglycerin is the drug of choice for relief of  LEVINE’S SIGN: initial sign that shows the hand
pain from acute ischemic attacks clutching the chest
 Instruct to avoid over fatigue  CHEST PAIN: characterized by sharp stabbing
 Plan regular activity program pain located at the substerna usually radiates
from neck, back, arms, shoulder and jaw
 Antilipemic agents - STATINS
muscles, usually relieved by rest or after taking
nitroglycerin (NTG)
ANGINA PECTORIS
 Dyspnea
 Transient paroxysmal chest pain produced by
 Tachycardia
insufficient blood flow to the myocardium
 Palpitations
resulting to myocardial ischemia
 Chest pain is relieved by rest or nitroglycerine  diaphoresis
due to temporary myocardial ischemia DIAGNOSTIC PROCEDURE
TYPES OF ANGINA PECTORIS HISTORY TAKING AND PHYSICAL EXAM
 STABLE  ECG: may reveal ST segment depression, T wave
 Pain less than 15 minutes, recurrence is inversion during chest pain
 Stress test/ treadmill test: reveal abnormal ECG
less frequent, has known cause
 UNSTABLE during exercise
 Increase serum lipid levels
 Pain is more than 15 minutes but less
 Serum cholesterol and uric acid is also
than 30 minutes, recurrence is more
frequent and the intensity of pain increased
increases. MEDICAL MANAGEMENT
 VARIANT ANGINA (PRINZMETAL’S ANGINA) DRUG THERAPY: if cholesterol is elevated
NITRATES: drug of choice/ NITROGLYCERINE (SL, tab,
 Longer in duration and may even occur
patch, ointment, spray)
at rest. Results from CORONARY
Beta-adrenergic blocking agents
VASOSPASM.
Calcium-channel blockers
 ANGINA DECUBITUS
Ace-inhibitors
 Paroxysmal chest pain that occur when
MODIFICATION of diet and other risk factors
the client sits or stands.
Predisposing Factors
SURGERY:
 Sex: male
 CORONARY ARTERY BYPASS GRAFT
  PERCUTANEOUS TRANSLUMINAL CORONARY  Administer 1 hour before meal and 2 hours
ANGIOPLASTY (PTCA) after meal (Food delays absorption)
NURSING INTERVENTION
NURSING INTERVENTIONS  Administer oxygen inhalation
 Enforce complete bed rest  Place client on semi to high fowler’s position
 Give prompt pain relievers with nitrates or  Monitor strictly v/s, I/O, cardiopulmonary status
narcotic analgesics as ordered and ECG tracing
 Administer medications as ordered  Instruct decrease saturated fats, sodium and
MEDICATION THERAPY: NITROGLYCERINE caffeine
 When given in small doses will act as a  Provide client health teachings and discharge
venodilator, but in large doses will act as planning
vasodilator  Avoidance of 4Es
HOW TO GIVE PRN?  Prevent complication (myocardial
 Give 1st does of NTG SL 3-5 minutes; 2nd dose of infarction)
NTG if pain persists after 1st dose with interval  Instruct the client to take medication
of 3-5 minutes, Give 3rd and last dose of NTG if before indulging into physical exertion
pain still persists at 3-5 minutes intervals to achieve the maximum therapeutic
NITROGLYCERINE Tablets (sublingual) effect of the drug
 Keep the drug in a dry place, avoid moisture and  Provide client health teachings and discharge
exposure to sunlight as it may inactivate the planning
drug  Reduce stress and anxiety; relaxation
 Change stock every 6 months techniques and guided imagery
 Offer sips of water before giving sublingual  Avoid overexertion and smoking
nitrates. WHY?  Avoid extremes of temperature
 Relax for 15 minutes after taking a tablet to  Dress warmly in cold weather
prevent dizziness  Participate in regular exercise program
 Monitor side effects: orthostatic hypotension,
 Space exercise periods and allow for
flushed face, transient headache and dizziness
rest periods
(frequent side effect)
 Emphasize importance of follow up care
 Instruct the client to rise slowly from sitting
 Instruct the client to notify physician
position
immediately if pain occurs and persists
 Assist or supervise in ambulation
despite rest and medication therapy.
Cardiac Dysrhythmias
NITROGYLYCERINE TRANSDERMAL PATCH
 These are disturbances in regular heart rate
 Nitropatch is applied once a day, usually in the
and/or rhythm due to change in electrical
morning conduction or automaticity.
 Avoid placing near hairy areas. Why?  Maybe detected by change in pulse,
 Avoid rotating transdermal patches Why? abnormality on auscultation of heart rate, or
 Avoid placing near microwave ovens or during ECG abnormality.
defibrillation Why?  Continuous cardiac monitoring is indicated for
BETA- BLOCKERS potentially life-threatening dysrhythmias.
 Beta Blockers: decreases myocardial oxygen Causes of Cardiac Dysrhythmias
demand by decreasing heart rate, cardiac 1. Disturbance of Automaticity.
output and BP  This may involve a speeding up or
 What are your Beta Blockers? slowing down of areas of automaticity
 Assess PR, withhold if decreased such as sinus node, the atrioventricular
 Administer with food Why? node, or the myocardium.
 PROPANOLOL is NEVER GIVEN  Abnormal beats may arise through this
 with RESPI-COPD cases, Why? mechanism from the atria, the AV
 With DM cases Why? junction, or the ventricles.
 Side effects: hypotension, nausea, 2. Disturbance in Conduction
vomiting, depression, fatigue  Conduction may be either too rapid or
CALCIUM CHANNEL BLOCKERS too slow. The mechanism of reentry
 CALCIUM CHANNEL BLOCKERS relaxes smooth depends on the presence of slowed
cardiac muscle, reduces coronary vasospasm conduction.
 What are your CCBs? 3. Combinations of Altered Automaticity and
 Assess HR and BP Conduction.
  A simple example would be a
premature atrial contraction with first-
degree AV block or atrial tachycardia.

Rate
 Equals how fast the heart is depolarizing. The
atria and ventricles depolarize at the same time,
but each can depolarize at a different rate.
 Normal: 60 – 100/min
 Bradycardia: <60/min
 Tachycardia: >100/min

Rhythm
 Rhythmicity refers to the regularity of the heart
beats.
 P waves used to establish ATRIAL RHYTHMICITY
 R waves used to establish VENTRICUALR
RHYTHMICITY

Normal Sinus Rhythm

Types of Supraventricular Arrhythmias

Supraventricular arrhythmias begin in the atria
- an irregular heart rate that begins above the
ventricles

Paroxysmal supraventricular tachycardia (PSVT)

- A rapid but regular heart rhythm that comes
from the atria. This type of arrhythmia begins
and ends suddenly.

Atrial tachycardia
A rapid heart rhythm that originates in the atria.

Atrial fibrillation
A very common irregular heart rhythm. Many impulses
begin and spread through the atria, competing for a
chance to travel through the AV node. The resulting
rhythm is disorganized, rapid and irregular. Because the
impulses are traveling through the atria in a disorderly
fashion, there is a loss of coordinated atrial contraction.

Premature ventricular contractions (PVCs)

 - Early, extra heartbeats that originate in the - (CPR) and defibrillation (delivery of an energy
ventricles. shock to the heart muscle to
- Most of the time, PVCs don’t cause any - restore a normal rhythm) as soon as possible.
symptoms or require treatment.
- is common and can be related to stress, too
much caffeine or nicotine, or exercise.
- can be also be caused by heart disease or
electrolyte imbalance.

Types of Bradyarrhythmias
A bradyarrhythmia is a slow heart rhythm that is usually
caused by disease in the heart’s conduction system.
Types of bradyarrhythmias include:

Sinus node dysfunction / Sinus Bradycardia

Slow heart rhythms due to an abnormal SA node.

Ventricular tachycardia (V-tach) First-degree heart block:

The electrical impulse still reaches the ventricles, but
- A rapid heartbeat that originates in the
ventricles. moves more slowly than normal through the AV node.
- The rapid rhythm keeps the heart from - The impulses are delayed. T
adequately filling with blood, and less blood is - This is the mildest type of heart block.
able to pump through the body.
- can be serious, especially in people with heart Second-degree heart block - the impulses are
disease, and may be associated with more intermittently blocked.
symptoms than other types of arrhythmia. • Type I, also called Mobitz Type I or
- A cardiologist should evaluate this condition. Wenckebach’s AV block: This is a less
serious form of second-degree heart
block. The electrical signal gets slower
and slower until your heart actually
skips a beat.
• Type II, also called Mobitz Type
II: While most of the electrical signals
reach the ventricles every so often,
some do not and your heartbeat
Atrial flutter becomes irregular and slower than
An atrial arrhythmia caused by one or more rapid normal.
circuits in the atrium. Atrial flutter is usually more
organized and regular than atrial fibrillation.

Third-degree heart block: 
The electrical signal from the atria to the ventricles is
completely blocked. To make up for this, the ventricle
usually starts to beat on its own acting as a substitute
pacemaker but the heartbeat is slower and often
Ventricular fibrillation (V-fib) irregular and not reliable. Third-degree block seriously
- An erratic, disorganized firing of impulses from affects the heart’s ability to pump blood out to your
the ventricles. body.
- The ventricles quiver and cannot generate an
effective contraction, which results
- in a lack of blood being delivered to the body.
- a medical emergency that must be treated with
cardiopulmonary resuscitation
  SUBENDOCARDIAL MYOCARDIAL INFARCTION:
characterized by occlusion of either right or left
coronary artery

MYOCARDIAL INFARCTION
 6-8 HOURS because of majority of death occurs
due to arrhythmia leading to premature
ventricular contractions
PREDISPOSING FACTORS
 SEX: male
 RACE: black,
 African Americans
 Smoking
 Obesity
 CAD: Atherosclerosis
 Thrombus formation
 Genetic predisposition
 Hyperlipidemia

CLINICAL MANIFESTATIONS
 CHEST PAIN:
 EXCRUCIATING: visceral, viselike pain
with sudden onset located at substernal
and rarely in precordial
 Usually radiates from neck, back,
shoulders, arms, jaw and abdominal
muscles (abdominal ischemia): severe
crushing
 Not usually relieved by rest or by
MYOCARDIAL INFARCTION nitroglycerine
 Death of myocardial cells from inadequate  Nausea and vomiting
oxygenation often caused by sudden blockage  Dyspnea
of a coronary artery  Increased blood pressure and pulse with
 Characterized by localized formation of necrosis gradual drop in blood pressure (initial sign)
(tissue destruction) with subsequent healing by  Hyperthermia: elevated temperature
scar formation and fibrosis  Skin: cool, clammy, ashen
 Also called heart attack  Mild restlessness and apprehension
 Terminal stage of CAD characterized by  Occasional findings: pericardial friction rub,
malocclusion, necrosis and scarring rales upon auscultation, s4 or atrial gallop

DIAGNOSTIC PROCEDURES
 CARDIAC ENZYMES
 CK-MB elevated
 Creatinine phosphokinase (CPK):
elevated
 Lactate dehydrogenase: increased
 Serum glutamic pyruvate transaminase
(SGPT): increased
 Serum glutamic oxalacetic transaminase
(SGOT): increased
 TROPONIN TEST: increased
 ECG tracing reveals: ST segment elevation,
Twave inversion, widening QRS complexes
(indicates that there is arrhythmia in MI),
MYOCARDIAL INFARCTION
pathologic Q wave
 TRANSMURAL MYOCARDIAL INFARCTION:
 Serum cholesterol and uric acid are both
most dangerous type characterized by occlusion
increased
of both right and left coronary artery
 CBC: increased WBC
  Encourage client to take 20-30 cc/week of wine,
NURSING INTERVENTIONS whisky and brandy to induce vasodilation
GOAL: decrease myocardial oxygen demand  Avoidance of modifiable risk factors
 DECREASE MYOCARDIAL WORKLOAD (rest the PREVENT COMPLICATIONS:
heart!)  ARRYHTMIAS: caused by premature ventricular
 Establish a patent IV line contractions
 Administer narcotic analgesic (drug of  CARDIOGENIC SHOCK: late sign is oliguria
choice): Morphine sulfate IV why?  LEFT CONGESTIVE HEART FAILURE
 Side effects: HYPOTENSION/  THROMBOPHLEBITIS: positive homan’s sign
RESPIRATORY DEPRESSION  STROKE/ CVA
 ANTIDOTE : ?  DRESSLER’S SYNDROME (POST MI syndrome):
 SIDE EFFECT OF ANTIDOTE: ? client is resistant to pharmacologic agents:
 Administer oxygen low flow 2-3 lpm: to prevent administer 150000-450000 units of
respiratory arrest or dyspnea and prevent streptokinase as ordered
arrhythmias  Emphasize importance of participation in
 Enforce CBR in semi fowlers position without progressive activity program
bathroom privileges (use bedside commode):  Resumption of ADLs particularly in sexual
Why? intercourse is 4-6 weeks post cardiac rehab,
 Instruct client to avoid forms of Valsalva post CABG and instruct to:
maneuver: Why?  Make sex as an appetizer rather than a dessert
 Place client on semi fowler’s position  Instruct client to assume a non weight bearing
 Monitor strictly VS, I/O, ECG tracing and position
hemodynamic procedures Client can resume sexual intercourse if can climb or use
 Perform complete lung and cardiovascular the staircase
assessment
 Monitor urinary output and report output of
less than 30 ml/ hr: Why? Need to report the ff s/sx:
 Provide a full liquid diet with gradual increase to  Increased persistent chest pain
soft diet: low in saturated fats, Na and caffeine  Dyspnea
 Maintain quiet environment  Weakness
 Administer stool softeners as ordered to  Fatigue
facilitate bowel evacuation and prevent  Persistent palpitations
straining  Light headedness
 Relieve anxiety associated with CCU  MYOCARDIAL INFARCTION
environment  Enrollment of client in cardiac
 Administer medications as ordered: rehabilitation program
 Vasodilators: NTG, ISDN  For strict compliance to all
 Anti- Arrhythmic agents: What are medication regimen and
they? importance of follow up care
 B-blockers
 ACE inhibitors CARDIOGENIC SHOCK
Administer medications as ordered:  Is a shock state which results from profound left
 Calcium Channel blockers ventricular failure usually from massive MI.
 Thrombolytics/ Fibrinolytic agents: What are  It results to low cardiac output, thereby
they? systemic hypoperfusion
 Side effects: ?
 Nursing interventions: ? SIGNS AND SYMPTOMS:
 ANTICOAGULANTS : What are they?  Decreased systolic BP
 ANTIPLATELET AGGREGATES: What are they?  Oliguria
Provide client teaching and discharge planning  Cold, clammy skin weak pulse
concerning:  Cyanosis
 Effects of MI healing process and treatment  Mental lethargy
 Medication regimen including time name  Confusion
purpose schedule dosage side effects of the NURSING INTERVENTIONS
medicines  Perform hemodynamic monitoring
 Dietary restrictions: low SODIUM, low  Administer oxygen therapy
CHOLESTEROL, avoidance of coffee  Correct HYPOVOLEMIA. How?
 PHARMACOLOGY:
  Inotropic agents: ? CARDIAC TAMPONADE
 Sodium Bicarbonate: to relieve lactic  Also known as pericardial tamponade, is an
acidosis emergency condition in which fluid accumulates
 Monitor hourly urine output, LOC and in the pericardium
arrhythmias  If the fluid significantly elevates the pressure on
 Provide psychosocial support the heart it will prevent the heart’s ventricles
 Decrease pulmonary edema from filling properly.
 Auscultate lung fields for crackles and wheezes  This in turn leads to a low stroke volume.
 Note for dyspnea, cough, hemoptysis and  The end result is ineffective pumping of blood,
orthopnea shock and often death.
 Monitor ABG for hypoxia and metabolic acidosis PREDISPOSING FACTORS
 Place in fowler’s position to reduce venous  Chest trauma (blunt or penetrating)
return  Myocardial ruptured
 Decrease pulmonary edema  Cancer
 Administer during therapy as ordered:  Pericarditis
 MORPHINE SULFATE: to reduce venous  Cardiac surgery (first 24-48 hours)
return  Thrombolytic therapy
 AMINOPHYLLINE: why? CLINICAL MANIFESTATIONS
 VASODILATORS: to reduce venous return  BECK’S TRIAD
 Hypotension
PERICARDITIS/ DRESSLER’S SYNDROME  Jugular vein distension
 Is the inflammation of the pericardium which  Muffled heart sounds
occurs approximately 1-6 weeks after AMI.  PULSUS PARADOXUS (drop of at least 10mmHg in
 Results in antigen-antibody response. The arterial BP on inspiration)
necrotic tissues play the role of an antigen,  Tachycardia
which trigger antibody formation.  Breathlessness
INFLAMMATORY PROCESS FOLLOWS.  Decrease in LOC
 CONSTRICTIVE PERICARDITIS is a condition in
which a chronic inflammatory thickening of the NURSING INTERVENTIONS
pericardium compresses the heart so that it is  Administer oxygen
unable to fill normally during diastole.  Elevate HOB, place pillow on the overbed
table so that the patient can lean on it
 Bed rest
CLINICAL MANIFESTATIONS  Administer anti-inflammatory medicines
 Pain in the anterior chest, aggravated by  Assist in pericardiocentesis and
coughing, yawning, swallowing, twisting and thoracotomy
turning the torso, relieved by upright, leaning
forward position. CONGESTIVE HEART FAILURE
 Pericardial friction rub – scratchy, grating or  Inability of the heart to pump blood towards
crackling sound systemic circulation
 Dyspnea  LEFT SIDED HEART FAILURE
 Fever, sweating, chills  90% mitral valve stenosis
 Joint pains  RHD – inflammation of mitral valve
 arrhythmias  Anti-streptolysin O (ASO) titer - 300
todd units
NURSING INTERVENTIONS  Penicillin, PASA, steroids
 Elevate HOB, place pillow on the overbed table so  Aging
that the patient can lean on it.
 Bed rest LEFT SIDED HEART FAILURE
 Administer pharmacotherapy: CLINICAL MANIFESTATIONS
 ASA and corticosteroids: why? - Volume overload
 Assist in pericardiocentesis if cardiac tamponade - Aortic regurgitation
is present - Mitral regurgitation
- Patent ductus arteriosus
PERICARDIOCENTISIS - Pressure overload
ASPIRATION OF BLOOD OR FLUID FROM PERICARDIAL - Systemic hypertension
SAC - Aortic stenosis
- Myocardial diseases
- Ischemic heart diseases
 - Dilated cardiomyopathy

DIAGNOSTICS

 Chest x-ray – cardiomegaly

 PAP – pulmonary arterial pressure
 Measures pressure in right ventricle
 Reveals cardiac status
 PCWP – pulmonary capillary wedge pressure
 Measures end systolic and end diastolic
pressure
 Done through cardiac catheterization
(swan-ganz catheter)
 Echocardiogram – reveals enlarged chamber LEFT SIDED HEART FAILURE
 Arterial blood gases – increased PCO2,
 PULMONARY s/sx related:
decreased PO2
 PULMONARY EDEMA/CONGESTION
PREDISPOSING FACTORS (CONGESTIVE HEART - Dyspnea, PND, 2-3 pillows orthopnea
- Productive cough (blood tinged)
FAILURE)
- Rales/ crackles
 Increased pressure of blood backing up from a
- Bronchial wheezing
failing left ventricle - Frothy salivation
 Further back up of fluid and pressure into the  PULSUS ALTERANS – a unique pattern during
pulmonary arteries causing pulmonary which the amplitude of the pulse changes or
congestion, pulmonary edema, pulmonary alternates in size with a stable heart rhythm.
hypertension Common in severe left ventricular dysfunction.
 DECREASED EJECTION FRACTION of left ventricle  Anorexia, body malaise
due to muscle weakness or increased afterload  PMI displaced laterally, cardiomegaly
 DIASTOLIC DYSFUNCTION due to decreased  S3 (ventricular gallop)
compliance of the left ventricle.
 Decreased stroke volume
 Decreased cardiac output RIGHT SIDED HEART FAILURE
 Decreased preload due to less filling because of PREDISPOSING FACTORS
stiffness of ventricles  Tricuspid valve stenosis
 Decreased blood flow and oxygenation to  COPD/COLD
chemoreceptors and body tissues  Pulmonary embolism (characterized by chest
 DECREASED PERFUSION pain and dyspnea)
LEFT SIDED HEART FAILURE  Pulmonic stenosis
CLINICAL MANIFESTATIONS  Left sided heart failure
DIAGNOSTICS
 Chest X-ray – cardiomegaly
 Central venous pressure – ELEVATED
 Echocardiogram – reveals enlarged heart
chamber
 Muffled heart sounds –
cardiomyopathy
 CYANOTIC HEART DISEASES
 TETRALOGY OF FALLOT (TOF) – “tet
spells” – cyanosis with hypoxemia
 Tricuspid valve stenosis
 Transposition of aorta
 ACYANOTIC – PATENT DUCTUS
ARTERIOSUS
CLINICAL MANIFESTATIONS
- Jugular vein distention
- Pitting edema
- Ascites
- Weight gain
- Hepatosplenomegaly
- Jaundice
 - Pruritus/urticaria - Erythromycin and azithromycin (macrolide
- Esophageal varices antibiotics) to treat strep throat, particularly for
- Anorexia people who are allergic to penicillin.
- Generalized body malaise
Rheumatic Heart Disease
NURSING MANAGEMENT: BOTH HEART FAILURE  Antibiotics for infection (especially of the heart
 GOAL: increase myocardial contraction/ increase valves)
cardiac output  The antibiotic treatment that is most effective
 ADMINISTER MEDICATIONS in preventing further infection is benzathine
- CARDIAC GLYCOSIDES – DIGOXIN penicillin G, which is given by intramuscular
- LOOP DIURETICS – why? injection every 3-4 weeks over many years.
- BRONCHODILATORS – why?  Blood-thinning medicine to prevent stroke or
- NARCOTIC ANALGESICS – why? thin blood for replacement valves.
- NITROGLYCERINE – WHY?  Balloons inserted through a vein to open up
- ANTI-ARRHYTHMIC AGENTS – why? stuck valves.
- BETA BLOCKERS – debatable therefore give  Heart valve surgery to repair or replace
low dose damaged heart valves.
- RIGHT SIDED HEART FAILURE
 ADMINISTER O2 inhalation at 3-4 lpm via nc as Nursing interventions for rheumatic fever include:
ordered • Provide comfort and reduce pain.
 High Fowler’s, 2-3 pillows – why? • Provide diversional activities and sensory
 Restrict sodium and fluids – why? stimulation.
 Monitor strictly VS, IO and breath sounds • Promote energy conservation.
 Weigh patient daily and assess for pitting edema • Prevent injury.
 Abdominal girth daily and notify MD
RAYNAUD’S DISEASE
 Provide meticulous skin care
- a form of intermittent arteriolar
 Provide a dietary intake which is low in saturated
vasoconstriction that results in coldness, pain,
fats and caffeine and pallor of the fingertips or toes.
 Health teachings and discharge planning: - Primary or idiopathic Raynaud’s (Raynaud’s
- PREVENT COMPLICATIONS: arrhythmia, disease) occurs in the absence of an underlying
shock, thrombophlebitis, MI disease.
- Regular adherence to medications - Secondary Raynaud’s (Raynaud’s syndrome)
- Diet modifications occurs in association with an underlying
- Importance of ff up care disease, usually a connective tissue disorder,
such as systemic lupus erythematosus,
RHEUMATIC FEVER rheumatoid arthritis, scleroderma; trauma; or
 Occurs most often in school age children obstructive arterial lesions.
 most common in women between 16 and 40
 May develop after an episode of group A beta-
years of age,
hemolytic streptococcal pharyngitis
 occurs more frequently in cold climates and
during the winter.
Rheumatic Heart Disease
 Prognosis: varies; some slowly improve, some
 May developed from RF
become progressively worse, and others show
 Signs and symptoms: heart murmur,
no change. Raynaud’s symptoms may be mild so
cardiomegaly, pericarditis and heart failure that treatment is not required. However,
 Transmission: direct contact with oral or secondary Raynaud’s is characterized by
respiratory secretions vasospasm and fixed blood vessel obstructions
 Causative agents: Group A beta hemolytic that may lead to ischemia, ulceration, and
streptococcus gangrene.
 Other Predisposing Factors: malnutrition,
overcrowding, poor hygiene and lower Clinical Manifestations
socioeconomic status a) Pallor brought on by sudden vasoconstriction
followed by cyanosis followed by hyperemia
Medical Management: Antibiotics: (exaggerated reflow) due to vasodilation with a
- Penicillin V is usually considered the drug of choice resultant red color (rubor)
(dose: 250 mg orally 2 times a day for 10 days for b) progression follows the characteristic color
patients < 27 kg and 500 mg for those > 27 kg. change white, blue, red.
- Amoxicillin is effective and more palatable if a c) Numbness, tingling, and burning pain occur as
liquid preparation is required. color changes.
 d) Involvement tends to be bilateral and that appears when the extremity is in a
symmetric and may involve toes and fingers dependent position.
 Various types of paresthesia may develop;
Medical Management: radial and ulnar artery pulses are absent or
a) Avoiding the particular stimuli (eg, cold, diminished if upper extremities are involved.
tobacco) that provoke vasoconstriction is a  Eventually ulceration and gangrene occur
primary factor
Assessment and Diagnostic Methods
b) Calcium channel blockers (nifedipine
Segmental limb blood pressures, duplex
[Procardia], amlodipine [Norvasc]) may be
ultrasonography, and contrast angiography are used to
effective in relieving symptoms.
identify occlusions.
c) Sympathectomy (interrupting the sympathetic
nerves by removing the sympathetic ganglia or
Medical Management:
dividing their branches) may help some patient
Main objectives:
 to improve circulation to the extremities,
Nursing Management
 prevent the progression of the disease,
• Instruct patient to avoid situations that may be
 protect the extremities from trauma and
stressful or unsafe.
infection.
• Advise patient to minimize exposure to cold,
remain indoors as much as possible, and wear
Treatment measures include the following:
protective clothing when outdoors during cold
weather. • Completely stopping use of tobacco.
• Reassure patient that serious complications • Regional sympathetic block or ganglionectomy
(gangrene and amputation) are not usual. produces vasodilation and increases blood flow.
• Emphasize the importance of avoiding nicotine • Conservative debridement of necrotic tissue is
(smoking cessation without use of nicotine used in treatment of ulceration and gangrene.
patches); assist in finding support group. • If gangrene of a toe develops, usually a below-
• Advise patient to handle sharp objects carefully knee amputation, or occasionally an above-
to avoid injuring the fingers. knee amputation, is necessary. Indications for
• Inform patient about postural hypotension that amputation are worsening gangrene(especially
may result from medications. if moist), severe rest pain, or severe sepsis.
• Vasodilators are rarely prescribed (cause
dilation of healthy vessels only).
BUERGER’S DISEASE (TAO)
 or Thromboangiitis Obliterans
Nursing Management
 a recurring inflammation of the intermediate
 Monitoring and Managing Potential
and small arteries and veins of the lower and
Complications
upper extremities.  maintain adequate circulation through the
 results in thrombus formation and segmental arterial repair.
occlusion of the vessels and is differentiated  Check pulses, Doppler assessment, color and
from other vessel diseases by its microscopic temperature, capillary refill, and sensory and
appearance motor function of the affected extremity and
 occurs most often in men between 20 and 35 compare with those of the other extremity;
years of age, record values initially every 15 minutes and
 heavy smoking or chewing of tobacco is a then at progressively longer intervals.
causative or an aggravating factor.  Perform Doppler evaluation of the vessels distal
to the bypass graft for all postoperative vascular
patients because it is more sensitive than
palpation for pulses.
 Monitor ABI every 8 hours for the first 24 hours.
Clinical Manifestations  Notify surgeon immediately if a peripheral pulse
 Pain-outstanding symptom (generally bilateral disappears; this may indicate thrombotic
and symmetric with focal lesions).
occlusion of the graft.
 complain of cramps in the feet, particularly the
 Monitor urine output (more than 30 mL/h),
arches, after exercise (instep claudication).
 relieved by rest. CVP, mental status, and pulse rate and volume
 Burning pain aggravated by emotional to permit early recognition and treatment of
disturbances, nicotine, or chilling; digital rest fluid imbalances.
pain (fingers or toes); feeling of coldness or  Instruct patient to avoid leg crossing and
sensitivity to cold may be early symptoms. prolonged extremity dependence.
 Color changes (rubor) of the feet progress to  Teach patient to perform leg elevation and to
cyanosis (in only one extremity or certain digits) exercise limbs while in bed to reduce edema.
  Monitor for compartment syndrome (severe Routine screenings: for specific genetic conditions,
limb edema, pain, and decreased sensation). prescribe medications to lower your cholesterol and
reduce your blood pressure.
Promoting Home- and Community-Based Care
• Assess patient’s ability to manage major problem or grows rapidly in size - you might need
independently or availability of family and surgery. Your doctor will replace the damaged section
friends to assist. of your aorta with a man-made tube. Once it’s in place,
• Determine patient’s motivation to make the graft will make that section of the aorta stronger.
lifestyle changes needed with chronic disease.
• Assess patient’s knowledge and ability to assess VARICOSITIES
for postoperative complications, such as
- Varicose veins are formed due to weakened
infection, occlusion of graft, and decreased
vein valves, which has nothing to do with your
blood flow.
• Determine if patient wants to stop smoking and current heart health.
encourage all efforts to do so - There is no link between varicose veins and
heart disease or arterial disease, or being
ANEURYSMS overweight.
- a localized sac or dilation formed at a weak - indicates a problem with moving blood back to
point in the wall of the artery. the heart for oxygenation, generally a diagnosis
- It may be classified by its shape or form. of varicose veins does not put you at a higher
- could cause a leak that spills blood into your risk for cardiac issues.
body. Common Causes:
- Some burst, some don’t while others force - Any condition that puts excessive pressure on
blood flow away from your organs and tissues, the legs or abdomen can lead to varicose veins.
causing problems, such as heart attacks, kidney The most common pressure inducers
damage, stroke, and even death. are pregnancy, obesity, and standing for long
Types of Aortic Aneurysms periods. Chronic constipation and -- in rare
 locations of aortic aneurysms. cases, tumors -- also can cause varicose veins.
a. in the chest, is a thoracic aortic aneurysm. Treatment:
b. in the abdomen, is called an abdominal aortic - larger varicose veins are generally treated
aneurysm. with ligation and stripping, laser treatment, or
radiofrequency treatment. In some cases, a
a.Thoracic aortic aneurysm. combination of treatments may work best.
Caused by: - smaller varicose veins and spider veins are
a) Genes play a role usually treated with sclerotherapy or laser
b) can affect the aorta include a bicuspid aortic therapy on your skin.
valve, Marfan syndrome, and Loeys-Dietz
syndrome. HYPERTENSION (AND HYPERTENSIVE CRISIS)
c) Other causes for thoracic aneurysm might  defined as a systolic blood pressure greater
include: than 140 mm Hg and a diastolic pressure
 High blood pressure greater than 90 mmHg, based on two or more
 Infection measurements.
 Plaque buildup in your arteries  Hypertension can be classified as follows:
(atherosclerosis)  Normal: systolic less than 120 mm Hg; diastolic
 High cholesterol less than 80 mm Hg
 Sudden traumatic injury  Prehypertension: systolic 120 to 139 mm Hg;
 symptoms often don’t show up until the diastolic 80 to 89 mm Hg
aneurysm becomes large, or bursts.  Stage 1: systolic 140 to 159 mm Hg; diastolic 90
As it grows, you may notice some signs, including: to 99 mm Hg
• Chest or back pain  Stage 2: systolic 160 mm Hg; diastolic 100 mm
• Difficulty breathing or swallowing Hg
• Shortness of breath  NOTE: Seventh Report of the Joint National
• Coughing Committee on Prevention, Detection,
• Hoarseness Evaluation, and Treatment of High Blood
Pressure.
Diagnosis - X-ray, echocardiogram, CT scan,
or ultrasound.; often monitored on an annual basis to
assess for growth.
 spots (small infarctions), and papilledema may
be seen in severe hypertension.
• Symptoms usually indicate vascular damage
related to organ systems served by involved
vessels.
• Coronary artery disease with angina or
myocardial infarction is the most common
consequence.
• Left ventricular hypertrophy may occur; HF
ensues.
Hypertension
• Pathologic changes may occur in the kidney
- is a major risk factor for atherosclerotic
(nocturia and increased BUN and creatinine
cardiovascular disease, HF, stroke, and kidney
levels).
failure.
• Cerebrovascular involvement may occur (stroke
- Hypertension carries the risk for premature
or transient ischemic attack [TIA] [ie, alterations
morbidity or mortality, which increases as
in vision or speech, dizziness, weakness, a
systolic and diastolic pressures rise.
sudden fall, or transient or permanent
- Prolonged blood pressure elevation damages
hemiplegia]).
blood vessels in target organs (heart, kidneys,
brain, and eyes)
Assessment and Diagnostic Methods
1. History and physical examination, including
A. Essential (primary) hypertension, which has no
retinal examination; laboratory studies for
identifiable medical cause; it appears to be a
organ damage, including urinalysis, blood
multifactorial, polygenic condition
chemistry (sodium, potassium, creatinine,
B. Secondary hypertension is characterized by: fasting glucose, total and high-density
- elevations in blood pressure with a specific lipoprotein); ECG; and echocardiography to
cause, such as narrowing of the renal arteries, assess left ventricular hypertrophy.
renal parenchymal disease, hyperaldosteronism 2. Additional studies, such as creatinine clearance,
(mineralocorticoid hypertension), certain renin level, urine tests, and 24-hour urine
medications, pregnancy, and coarctation of the protein, may be performed.
aorta.
- Hypertension can also be acute, a sign of an Medical Management:
underlying condition that causes a change in goal - to prevent death and complications by achieving
peripheral resistance or cardiac output and maintaining an arterial blood pressure at or below
140/90 mm Hg (130/80 mm Hg for people with diabetes
Hypertensive crisis, or hypertensive emergency, mellitus or chronic kidney disease), whenever possible.
exists when an elevated blood pressure level must be
lowered immediately (not necessarily to less than Assessment and Diagnostic Methods
140/90 mm Hg) to halt or prevent target organ damage. Nonpharmacologic approaches include weight
reduction; restriction of alcohol and sodium; regular
Hypertensive urgency exercise and relaxation.
- exists when blood pressure is very elevated but • A DASH (Dietary Approaches to Stop
there is no evidence of impending or Hypertension) diet high in fruits, vegetables,
progressive target organ damage. and low-fat dairy products has been shown to
Treatment: lower elevated pressures.
Select a drug class that has the greatest effectiveness,
- Oral agents (beta-adrenergic blocking agents fewest side effects, and best chance of acceptance by
[eg, labetalol], ACE inhibitors [eg, captopril], or patient. Two classes of drugs are available as first-line
alpha2-agonists [eg, clonidine] can be
therapy: diuretics and beta-blockers.
administered with the goal of normalizing blood
Promote compliance by avoiding complicated drug
pressure within 24 to 48 hours.
schedules.
- Close hemodynamic monitoring of the patient’s
blood pressure and cardiovascular status is
required.
- Vital signs should be checked as often as every 5
minutes

Clinical Manifestations
• Physical examination may reveal no abnormality NURSING PROCESS
other than high blood pressure. THE PATIENT WITH HYPERTENSION
• Changes in the retinas with hemorrhages, Assessment
exudates, narrowed arterioles, and cotton–wool
 - Assess blood pressure at frequent intervals;  Inform patient that rebound hypertension can
know baseline level. Note changes in pressure occur if antihypertensive medications are
that would require a change in medication. suddenly stopped; advise patient to have an
- Assess for signs and symptoms that indicate adequate supply of medication.
target organ damage (eg, anginal pain;  Inform patients that some medications, such as
shortness of breath; alterations in speech, betablockers, may cause sexual dysfunction and
vision, or balance; nosebleeds; headaches; that other medications are available if problems
dizziness; or nocturia). occur.
- Note the apical and peripheral pulse rate,  Encourage and teach patient to measure their
rhythm, and character. blood pressure at home; inform patient that
- Assess extent to which hypertension has blood pressure varies continuously and that the
affected patient personally, socially, or range within which their pressure varies should
financially. be monitored.
Diagnosis
Nursing Diagnoses Monitoring and Managing Potential Complications
- Deficient knowledge regarding the relationship - Assess all body systems when patient returns
between the treatment regimen and control for follow-up care to detect any evidence of
of the disease process vascular damage.
- Noncompliance with therapeutic regimen - Question patient about blurred vision, spots, or
related to side effects of prescribed - diminished visual acuity.
therapy - Report any significant findings promptly to
determine
Collaborative Problems/Potential Complications - whether additional studies or changes in
• Left ventricular hypertrophy medications are required.
• Myocardial infarction
• HF, TIA, CVA Evaluation
• Renal insufficiency and failure Expected Patient Outcomes
• Retinal hemorrhage • Maintains adequate tissue perfusion
Planning and Goals • Complies with self-care program
- The major goals for the patient include • Experiences no complications
understanding of the disease process and its
treatment, participation in a selfcare
program, and absence of complications

Nursing Interventions
Increasing Knowledge
- Emphasize the concept of controlling
hypertension (with lifestyle changes and
medications) rather than curing it.
- Arrange a consultation with a dietitian to help
develop a plan for improving nutrient intake or
for weight loss.
- Advise patient to limit alcohol intake and avoid
use of tobacco.
- Recommend support groups for weight control,
smoking cessation, and stress reduction, if
necessary.
- Assist the patient to develop and adhere to an
appropriate exercise regimen.

Promoting Home- and Community-Based Care

TEACHING PATIENTS SELF-CARE
 Help the patient achieve blood pressure control
through education about managing blood
pressure, setting goal blood pressures, and
providing assistance with social support;
encourage family members to support the
patient’s efforts to control hypertension.
 Provide written information about the expected
effects and side effects of medications; ensure
patient understands importance of reporting
side effects (and to whom) when they occur.