Cardio care plan please help!

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I need help developing a care plan (with only a cardio diagnosis) for someone who was admitted to the hospital for syncope....this patient also has pneumonia.........a thoracic echo was performed and there is nothing indicative of decreased cardiac output (left ventricular function within normal limits and ejection fraction of 55%)..........The patient has a history of hypertension and high cholesteral ............the patient's left carotid is 75% occluded.......since this patient was eating at the time of syncope, I am hypothesizing that all the blood was rushing to their stomache while eating and the already decreased blood flow to the brain (due to the occlusion in the carotid) was diminished even more and they fainted....I was thinking of using a decreased tissue perfusion diagnosis but than that would only be pertaining to cerebral tissue since I do not know whether there are any other arterial occlusions.......If I use the decreased cerebral tissue perfusion diagnosis I also need ten interventions....any thoughts or input would be much apprciated

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The pt has hx of HTN and high cholesterol? Does pt have CAD or PVD? Any hx of dyrhythmias, MI, cardiomegally, left ventricular hypertrophy? ANYTHING ELSE? Pt could be at risk for decreased cardiac output r/t HTN and high cholesterol if he had some symptoms.

Assess neuro, cardio, circ, pulmonary,,,monitor for s/s of seizure, bleeding if put on anticoagulants/antithromolytics, monitor O2, VS, resp, all that good stuff, labs. Some teaching with any meds, diet, exercise? If pt had syncope and takes meds for HTN, are they taking them correctly? Give me some more info and I might be able to help more. Hey, not quite an RN yet so I hope nobody minds me trying to help a fellow student?!

sorry, jules

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Unfortunately my patient has severe cognitive impairment and cannot give me much of a cardiac history.........this patient's records didnt give me any cardiac history other than hypertension and high cholesterol.......they arent on any meds other than aspirin, lipitor and norvasc....the patient's blood pressure was WNL and I was able to palpate all peripheral pulses during assessment.......do you think I have enough to use a C/O diagnosis with just a history of HTN and high cholesteral

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No unless they're having symptoms. Do you have to have a cardiac dx?

jules

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HTN and hyperlipidemia are good cardiac dx; right there you have compromised CV function for HTN and potential for compomise 2/2 hyperlipidemia...interventions and goals would b maintain nml B/P by educating pt on how to monitor his own B/P, you could assess B/P q4, q8 etc, teach about lifestyle changes...as he has cognitive impairment educate sig other re: diet, exercise, lifestyle etc... hope this helps.

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Red fish

So I can safely say that the patient is at risk for decreased Cardiac output based on the hypertension and high cholesterol...correct?

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

hi, blulie!

i've just been reading your post and request for help with this care plan you are writing. first of all, let me tell you that there are two threads on the nursing student forums that you should review that have helpful information in them for care planning:

i don't know what kind of experience you have at writing care plans or what your understanding is of the nursing process, but i will tell you that a care plan is nothing more than the written expression of the nursing process. it all starts with the assessment information that you have gathered about your patient. assessment information forms the foundation of everything that comes after it. like building a house, a piece of furniture or sewing a piece of clothing, if your foundation (assessment) isn't the best it could be, the result of any work coming after is going to suffer. a good analogy is the leaning tower of pisa. what happened with that?

i looked over what you have posted very carefully. determining a nursing diagnosis is based on the symptoms a patient has. nanda uses the term defining characteristics in place of symptoms. they are also the abnormal assessment items you identify in your assessment of the patient. these defining characteristics, symptoms, or abnormal assessment items come from your physical assessment and interviewing of the patient and/or their caregivers as well as from the medical record or other written documentation that is available. these were the defining characteristics i was able to learn about this patient from your postings:

  • he fainted while he was eating
  • severe cognitive impairment
  • left carotid artery is 75% occluded

you've really supplied no other assessment data. now, i've been a nurse a long time who worked in med/surg. with a 75% carotid artery occlusion and cognitive impairment there is a lot more going on medically with this patient that what seems to be, especially with medical diagnoses of hypertension and elevated cholesterol. i would have pulled out symptoms from the doctor's history and physical to use in support of some nursing diagnoses for this patient.

every nursing diagnosis has a definition, defining characteristics (symptoms) and related factors. you choose a nursing diagnosis based on the fact that the patient has some of the defining characteristics (symptoms) that fit that particular nursing diagnosis and the definition of the nursing diagnosis is describing the patient's problem. for this reason, having a book with nursing diagnoses in it that includes the definitions, defining characteristics and related factors is extremely helpful.

you are on the right tract to use ineffective tissue perfusion, cerebral (nanda language). the definition of this diagnosis is "decreased oxygen resulting in the failure to nourish the tissues at the capillary level. (nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international, page, 228). the defining characteristics for the cerebral part of this diagnosis are: altered mental status, behavioral changes, changes in motor response, changes in pupillary reactions difficulty in swallowing, extremity weakness, paralysis, speech and abnormalities." so, an appropriate nursing diagnosis statement for you to use for this patient would be: ineffective tissue perfusion, cerebral r/t interruption of blood flow aeb severe cognitive impairment. if i were your instructor i would want you to elaborate a bit and be more specific on the symptoms of this cognitive impairment (was he disoriented to person, place or time, unable to perform simple arithmetic or remember simple instructions, etc.) to use the diagnosis of decreased cardiac output in a patient with syncope you would have to be able to show that there was causality between the syncope and the heart, usually an arrhythmia. you don't have the information at all. in fact, his heart is ok with relation to the syncope. his syncope was more likely due to the occlusion of the carotid arteries.

nursing interventions are always based upon your defining characteristics (symptoms) which in this case would be the severe cognitive impairment. this is why i mention that it would be better to be more elaborate on this cognitive impairment because developing nursing interventions for "severe cognitive impairment" may be a little difficult. assuming you don't have a care plan book, here is a link to a nursing diagnosis page on the gulanick/myers and ackley/ladwig care plan constructor sites to help you out with interventions.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=55

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_072.php

you would also find these links posted on the "desperately need help with careplans" thread which i posted a link for you at the beginning of my post.

something else that might help you in assessing cognition are some of the tools on this geriatric site: http://www.healthcare.uiowa.edu/igec/tools/categorymenu.asp?categoryid=1

you should also review the nursing diagnoses of acute confusion and chronic confusion to get an idea of what the defining characteristics are for these two and some of the nursing interventions to see if some of them don't apply to your patient and maybe tweak your thinking as to how to present your information on the diagnosis you will use.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=12

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_017.php

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_018.php

you didn't mention how extensive this care plan needs to be, but i would also suggest that this patient is at a risk for injury or risk for falls until, or if, something is not done to correct this carotid occlusion. he is at a risk not only for physical injury he could receive from falling down during a syncopal episode (risk for falls r/t history of fainting and severe cognitive impairment), but he is at a risk to have a stroke (risk for injury r/t tissue hypoxia). you also need to consider how this medical diagnosis is going to potentially change his ability to perform his adls, so self-care deficits may be something to consider as well as knowledge deficit.

just some ideas. i don't know the patient, but i've seen this in hundreds of others. good luck with your care plan.

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Sorry for delay..yes HTN is a cardiac dx, there is increased workload on the heart and hyperlipidemia is actual and potential... go c comprised cardiac function r/t htn then use interventions aimed at maintaining nml B/p... as well as decreasing cholesterol...lifestyle, meds, assessment etc

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