Decreased Cardiac Output - NCP for Angina Pectoris

Decreased Cardiac Output - NCP for Angina Pectoris


Nursing Care Plan for Angina Pectoris

Angina pectoris is a clinical syndrome characterized by paroxysmal episodes or pain or feeling of pressure in front of the chest. (Brunner and Suddart, 1997)

Angina usually occurs when exercise, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed arteries can provide. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerin tablet under the tongue. Nitroglycerin relaxes blood vessels and lowers blood pressure. Both rest and nitroglycerin reduce myocardial demand for oxygen, thus freeing angina.

Factors causing angina pectoris, among others:
  • Insufficient oxygen supply to the cells of the heart muscles compared needs.
  • When the move, especially heavy activity, increased cardiac workload. Pumping heart muscle stronger.
  • History of smoking (both active smokers and passive smokers)
  • Angina is caused by a decrease in blood flow to the heart area. Sometimes, other types of heart disease or uncontrolled hypertension can lead to angina.
  • Arteriosclerosis is a general term for several diseases, in which the arterial wall becomes thicker and less flexible which fatty materials collect under the inner lining of the artery wall.
  • Coronary artery spasm.
  • Severe anemia.
  • Arthritis.
  • Aortic insufficiency.

Nursing Diagnosis : Decreased Cardiac Output

Goal: An increase in cardiac output.

Outcomes:
Patients reported a reduction in episodes of dyspnea, angina and dysrhythmias showed increased activity tolerance, clients participating in behaviors or activities that lower cardiac work.

Interventions :

1. Monitor vital signs, eg heart rate, blood pressure.
R :/ tachycardia can occur due to pain, anxiety, hypoxemia, and decreased cardiac output. Changes in BP (hypertension or hypotension) due to cardiac response.

2. Evaluation of mental status, note the occurrence of confusion, disorientation.
R :/ Lowering the perfusion of the brain can result in changes in sensorium.

3. Note the presence of skin color and pulse quality.
R :/ decreased peripheral circulation when cardiac output falls, making the skin pale and gray (depending on the degree of hypoxia) and a decline in the strength of peripheral pulses.

4. Maintaining bed rest in a comfortable position during an acute episode.
R :/ Lowered oxygen consumption or decrease the need for labor and the risk of myocardial decompensation.

5. Give adequate rest periods. Assist in or perform self-care activities, as indicated.
R :/ saving energy, lowering cardiac work.

6. Monitor and record the effects or loss of drug response, blood pressure levels, heart rate and rhythm.
R :/ desired effect to decrease myocardial oxygen demand by decreasing ventricular stress. Drug with negative inotropic content can decrease perfusion to the ischemic myocardium. The combination nitras and beta-blockers may exert its effects on cardiac output collected.

7. Assess for signs and symptoms of CHF.
R :/ Angina only pathological symptoms caused by myocardial ischemia, a disease which affects the function of the heart became decompensated.

8 Give the drug as indicated: calcium channel blockers.
R :/ Although different in its form, calcium channel blockers play an important role in preventing and eliminating ischemia originator of coronary artery spasm and decrease vascular resistance, thus reducing BP and heart work.

Nursing Care Plan for Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva, the mucous membrane that covers the white part of the eye and the inner eyelid. Condition characterized by red eyes is the most common eye disorder in children.

Types of Conjunctivitis

Conjunctivitis can be caused by bacterial infections, viral infections, allergies or irritation.:
  • Bacterial conjunctivitis : infections caused by bacteria, such as staphylococci, streptococci or Haemophilus. Eyes are usually issued dung eyes yellow / greenish yellow which may spread to the lashes and cause a sticky eyelids, especially in the morning.
  • Viral conjunctivitis : an infection caused by a virus called adenovirus, often associated with the common cold. Types of conjunctivitis are very contagious among humans and can cause epidemics. Eye redness and discharge may be watery. Often the swollen eyelids. This type of conjunctivitis may also spread to the cornea and cause blurred vision.
  • Allergic Conjunctivitis : allergy due to objects such as pollen, dust mites, or dust. Itchy eyes and redness that may be accompanied by many tears, eyelid crusting and photophobia (eye glare). This condition can occur at certain times of the year, for example during a drought when a lot of pollen and dust flying through the air. Children who have a history of allergic conjunctivitis often have other atopic diseases such as allergic rhinitis, eczema or asthma.
  • Irritation Conjunctivitis : caused by chlorine in the pool, smoke, or steam.
In addition, the newborn child called neonatal conjunctivitis or ophthalmia neonatorum which is transmitted during the birth process and including sexually transmitted diseases such as gonorrhea or chlamydia infection. In small infants, symptoms of watery eyes and more eyes droppings caused by tear drainage problems that have not evolved than conjunctivitis. The condition is known as the naso-lacrimal duct obstruction, which will disappear when the baby is getting older.


Nursing Diagnosis for Conjunctivitis

  1. Acute pain related to inflammation of the conjunctiva.
  2. Anxiety related to lack of knowledge about the disease process.
  3. Risk of spread of infection associated with inflammatory processes.
  4. Impaired self-concept (body image decreases) related to the change of the eyelids (swelling / edema).
  5. Risk for injury related to limited vision.


5 Nursing Diagnosis for Meningitis

5 Nursing Diagnosis for Meningitis


Meningitis is a severe inflammation of the lining of the brain. Inflammation that may occur after the attacks of otitis media, mastoid inflammation, brain abscess, even inflamed tonsils. Something cracked in the skull or a penetrating head injury that may result in meningitis. (Clifford R Anderson: 1975)

Meningitis is an acute infection of the lining of the meninges (the membranes covering the brain and spinal cord). These infections can be caused by:
Bacteria, such as : pneumococcus, meningecoccus, stapilococcus, streptococcus, salmonella, etc..
Viruses, such as : Haemophilus influenza and herpes simplex.

Signs and Symptoms

1. Changes in cerebral tissue perfusion related to cerebral edema / obstruction of blood flow.
2. Acute pain associated with the infection process.
3. Damage to physical mobility related to neuromuscular damage.
4. High risk of trauma / injury associated with generalized seizure activity.
5. Associated with an increased risk of exposure to infection, the immune system is weak.

Characterized by symptoms of refusing to eat, less to suck reflexes, vomiting, diarrhea, lack of muscle tone, weak cry. In children and adolescents usually there are signs and symptoms of high fever, headache, vomiting, sensory changes, seizures, easily stimulated, photo phobia, delirium, hallucinations, manic, stupor, coma, neck stiffness, positive Kernig and Brudzinski, ptechial (show meningococcal infection).


1. Ineffective tissue perfusion (cerebral)
related to:
cerebral edema,
hypovolemia.

2. Risk for injury
related to:
generalized seizures / focal,
general weakness,
vertigo.

3. Acute Pain
related to:
inflammatory process,
toxin in the circulation.

4. Impaired physical mobility
related to:
Neuromuscular damage,
decrease in strength.

5. Anxiety
related to:
crisis situation,
threat of death.

Acute Pain - Nursing Care Plan for Vertigo

Vertigo is a symptom of dizziness that can happen to anyone, ranging from mild symptoms to severe. Vertigo can be characterized by a sense of dizziness as the head spins and inverted vision. As a result, patients experience dizziness highly and will not be able to get up because of the dizziness.

Dizziness is actually a common symptom associated with various disorders. Causes of dizziness may be related to the nervous system, but can be derived from ENT, heart, eyes, and even psychologically.

After all dizziness complaints, ranging from mild to severe, should be evaluated carefully in order to clear the source and the cause can be found so that the obtained optimal treatment or handling.

Symptoms of vertigo can be triggered by various things, such as a hormonal disorder that is marked by the presence of acne, fatigue, stress, lack of rest and so on.


Nursing Diagnosis for Vertigo : Acute Pain related to stress and tension, irritation / nerve pressure, vasospasm, increased intracranial pressure.

Characterized by :
Stating that pain is influenced by such factors, changes in position, changes in sleep patterns, anxiety.

Goal : Pain is lost or reduced

Outcomes:
  • The client expresses pain is reduced.
  • Normal vital signs.
  • The client appeared calm and relaxed.

Intervention :
1. Monitor vital signs , intensity / pain scale
Rationale : Identify and facilitate the nursing action.

2. Encourage clients to rest in bed.
Rational : the break to reduce the intensity of pain.

3. Adjust the position of the patient as comfortable as possible.
Rational : the exact position reduces stress and prevent muscle tension and reduce pain.

4. Teach relaxation techniques and breathing deeply.
Rationale : relaxation reduces tension and makes the feeling more comfortable.

5. Collaboration for providing analgesic.
Rationale : useful analgesic to reduce pain so that the patient becomes more comfortable.
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