I need six nursing diagnosis

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cleo777

51 Posts

Okay when I read post # 35, the heart is working against arteries that are no longer flexible, so heart has to work harder to get the blood out to the tissues...no a great verbal understanding but I do have the garden hose picture in my head!!!!

But where I am confused with, cardiac output, and maybe that is what I don't understand, but I would think then the cardiac output would then be increased, not a cardiac output decreased?

cleo777

51 Posts

When I think of decreased cardiac output I think of a decreased about of blood, volume, 4 liters instead of 5 liters, going out into the tissues. When I look at it in my book it is litres per min, so is decreased cardiac output a decrease in total amount of blood volume to the tissues or is the same amount of volume over a longer period of time, because of the effects of CAD, the pressure starts out higher and ends lower, causing the edema.

cleo777

51 Posts

I think I finally got the understanding and was looking at it backwards!!!!!!!!

When there is a increase venous return of blood ...increase cardiac output, more volume also known as preload...when blood is being returning back to the venous system via the aorta, if there is resistance, the heart has to pump harder to get the blood back into the venous system, slowing contraction do.wn, decreased cardiac output!! Are you gritting your teeth at me yet!!!! It may take me awhile to get this nursing thing.

cleo777

51 Posts

I don't know how you really feel about the asking of all these questions, don't think I am not looking these diseases up, because I am, I am finding this is a huge learning experience and pulling out info that is important. You seen my earlier few posts, so I think I have the decreased cardiac output understood, when the heart has to work harder, it becomes decreased cardiac output?

Now, looking and this I read, for nursing interventions, I see in my book, it states, semi-fowlers position to reduce the venous return, so patient doesn't have a increase preload, this is stated in cardiac disorders, but somewhere I read and I can't find it now, is to lie in supine position, Elastic stocking to promote venous return to the heart? Which would it be? When are we worried about preload, when there could be a possiblity of a fluid excess?

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

i had to leave to go to meetings. the problem with the peripheral edema is related to his cad and hypertension. i may not have explained it very well because i was in a hurry to get out the door. what you were talking about earlier was the pathophysiology of heart failure and that wasn't what was going on. the problem is peripheral resistance in his blood vessels because of the atherosclerosis. his atherosclerosis is system wide and the peripheral resistance is also in his lower extremities as well. in the heart it affects the stroke volume (blood pressure) making it higher. that, in turn, raises the hydrostatic and arterial pressure in all the vessels and lowers the osmotic pressure in the tissues of the legs which respond by retaining the fluid in their tissues so that edema is the result. muscular movement helps the circulation, but since this person is significantly immobile and the lower extremities are the farthest point from the heart, the edema is going to be most manifested there. i honestly do no know the significance of pitting except that it is more often seen in the lower extremities.

blood pressure consists of two main components:

  1. cardiac output

    • heart rate - beats per minute :redbeathe

    • stroke volume - amount of blood pumped per beat

[*]peripheral resistance - resistance of the arteries against the flow of blood through them

increasing
any one
of the above factors increases the blood pressure and vice versa.

cnbowling

14 Posts

How about Fluid Volume Imbalance or Imbalanced Nutrition

GipsGrl

19 Posts

Specializes in OR (Scrub Tech/LPN).

Hey, not sure if you used dememtia ( impaired cognitive ability) for the reason for self deficit: self feeding, but here goes

Nursing Diag: Self deficit: self feeding

R/T: Impaired cognitive ability

Patient outcomes:(goals)1.) On 4/18/09@ 0900, Pt's family will demonstate positioning of pt for feedings to prevent aspiration

2.) On 4/18/09 @ 0900, Family members will verbalize s/s of aspiration.

Nursing Rx: 1.)Student Nurse will teach family positioning of pt for feeding, at 0900, on 4/18/09.

2.) Student Nurse will teach family member s/s of aspiration

Scientific rationales: should be able to find these easily in one of your books.

Interventions: 1) Student Nurse educated family members on position of pt during feedings.

2) Student Nurse taught family member s/s of aspiration.

GOALS:

If family members showed up for teaching of position and aspiration, you would put GOALS met as evidence by attendence of meeting by family.

If family didn't come to planned meeting, you would write Goals unmet due to family unavailable for meeting. Also, if they didn't come to meeting, you would need to go back on interventions and write Student Nurse available to teach (educate), on 4/18/09 @ 0900, then on goals you could reword and put unmet due to family not availabe.

I hope this helps. I am not sure if we are on the same format, but this is our format, and I hope it helps..let me know and have a great day b blessed

cleo777

51 Posts

Your patience is much appreciated...I understand the resistance in the arteries but what I am having a problem grasping...is why is it deceased cardiac output, if the blood coming from the heart has to work against resistance from the peripheral system I would think it is increasing the workload of the heart, increasing the cardiac output, not decreasing the cardiac output, ..is it decreased because it is working against the peripheral resistance or is it that the flow of blood. I read these chapters over and over and I just don't understand why is is decreased and not increased cardiac out, what am I missing or not getting...how does it decrease the cardiac output and not increase it as below you gave me this nursing diagnosis for the edema, and I really have to try and understand......it is driving me crazy...I really don't know where else to go to understand..I am trying

Decreased Cardiac Output r/t altered electrical conduction and altered contractility M/B irregular heart rate and bilateral edema of lower extremities

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

Cardiac output is explained by this formula:

  • stroke volume X heart rate = cardiac output

Once stroke volume or heart rate is affected, cardiac output changes. So, when this patient's atrial fib (elevated heart rate) starts pumping less volumes of blood per beat, as tends to happen when heart rates speed up, the cardiac output lowers. Peripheral resistance is occurring in the vessels because of the atherosclerosis.

cleo777

51 Posts

Okay I think I am seeing the whole picture I apologize for asking so many questions but I refuse to put something on paper, that I cannot understand, it just masks the learning, I want to know. Okay I knew with Afib your heart is basically shakening and blood not being pumped, which can also be a risk for a blood clot

Is Afib happening all the time in the heart, or it is just periodally? and when it isnt happening is really still decreasing the cardiac output..

You have taught me how important a assessment is and how to ask the right questions!!!!!!!!!!!!!!!!!! This has been a huge learning for me, I have learned more from you than any of my teachers!!!!!!!!!!

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.
Is Afib happening all the time in the heart, or it is just periodally? and when it isnt happening is really still decreasing the cardiac output..

This is something you would need to have assessed in the patient when you were with them. Sometimes AF converts to a sinus rhythm when the patient is given medication and sometimes it doesn't. My AF is periodic, but that is mine. I would say CO is still decreased all the time because of the damage his CAD has done to his heart muscle.

cleo777

51 Posts

I am looking for a Integrity vs Despair, without having very little conversation on speaking with the patient or spending anytime with the patient...apprx 6 hr

.hmmessage P { margin:0px; padding:0px } body.hmmessage { font-size: 10pt; font-family:Verdana } depression r/t chronic illness m/b immobilty and inability to do ADL's

I know that is a stretch, and does it even work???????

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