Decreased Cardiac Output - NCP for Angina Pectoris

Nursing Diagnosis for Angina Pectoris : Decreased cardiac output related to contraction disorders

NOC :

• Cardiac Pump Effectiveness
• Circulation Status
• Vital Sign Status

Outcomes :

• Vital Signs within the normal range (blood pressure, pulse, respiration).
• Can tolerate the activity, there is no fatigue.
• No pulmonary edema, peripheral and no ascites.
• There is no loss of consciousness.

NIC

Cardiac Care

• Evaluation of chest pain (intensity, location, duration).
• Note the presence of cardiac dysrhythmias.
• Note the reduction in signs and symptoms of cardiac putput.
• Monitor cardiovascular status.
• Monitor respiratory status that indicates heart failure.
• Monitor the abdomen as an indicator of decreased perfusion.
• Monitor fluid balance.
• Monitor any changes in blood pressure.
• Monitor the patient's response to the effects of antiarrhythmic treatment.
• Set exercise and rest periods to avoid fatigue.
• Monitor the patient's activity tolerance.
• Monitor the presence of dyspnea, fatigue, tachypnea and orthopnoea.
• Suggest to reduce stress.

Vital Sign Monitoring

• Monitor BP, pulse, temperature, and RR.
• Note the fluctuations in blood pressure.
• Monitor VS when the patient is lying down, sitting, or standing.
• Auscultation of blood pressure in both arms and compare.
• Monitor BP, pulse, RR, before, during, and after activity.
• Monitor the quality of the pulse.
• Monitor the presence of pulsus paradoxus and pulsus alterans.
• Monitor the number and monitors the heart rhythm and heart sounds.
• Monitor respiratory rate and rhythm.
• Monitor lung sounds, abnormal breathing patterns.
• Monitor temperature, color, and moisture.
• Monitor peripheral cyanosis.
• Monitor the presence of Cushing's triad (widened pulse pressure, bradycardia, increased systolic).
• Identify the cause of vital sign changes.

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.

Acute Pain related to Angina Pectoris

Nursing Care Plan for Angina Pectoris

Angina Pectoris is described as severe chest pain that results from insufficient blood flow to the heart. The main cause is a coronary artery disease called atherosclerosis, or a clogging of the arteries.

Signs and symptoms of this heart related condition may include tightness or pressure in the chest that may radiate to the left shoulder and arm, or possibly the neck and jaw. Other symptoms may include difficulty breathing, anxiety, sweating, or pale skin.

During an attack of angina pectoris, a person should rest and take nitroglycerin under the tongue. This may be enough to eliminate the symptoms. Depending on possible underlying conditions, other treatment such as balloon angioplasty or other surgeries may be recommended, or certain medications (beta-blockers, daily aspirin) may be needed. In most cases, a patient can benefit from a healthy diet and exercise, which should be prescribed by their doctor.


Nursing Diagnosis : Acute Pain related to Myocardial Ischemia

Goal: reduced pain / resolved
Outcomes:

• Stated / said no pain,
• Reported angina episodes decreased in frequency, duration and severity.

Nursing Interventions :

1. Instruct the patient to notify nurse quickly in the event of chest pain.
R:/ pain and decreased cardiac output can stimulate the sympathetic nervous system to release large amounts of nor epinephrine, which increases platelet aggregation and thromboxane A2 issued. Pain can not be detained cause vasovagal response, reducing BP and heart rate.

2. Identification of the precipitating factors, if any: frequency, duration, intensity and location of pain.
R: / Help distinguish early chest pain (stable angina usually ends 3 to 5 minutes while unstable angina longer and can last more than 45 minutes).

3. Evaluation report pain in the jaw, neck, shoulder, hand or arm (especially on the left side).
R:/ Cardiac pain may spread to the sample surface pain more often innervated by the same spinal level.

4. Instruct the patient to bed rest during episodes of angina.
R:/ Reduce myocardial oxygen demand in order to minimize the risk of tissue injury or necrosis.

5. Elevate the head of the bed when the patient is short of breath.
R:/ Facilitate the exchange of gases to reduce repetitive hypoxia and shortness of breath.
Monitor the speed or rhythm of the heart.

6. Monitor the speed or rhythm of the heart.
R:/ Patients with unstable angina have increased dysrhythmias, acute life-threatening, which occurs in response to ischemia and or stress.

7. Panatau vital signs every 5 minutes during an attack of angina.
R:/ BP can rise early with respect to sympathetic stimulation , then dropped when the cardiac output is affected.

8 . Maintain a calm, comfortable environment, limit the visitor when necessary.
R:/ mental or emotional stress increase myocardial work.

9. Give soft foods. Let the patient rest for 1 hour after eating.
R :/ Lowering myocardial work in connection with the work of digestion, lowers the risk of angina attacks