Nursing management:
-O2 inhalation
-Semi to high fowler’s position
-Heart monitoring
-Proper relief of pain with nitrates
- nitroglycerine tablets – given sublingual
*take 1 tab in anticipation of strenuous activity
*1 tab every 5 mins (3 tabs within 15 mins)
*headache – frequent side effects (transient)
*hypotension
*keep cap tight; prevent exposure to light, air and heat
Angina Pectoris
Nursing Management:
- nitro ointments or nitrodisc
*rotate sites to prevent dermal inflammation
*avoid massage or rub because of increased absorption
and interferes
with drug’s sustained action
*avoid skin contact with medication
-patient education to minimize precipitating events
-reduce stress and anxiety
-avoid overexertion and smoking
-decrease cholesterol and saturated fat diet
-small, frequent meals
-avoid extremes of temperature
-dress warmly in called weather
Common Cardiac Problems
Myocardial Infarction – death of myocardial cells
from inadequate oxygenation, often caused by
a sudden, complete blockage of a coronary
artery characterized by localized formation of
necrosis with subsequent healing by scar
formation and fibrosis.
Signs and Symptoms:
– Pain usually substernal radiating to neck, arm , jaw or
back, severe and crushing, sudden onset unrelieved
by rest or nitrates; may be referred pain (epigastric
pain)
– Nausea and vomiting
– Dyspnea
– Cool, clammy and
Myocardial Infarction
Signs and Symptoms:
– Initially increased blood pressure ashen skin
– Increased temperature and pulse rate then decrease
blood pressure
– Increased WBC, CPK and CPK-MB, increased SGOT,
increased LDH, increased ESR
*CPK and SGOT – increases in 4 to 6 hours, and decreases
in 3 to 7 days
– ECG changes – ST elevation, presence of U-waves, T
wave inversion
Myocardial Infarction
Nursing interventions:
Objective of care – restore ability of heart to
maintain adequate circulation;
-IV lines – pain relief – IV morphine sulfate (no
IM injections-stimulates increase CPK)
-O2 inhalation
-Bedrest, semi-fowlers position; ambulate after
3 days
-Antiarrhytmics – lidocaine bolus 50-100 mg +
drip at 1-4 mg/min; procainamide, quinidine
-Full liquid to soft diet, decreased sodium and cholesterol,
no caffeine
-Stool softeners to prevent straining
Myocardial Infarction
Nursing Interventions:
-Fibrinolytics – streptokinase drip to lyse the
thrombose
-Anticoagulants
*heparin – serial PT; antidote – protamine sulfate
*coumadin or warfarin sodium – serial PTT;
antidote – Vitamin K
-TPA (tissue type plasminogen activator or
platelet deagreggator)
*low doses of aspirin a day
*persantine or dipyridamole
-Resumption of sexual activity in 4 to 6 weeks
Common Cardiac Problems
Congestive heart failure – inability of heart
to pump blood to adequately meet the
metabolic needs of body
-Left sided heart failure – (forward failure)
causes blood to back up through left
atrium into pulmonary veins; pulmonary
congestion.
Signs and Symptoms – dyspnea,
orthopnea, paroxysmal nocturnal
dyspnea, wheezing, moist rales,
cyanosis, pallor, cough with frothy
sputum
Congestive Heart Failure
-Right sided heart failure – (backward
failure) right valve is unable top pimp
blood into pulmonary system; systemic
venous congestion
Signs and Symptoms – dependent and
pitting edema, jugular vein
distention, bounding pulse, weight
gain, decreased renal function, oliguria,
ascitis, anasarca
Congestive Heart Failure
Nursing management
– Control of underlying cause
– O2 therapy
– Sodium restricted diet
– Pharmacotherapeutics
*vasodilators (nitoglycerine, isosorbide, morphine
sulfate) to decrease? amount of blood return to
heart
*digitalis therapy (lanoxin, cedilanid) to improve
cardiac output
Signs and Symptoms of digitalis toxicity:
*CV symptoms: bradycardia, tachycardia, bigeminy,
ectopic beats
Congestive Heart Failure
Nursing Management:
Signs and Symptoms of digitalis toxicity:
*GI symptoms: anorexia, nausea and vomiting,
diarrhea, abdominal pain
*Neuro symptoms: headache, double vision, blurred or
colored vision; drowsiness, confusion, restlessness,
irritability, muscle weakness
*diuretics – relieve fluid retention
Congestive Heart Failure
Nursing Management:
– Rotating tourniquets (bloodless phlebotomy) – to
retard venous return to heart
General Principles of Care
– Use 3 tourniquets or 3 BP cuffs on 4 extremities
cuff inflated at pulse pressure
– Apply tourniquet using one direction –
clockwise
– Tourniquet is applied one at a time at 15
minutes interval
– Tourniquet is removed one at a time at 15
minutes interval
– Maximum time of stay in each extremity is 45
minutes
- Phlebotomy – removal of 300-500cc blood from
peripheral vein
- Intraaortic balloon pump, heart
transplant,mechanical heart