NEURO/CARDIOVASCULAR NURSING

Presented by: GROUP II

OUTLINE
1. 2. 3. 4. 5. 6. 7. 8. 9.

INCREASE INTRACRANIAL PRESSURE CVA SEIZURES DEGENERATIVE DISEASES PARKINSONS DISEASE ALZHEMERS DISEASE MYOCARDIAL INFARCTION / ANGINA PECTORIS HEART FAILURE HYPERTENSION

LEARNING OBJECTIVES:
Present the clinical manifestations of common nervous/cardiovascular disorders. 2. Discuss the Etiology, risk factors and basic pathophysiology of nervous/cardiovascular disorders. 3. Necessary care for the prevention, management, prevention of complications and rehabilitations programs. 4. Implement Nursing interventions that optimize the quality of life for clients with N/C disorders. 5. Evaluate effectiveness of client outcomes
1.

NEUROLOGICAL SYSTEM

INTRACRANIAL PRESSURE -BROUGHT ABOUT BY INCREASE IN THE THREE INTRACRANIAL

COMPONENTS

A. PREDISPOSING FACTORS a. Head injury b. Tumor c. Localized abscesses d. Cerebral edema e. Hydrocephalus f. Hemorrhage g. Inflammatory conditions 1. Meningitis 2. Encephalitis

B. SIGNS AND SYMPTOMS a. Early signs 1. Decreased or change in LOC 2. Restlessness to confusion 3. Disorientation 4. Lethargy to stupor 5. Stupor to coma

MONROE KELLY HYPOTHESIS the skull is a closed vault, any increase in one component will bring about increases in ICP NORMAL ICP IS 0-15 MMHG; NORMAL CSF: 120250CC/DAY NORMAL CSF OPENING PRESSURE: 60-150 MMHG NORMAL CSF CONTENTS: GLUCOSE, PROTEINS, WBCS FORAMEN MAGNUM - The large opening in the basal part of the occipital bone through which the spinal cord becomes continuous with the medulla oblongata.

INTRACRANIAL PRESSURE
b. Late signs 1. Changes in the vital signs Elevated BP (SBP rising, DBP constant) N Pulse Pressure: 40 mmHG HR decreased RR decreased (CheyneStokes respiration: normal rhythmic respiration followed by periods of apnea) Elevated temperature 2. Headache, papilledema, projectile vomiting 3. Abnormal posturingdecorticate (flexion) damage to corticospinal tract (spinal cord and cerebral cortex) Remember: deCORDThreecate OR decerebrate (extension): upper brain stem damage pons, midbrain, cerebellum

INTRACRANIAL PRESSURE
5. possible seizures 6. Cushings reflex (hypertension with bradycardia) O SHOCK inadequate tissue perfusion o HYPOXIA inadequate tissue oxygenation C. NURSING MANAGEMENT 1. maintain patent airway and adequate ventilation by: prevention of hypoxia cerebral edema increased ICP) and hypercarbia (CO2 retention) cerebral vasodilation increased ICP decreased tissue perfusion possible shock Early signs of hypoxia Restlessness Agitation Tachycardia

INTRACRANIAL PRESSURE
Late signs of hypoxia Bradycardia Extreme restlessness Dyspnea Cyanosis Increased CO2 most potent respiratory stimulant in the normal person (irritates medulla oblongata) Decreased O2 stimulates respiration in CRDS Suctioning should only last for 10 -15 seconds and application of suction should be done upon withdrawal of catheter in a circular fashion.

INTRACRANIAL PRESSURE
2. Assist in mechanical ventilation 3. Elevate head of bed 30-45 degrees with neck in neutral position when contraindicated to promote venous drainage 4. Limit fluid intake to 1.2-1.5 l per day (Forced fluids = 2-3 L/day) 5. Monitor VS, NVS, I/O strictly 6. Prevent complications of immobility 7. Prevent further increase in ICP Provide comfortable environment Avoid use of restraints fractures 8. Keep side rails up

INTRACRANIAL PRESSURE
9. Avoid valsalva maneuver Straining of stools (give laxatives/stool softeners) Excessive vomiting (give Metoclopramide (plasil) anti-emetic) Lifting of heavy objects Bending or stooping
10. Administer medications as ordered Osmotic Diuretics Mannitol (Osmitol) cerebral diuresis Monitor VS especially BP (SE: Hypotension resulting from hypovolemia) Monitor I/O qH Given via side drip, fast drip to avoid precipitate formation Instruct client that a flushing sensation will be felt as drug is introduced

INTRACRANIAL PRESSURE
Loop Diuretics via IV push Furosemide BP Monitor 1/0 q1, notify if <30cc/hr IV push Lasix effect in 10-15 minutes, max 6 hours; best given in AM to prevent sleep interruption Corticosteroids Dexamethasone (decadron) Steroids administered 2/3 in AM to mimic diurnal rhythm Hydorcortisone Prednisone

Mild Analgesic Codeine sulfate Anti-Convulsant Pheytoin (Dilantin)

Benadryl is given at HS because it causes drowsiness Levothyroxine is given in AM to prevent insomnia

NEURO-DIAGNOSTIC TESTS
Routine

CT SCAN

labs Radiology Tests

CT scan, MRI Carotid ultrasound Cerebral angiogram/ MRA

Carotid US

MRA

NEURO-DIAGNOSTIC TESTS: LUMBAR PUNCTURE

Spinal needle inserted into SA L3/L4 or L-4 /L-5 using strict asepsis

Obtain CSF specimens and pressure readings To remove bloody or purulent CSF Administer spinal anesthesia

CEREBROVASCULAR ACCIDENT
(Stroke, brain attack, cerebral thrombosis, apoplexy) partial or total disruption in the blood supply of the brain, usually in the MCA or ICA (2 largest cerebral arteries)

CEREBROVASCULAR ACCIDENT
B. PREDISPOSING FACTORS 1. Thrombosis attached clot, #1 cause of stroke 2. Emboli detached/wandering thrombosis Pulmonary embolism Sudden sharp chest pain Unexplained dyspnea Tachycardia Palpitation Diaphoresis

Cerebral embolism Headache Dizziness Disorientation Change in LOC that may lead to coma

3. Hemorrhage

CEREBROVASCULAR ACCIDENT
C. RISK FACTORS 1. HPN 2. DM 3. Atherosclerosis MI 4. Valvular heart disease, Mitral/post-cardiac surgery/mitral valve replacement mlt CVA 5. Lifestyle Smoking Sedentary lifestyle Obesity (more than 20% ideal body weight) Diet rich in saturated fats Hyperlipidemia genetic; (+) genes that easily binds to cholesterol

CEREBROVASCULAR ACCIDENT
Type A personality Deadline driven person Does several things at the same time Feels guilty when not doing anything

Prolonged use of oral contraceptives Macropil estrogen Minipil progestin Increases lipolysis breakdown of lipids atherosclerosis HPN CVA

CEREBROVASCULAR ACCIDENT
D. CLINICAL MANIFESTATION 1. TRANSIENT ISCHEMIC ATTACK initial sign of CVA Headache, dizziness, tinnitus, visual and speech disturbances, paresis to plegia, increase in ICP possible, cheyne-stokes respirations

2. Stroke in evolution progression of S/sx 3. Complete Stroke resolution phase characterized by still dizziness and headache

CEREBROVASCULAR ACCIDENT

still dizziness and headache Cheyne-stokes respirations Anorexia Nausea and vomiting Dysphagia (+) Kernigs and Brudzinksis

Focal Neurological Deficits Plegia Aphasia Dysarthria speaking difficulty Alexia reading difficulty Agraphia writing difficulty Homonymous hemianopsia loss of vision field Unilateral neglect

CEREBROVASCULAR ACCIDENT
F. NURSING MANAGEMENT 1. Maintain patent airway and adequate ventilation Assist in mechanical ventilation Administer oxygen as ordered 2. Restrict Fluids 3. Elevate head of bed, 30-40 degrees to promote venous drainage 4. Avoid activities that cause valsalva maneuver 5. Prevent complications of immobility Prevent bed sores and hypostatic pneumonia TTS q2 Use of egg crate mattress or water bed Sand bag/foot board to prevent foot lag 6. Institute NGT feeding 7. ROM exercises q4h to prevent contractures and promote proper body alignment

CEREBROVASCULAR ACCIDENT
Alternative means of communication Non verbal cues Magic slate or picture board 9. If positive for hemianopsia, approach client on unaffected side 10. Administer meds as ordered Osmotic diuretics Mannitol (Osmitrol) Corticosteroids Dexamethasone (Decadron) Mild Analgesics Codeine Sulfate Thrombolytics Streptokinase Urokinase Tissue Plasminogen Activity Factor (TPAF) Monitor for bleeding

CEREBROVASCULAR ACCIDENT
Anti-coagulants as ordered. Heparin check PTT if prolonged, indicates bleeding give protamine sulfate when overdosed Coumadin check PT if prolonged, indicates bleeding vitamin K (aquamephyton) as antidote Given together because coumadin will take effect after 3 days still

Loop-diuretics Lasix (okay to administer in DM pts but monitor CBG) Anti-platelets ASA anti-thrombotic Contraindicated in dengue, ulcers and unknown cause of headache potentiates bleeding

CEREBROVASCULAR ACCIDENT
11. Health Teachings Avoid modifiable risk factors Avoid / prevent complications: Subarachnoid hemorrhage Diet modification: low saturated fat, sodium and caffeine

Rehabilitation for focal neurologic weakness Importance of ffup care and strict compliance to medications

CONVULSIVE DISORDERS

A disorder of the CNS characterized by paroxysmal seizures with or without loss of consciousness, alternation in sensation and perception, abnormal motor activity and changes in behavior; IDIOPATIHIC

CONVULSIVE DISORDERS

Febrile seizures are normal for children below 5 years only; can be outgrown Febrile seizures in children >5 yo = abnormal SEIZURE first convulsive attack EPILEPSY series of seizure activity

SEIZURES
A. PREDISPOSING FACTORS 1. Head injury secondary to birth trauma 2. Lead poisoning 3. Genetics 4. Brain tumor 5. Nutritional and metabolic deficiencies 6. Sudden withdrawal of anticonvulsive drugs Causes STATUS EPILEPTICUS DOC: diazepam, glucose 7. Physical and emotional stress B. TYPES OF SEIZURES 1. Generalized Grand Mal (Tonic-Clonic) With or without an aura Epigastric pain initial sign of an aura (aura is an initial sign of seizures) Visual -auditory - olfactory tactile sensory experience

SEIZURES

Epileptic cry Fall Loss of consciousness for 3-5 minutes Tonic-clonic contractions Direct symmetrical extension of extremities Shaking/convulsive activity Post-ictal sleep (unresponsive sleep)

Petit Mal (Absence Seizure) S/sx: Blank stare Decreased blinking of the eyes Twitching of the mouth and loss of consciousness for 510 seconds

2. Partial Seizures Jacksonian seizure (focal seizures) characterized by tingling and jerky movements of index finger and thumb spreads to shoulders Psychomotor seizure (focalmotor seizures) characterized by: Automatism stereotype, non-repetitive and nonpurposive behavior Clouding of consciousness not in contact with reality Mild hallucinating sensory experience

3. Status Epilepticus continuous uninterrupted seizure activity that if left untreated may lead to hyperpyrexia coma death Increased electrical activity in brain increased metabolism increased glucose and oxygen use, increased temperature coma death DOC: Valium, Glucose

C. DIAGNOSTICS 1. CT-SCAN brain lesion d/t head trauma 2. EEG hyperactivity of brain waves (all elevated) Alpha, beta, delta, theta waves

NURSING MANAGEMENT 1. Maintain patent airway and promote safety before seizure activity Clear the site of sharps, harmful objects Loosen clothing of the patient Avoid use of restraints fractures Maintain side rails Turn head to side to prevent aspiration Tongue guard is between mouth and teeth to prevent biting of the tongue

2. Avoid precipitating stimulus Bright/glaring lights Noise 3. Administer medications as ordered Phenytoin (Dilantin) Gingival Hyperplasia Use soft-bristled toothbrush

Ataxia Nystagmus Hirsutism Diazepam (Valium) for status epilepticus Carbamazepine (Tegretol) Also used for Trigeminal neuralgia (Tic Dolor) Phenobarbitals (Luminal)

4. Institute seizure and safety precautions Post-seizure: O2 inhalation Suction apparatus Monitor and document the following Onset and duration Type of seizure Duration of post-ictal sleep increased length of sleep can lead to status epilepticus

For a one year old client suffering grand mal seizures: NOT Mouthpiece Eh onte lang teeth ng one year old eh Give pillows support for the head (For banging of head during seizure activity)

DEGENERATIVE DISEASES

MULTIPLE SCLEROSIS
chronic, intermittent disorder of the CNS characterized by white patches of demyelination of the brain and spinal cord. IDIOPATHIC, AUTOIMMUNE

A. INCIDENCE RATE: 1535 yo, females B. PREDISPOSING FACTOR 1. Slow growing virus 2. Autoimmune body produces antibodies which attacks normal cells 3. REVIEW: ANTIBODIES IgG passes placenta (gestational) IgA found in bodily secretions, colostrums

IgM acute infections (mabilis) IgE allergic reactions IgD Chronic infections (dalas)

C. CLINICAL MANIFESTATION 1. Visual disturbances Blurring of vision Diplopia Scotoma (blind spot)

2. Impaired sensation to touch, pain, pressure, heat and cold Tingling sensation Paresthesia Numbness

3. Mood swings Euphoria sense of wellbeing 4. Impaired motor activity Weakness Spasticity Paralysis

Impaired cerebellar function CHARCOTS TRIAD: ataxia (unsteady gait), nystagmus, intentional tremors Scanning speech 6. Urinary retention or incontinence 7. Constipation 8. Decrease in sexual capacity

D. DIAGNOSTIC PROCEDURE 1. CSF Analysis LT: reveals increased CHON and IgG 2. MRI site and extent of demyelination

F. NURSING MANAGEMENT: Palliative 1. Administer medications as ordered Acute Exacerbation ACTH (Adrenocorticotropic hormone) reduces edema at site of demyelination thereby preventing paralysis; compression of spinal cord will lead to paralysis

Baclofen (Lioresal), Dantrolene Na to reduce muscle spasticity Interferons Immunosuppressives Diuretics PROPHANTHELENE BROMIDE (PROBANTHENE) anticholinergic for urinary incontinence

2. Provide for Relaxation DBE, biofeedback, yoga 3. Retain side rails 4. Prevent complications of immobility TTS Q2h, Q1 h for elderly, 20 minutes only on affected side

Increase OFI, high fiber diet (for constipation), acid-ash in diet to acidify urine to prevent bacterial multiplication (cranberry juice, prunes, grape juice, vitamin c, plums, orange and pineapple juice.) 6. Provide catheterization for urinary retention

MYASTHENIA GRAVIS (MG)

neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction (or motor end plate site of exchange of neurotransmitters) IDIOPATHIC; DECENDING MUSCLE WEAKNESS

A. INCIDENCE RATE 1. Women aged 20-40 years old B. PREDISPOSING FACTORS 1. Autoimmune Involves release of CHOLINESTERASE an enzyme which destroys Ach descending muscle weakness

C. CLINICAL MANIFESATION 1. PTOSIS INITIAL SIGN Check palpebral fissure drooping of upper eyelids 2. Double vision 3. Mask like facial expression 4. Weakened laryngeal muscles dysphagia (difficulty of swallowing, without food); odynophagia ang with food

5. Hoarseness of voice 6. Respiratory muscle weakness respiratory arrest; prepare trache set at bedside 7. Extreme muscle weakness especially during activity or exertion in AM

D. DIAGNOSTICS 1. TENSILON TEST (EDROPHONIUM HCL) Temporary relief of symptoms Strengthens muscles temporarily Pt, temporarily can open eyelids, increased muscle strength 5-10 minutes after admin

E. NURSING MANAGEMENT Airway Aspiration Immobility 1. Maintain patent airway and adequate ventilation Assist in mechanical ventilation Assess PFT (decreased Vital Lung Capacity) 2. Monitor Strictly VS, IO, NVS, motor grading scale (muscle strength)

3. Maintain side rails 4. institute NGT feeding to prevent aspiration 5. prevent complications of immobility q2 turning, q1 for elderly 6. Administer meds as ordered

Corticosteroids for immunosuppression Cholinergic/Anticholinergi c agents Mestinon (Pyridostigmine) Neostigmine (Prostigmin) Monitor for the two types of crisis

Monitor for BRITTLE CRISIS: characterized by severe respiratory muscle weakness and exertioal discomfort. Prepare trache set.

7. Assist in THYMECTOMY removal of thymus which is believed to produce autoimmunity Plasmaparesis filtering of blood; removal of autoimmune antibodies in the blood 8. Prevent complications respiratory arrest 9. Prepare trache set in pts with MG

PARKINSONS DISEASE

(degenerative disease) chronic progressive disorder of the CNS characterized by degeneration of the dopamine producing cells in the substantia nigra of the midbrain and basal ganglia (areas of gray matter in both hemispheres which is involved in the extrapyramidal tract) IRREVERSIBLE, IDIOPATHIC

A. PREDISPOSING FACTORS 1. Poisoning Lead (ANTIDOTE: Ca EDTA heavy metal antagonist) Carbon Monoxide decreased capacity of hemoglobin to carry oxygen cherry red skin color 2. Arteriosclerosis 3. Hypoxia inadequate tissue perfusion 4. Encephalitis 5. Drugs Reserpine (Serpasil) Has anti HPN properties Promote safety when giving this drug

SE: major depression suicidal ideation Linked to Breast Ca development SBE is done 7 days after menstruation Breast Ca - #1 Ca in women Cervical Ca - #2 Ca in women 1. multiple sex partners 2. early pregnancy Ovarian Ca - #3 Ca in women mammography lasts for 10-20 minutes

Methyldopa (Aldomet) has anti HPN properties Haloperidol (Haldol) anti-psychotic NEUROLEPTIC MALIGNANT SYNDROME (NMS) Tremors, tachycardia, tachypnea, fever Phenothiazides antipsychotic PHENERGAN only antipsychotic with anti-emetic properties

B. CLINICAL MANIFESTATION

1. PILL ROLLING TREMORS of the extremities first sx 2. Bradykinesia second sx 3. Rigidity (cogwheel type) third sx 4. Stooped posture, SHUFFLING GAIT, propulsive gait 5. Overfatigue

6. Mask-like facial expression, decreased blinking of the eyelids 7. Difficulty in rising from sitting position 8. Quiet monotone speech 9. Mood lability depression suicide 10. Increased salivation, drooling type

11. Autonomic changes Increased sweating and lacrimation Seborrhea Constipation Decreased sexual capacity

C. NURSING MANAGEMENT (palliative)

1. Administer medications as ordered Anti-Parkinsonian Agents increase dopamine relieves rigidity (CAPABLES!) Levodopa (L-dopa) short acting dopaminergic Amantadine HCl (Symmetrel) long acting dopaminergic Carbidopa (Sinemet) long acting dopaminergic

SE: (GIT) anorexia, nausea and vomiting, orthostatic hypotension, hallucination, arrhythmia Contraindications: narrow angle closure glaucoma loss of peripheral vision tunnel vision halos in light; normal IOP = 12-21 mmHg

Also contraindicated in patients taking MAOIs (Avoid tryptophan and tyramine in pts taking MAOIs) Administer with food or snack to lessen GIT irritation Inform client that stools/urine maybe darkened

INSTRUCT CLIENT TO AVOID FOODS RICH IN VITAMIN B6--PYRIDOXINE (Cereals, organ meat, green leafy vegetables) reverses therapeutic effect of levodopa Anti-cholinergics relieves tremors Relieves tremors Artane and Cogentin Mode of action: increases dopamine

SE: SNS Antihistamine relieves tremors Diphenhydramine HCl (Benadryl) SE: Drowsiness adult CNS excitement and hyperactivity children

Dopamine Agonists relieves tremors and rigidity Bromocriptine HCl (Parlodel) SE: CNS Depression No OCPs decreased effect

2. Maintain side rails to prevent injuries related to falls 3. Prevent complications of immobility 4. Maintain good nutrition. Provide dietary intake that is low in protein in AM and high protein at night to induce sleep TRYPTOPHAN induces sleep

5. Assists in passive ROM exercises to prevent contractures. Q4h for proper body alignment. 6. Increased OFI is encouraged and increased Fiber in the diet for constipation 7. Ambulate with assistance 8. Assist in STEROTAXIC THALAMOTOMY COMPLICATIONS: SUBARACHNOID HEMORRHAGE, ENCEPHALITIS, CEREBRAL ANEURYSM

ALZHEIMERS DISEASE
atrophy of the brain tissue characterized by: a. Amnesia b. Agnosia (-) sense of smell c. Apraxia (-) purposive movements d. Aphasia 1. Expressive/Brocas problem in speaking 2. Receptive/Wernickes problem in understanding; USUAL FOR ALZHEIMERS

3. Brocas area motor speech center; frontal 4. Wernickes area general interpretative area; temporal e. ARICEPT drug of choice, given at HS COGNEX also given PICKS Disease: a form of dementia wherein there is damage in the frontoparietal area

ANATOMY AND PHYSIOLOGY

 ANGINA PECTORIS Transient paroxysmal chest pain produced by insufficient blood flow to the myocardium resulting
1.

in myocardial ischemia. Risk Factors

2.

2.1 CAD 2.2 Atherosclerosis 2.3 HPN 2.4 Diabetes Mellitus ( DM ) 2.5 Severe Anemia 2.6 Severe Aortic Insufficiency
3.

Precipitating Factors 3.1 Physical Exertion 3.2 Consumption of Heavy Meal 3.3 Extremely Cold Weather 3.4 Strong Emotions 3.5 Cigarette Smoking 3.6 Sexual Activity

 ANGINA PECTORIS Transient paroxysmal chest pain produced by insufficient blood flow to the myocardium resulting
1.

in myocardial ischemia. Risk Factors

2.

2.1 CAD 2.2 Atherosclerosis 2.3 HPN 2.4 Diabetes Mellitus ( DM ) 2.5 Severe Anemia 2.6 Severe Aortic Insufficiency
3.

Precipitating Factors 3.1 Physical Exertion 3.2 Consumption of Heavy Meal 3.3 Extremely Cold Weather 3.4 Strong Emotions 3.5 Cigarette Smoking 3.6 Sexual Activity

 ASSESSMENT FINDINGS FOR ANGINA

PECTORIS

4. Assessment Findings 4.1 Pain : Substernal with possible radiation to the neck, jaw, back and arms but relieved by rest. 4.2 Palpitations and Tachycardia 4.3 Dyspnea 4.4 Diaphoresis 4.5 Increased Serum Lipid Levels 4.6 Diagnostic Tests a. ECG : Segment depression and I wave inversion during chest pain b. Stress Test : Abnormal ECG during exercise

 NURSING DIAGNOSIS AND GOALS FOR

ANGINA PECTORIS
5. Nursing Diagnosis

a. Ineffective myocardial tissue perfusion secondary to CAD as evidence by chest pain or equivalent symptoms. b. Anxiety related to fear of death c. Deficient knowledge about the underlying disease and methods for avoiding complications. d. Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.
6. Nursing Management Goals a. Immediate and appropriate treatment of angina. b. Prevention of angina. c. Reduction of anxiety. d. Awareness of disease process and understanding prescribed care. e. Adherence to self-care program. f. Absence of complications.

NURSING CARE MANAGEMENT FOR ANGINA PECTORIS

1. 2. 3. 4. 5. 6.

7.

Administer oxygen. Prompt relief with nitrates or narcotic analgesics as ordered. Monitor vital signs. Monitor ECG Place patient in semi to high fowlers position. Provide emotional support. Provide patient teaching and discharge planning. 7.1 Proper use of Nitrates 7.2 Proper use of Nitroglycerine Ointment ( Topical ) 7.3 Ways to minimize precipitating events or factors. 7.4 Gradual increase in activities and exercise. 7.5 Allow patient to notify physician immediately if pain occurs and persists despite rest and medication.

MYOCARDIAL Death of myocardialINFARCTION cells from inadquate oxygenation often caused by

1.

2..

3.

a sudden complete blockage of coronary artery; characterized by localized formation of necrosis ( tissue destruction ) with subsequent healing by scar formation and fibrosis. Risk Factors a. Atheresoclerotic CAD b. Thrombus formation c. Hypertension d. Diabetes Mellitus Degrees of Damage a. Zone of Necrosis b. Zone of Injury c. Zone of Ischemia

ASSESSMENT FINDINGS AND DIAGNOSTIC TESTS FOR MI

5.

6.

Assessment Findings a. Substernal pain with radiation to the neck, jaw, or back,;severe, crushing excruciating apin unrelieved by rest or nitrates. b. Nausea and vomiting c. Dyspnea d. Skin : cool, clammy and ashen e. Elevated Temperature f. Initial increase in Bp and pulse with gradual drop in blood pressure g. Restlessness h. Ocassional findings : rales or crackles; Presence of S4 and pericardial friction rub Diagnostic Tests for MI a. Elevated WBC b. Elevated CPK-MB c. Elevated SGOT and AST d. Elevated LDH e. ECG Changes : T wave inversion and St segment changes f. Increased ESR, elevated serum cholesterol

NURSING INTERVENTIONS FOR PATIENTS WITH MYOCARDIAL INFARCTION

Establish patent IV Line. Provide Pain relief. Administer oxygen needed. Provide bed rest with semi-fowlers position. Monitor ECG and hemodynamic procedures. Administer antiarrythmic drugs as ordered. Perform cardiac and lung assessments. Monitor urine output and report output < 30 cc/hr. Maintain full liquid diet with gradual increase to soft; low sodium Maintain quiet environment. Administer stool softeners as ordered. Relieve anxiety associated with CCU environment. Administer anticoagulants as ordered. Administer thrombolytics and monitor side effects.

NURSING CARE MANAGEMENT FOR PATIENTS WITH MYOCARDIAL INFARCTION

Provide client teaching and discharge planning concerning : 1. Effects of MI and healing process and treatment regimen. 2. Medication regimen 3. Risk factors with necessary lifestyle modification. 4. Dietary restrictions 5. Importance of participation in progressive activity program. 6. Resumption of sexual activity according to physicians order. 7. Need to report the following symptoms : a. Increased and persistent chest pain b. Dyspnea c. Weakness d. Fatigue e. Persistent Palpitations f. Light Headedness 8. Enrollment in Cardiac Rehabilitation Program

 HYPERTENSION 1. Persistent elevation of systolic BP > 140mmHg and

3.

diastolic > 90mmHg Risk Factors a. Nonmodifiable Risk Factors 1. Family History 2. Age 3. Gender 4. Ethnicity b. Modifiable Risk Factors 1. Stress 2. Obesity 3. Nutrients 4. Substance Abuse

 ASSESSMENT FINDINGS AND NURSING DIAGNOSIS FOR PATIENTS WITH HYPERTENSION

Assessment Findings
a. Pain similar to anginal pain; Pain in calves after ambulation or exercise; Severe occipital headaches particulary in the morning, nocturia, fatigue, dizziness, epistaxis, dyspnea exertion. b. BP persistently 140/90 with retinal hemmorhages and exudates, edema of extremities c. Rise in systolic BP from supine to standing position d. Diagnostic Tests ( Elevated cholesterol, and sodium levels )

Nursing Diagnosis
a. Knowledge deficit regarding the relationship between treatment regimen and control of the disease process. b. Ineffective Management of therapeutic regimen related to medication side effects and difficult lifestyle adjustments

 NURSING CARE MANAGEMENT FOR

PATIENTS WITH HYPERTENSION

Record baseline BP in 3 positions and in both arms. Continuous assessment of BP. Administer antihypertensive medications as ordered and monitor side effects. Monitor intake and hourly output. Provide patient teaching and discharge planning. 1. Risk factor identification and development. 2. Restricted sodium, kcal, cholesterol diet include family teaching. 3. Antihypertensive drug regimen. a. Names, action, dosages and side effects of prescribed drugs. b. Take drugs at regular times and avoid omission of dosage. c. Never abruptly discontinue the drug therapy. d. Supplement diet with potassium rich foods if taking potassium wasting diuretics. e. Avoid hot baths or strenous exercise within 3 hours taking medications. f. Development of gradual exercise program. g. Importance of routine follow-up care.

 CONGESTIVE HEART FAILURE

1.Clinical syndrome that results from the hearts inability to pump adequate amount of oxygenated blood to meet the metabolic requirements of the body. 2. Circulatory congestion due to decreased myocardial contractility as a result,there is inadequate cardiac output to maintain blood flow to body organs and tissues. 3. It causes sodium and water retention and elevation of left atrial pressure resulting to pulmonary vascular congestion.

RISK FACTORS AND CAUSES OF CHF

4. Risk Factors a. Disorders of Heart Muscles b. CHD leading to MI c. Hypertension d. Valvular Disease e. Cardiomyopathies f. Dysrhythmias 5. Other Causes of Congestive Heart Failure (CHF) a. Pulmonmary Embolism, Chronic Lung Disease b. Hemorrhage and Anemia c. Anesthesia and Surgery d. Transfusions and Infusions e. Increased Body Demands f. Drug Induced g. Physical and Emotional Stress h. Excessive Sodium Intake

 TYPES OF CONGESTIVE HEART FAILURE

1.

Left Sided Heart Failure ( Forward Failure )

a. Congestion mainly occurs in the lungs from backing up of blood through the left atrium into pulmonary veins and capillaries. b. Caused by left ventricular damage, hypertension,, Aortic Valve Disease, Mitral Stenosis

c. Assessment Findings
1. Dyspnea, Orthopnea,, tiredness, muscle weakness, cough 2. Tachycardia,, bronchial wheezing, rales or crackles, cyanosis or pallor 3. Decreased PO2, Increased PCO2

 TYPES OF CONGESTIVE HEART FAILURE

2. Right Sided Heart Failure ( Backward Failure )
a. Weakened right ventricle unable to pump blood into the pulmonary system b. Systemic Venous Congestion c. Caused by left sided heart failure, right ventricular infarction, atherosclerotic

heart disease, COPD, pulmonic stenosis, pulmonary embolism

d. Assessment Findings 1. Anorexia, nausea 2. Dependent pitting edema, jugular venous distention, bounding pulses, hepatomegaly, cool extremities, oliguria

 NURSING DIAGNOSIS FOR CONGESTIVE HEART FAILURE

1.

Nursing Diagnosis

a. Activity Intolerance related to imbalance between oxygen supply and demand because of decreased carbon dioxide. b. Excess fluid volume related to excess fluid or sodium intake and retention of fluid because of heart failure and its medical therapy. c. Anxiety related to breathlessness and restlessness from inadequate oxygenation. d. Powerlessness related to inability to perform role responsibilities because of chronic illness and hospitalizations. e. Noncompliance related to lack of knowledge.

 CARDIOVASCULAR FINDINGS AND

DIAGNOSTIC EVALUATION
1. Cardiovascular Findings a. Cardiomegaly b. Ventricular Gallop c. Rapid Heart Rate d. Development of Pulsus Alterans

2. Diagnostic Findings a. ECG : Ventricular Hypertrophy b. Echocardiography : Ventricular Hypertrophy, Increased Size of Heart Chambers c. Chest X-ray : Cardiomegaly, Pleural Effusion and Vascular Congestion d. ABG : Hypoxemia due to Pulmonary Vascular Congestion e. Liver Function Test Studies : Altered