help with cardiology care plan

[little ticker]

Hi,

I am trying to develop 2 nursing diagnoses for my care plan. I was on the cardiology floor with a pt who was admitted for cardiac arrhythmia. telemetry monitoring recorded bouts of VT. He has an ICD/pacemaker but the settings were set for the icd to be activated if HR went to 160. His HR during VT was 150 so his ICD was not activated. He used to have a "fluttering" in his chest during bouts of VT. My diagnoses I have chosen to develop are Decreased cardiac output related to cardiac arrhythmia, and anxiety related to increased heart rate. If anyone has any ideas of the outcomes, nursing interventions and rationales that I can use I would greatly appreciate it. Also if you have any other nursing diagnoses that you think would be more applicable feel free to suggest.

Thank You!!!

[Daytonite, BSN, RN]

Any outcomes and interventions that are used must be based on the abnormal assessment data that supports the nursing diagnoses that have been chosen. None of that information is given.

[little ticker]

client feels fluttering in chest, tired and "lazy" throughout day, decrease in appetite, spends majority of shift in bed, eats only 1/4 of meals, dizziness, SOB, low bp 80/46, telemetry readings of VT HR 150, decrease mg and ca levels in blood work. Symptoms that brought him to hospital: chest pain, SOB, dizziness, heaviness in chest, nausea/vomiting, sweating. Client is also on warfarin and 2 other antiplatelet meds, as well as IDDM, ICD/Pacemaker implanted in 2006.

[Daytonite, BSN, RN]

diagnoses, goals and nursing interventions are derived from the patient's abnormal data:

• symptoms of mi on admission:
  • chest pain on admission
    
  • nausea/vomiting on admission
    
  • sweating on admission

  [*]fluttering in chest

  [*]feels tired and "lazy" throughout day

  [*]decrease in appetite

  [*]eats only 1/4 of meals

  [*]spends majority of shift in bed

  [*]dizziness

  [*]sob

  [*]low bp 80/46

  [*]telemetry readings of vt

  [*]hr 150

  [*]decreased mg and ca levels

i want to look first at the nursing diagnoses you are saying you are going to use. keep in mind that every nursing diagnosis, just like every medical diagnosis, has a list of symptoms that serve as evidence supporting it.

decreased cardiac output related to cardiac arrhythmia as evidenced by telemetry readings of ventricular tachycardia and sensations of fluttering in the chest and dizziness.

your outcomes and nursing interventions will be for the (1) ventricular tachycardia, (2) fluttering sensation in the chest, and (3) dizziness. look in the index of your nursing textbook to find information and care strategies.

anxiety related to

increased heart rate

(????)

you need to look at the causes of anxiety. increased heart rates do not cause anxiety. if they did, there would be a lot more anxious people in the world. you are looking for etiologies that cause a feeling of dread or anticipation of danger. a threat to a person's health or a situational crisis are related factors of anxiety. feeling tired and "lazy" throughout day, a decrease in appetite, eating only 1/4 of meals, and spending a majority of the shift in bed could be symptoms of the anxiety. those would be the things you will develop nursing interventions and outcomes for.

that, however, doesn't account for all the patient's other symptoms. there is still:

• sob
  
• low bp 80/46
  
• hr 150
  
• decreased mg and ca levels

i'm curious as to the reason for this patient's sob. does he get it with activity? is it related to the heart or the lungs? are the lung fields clear? what else is going on with the heart? since the patient also has iddm, is there any atherosclerosis going on? is cardiac ischemia due to atherosclerosis the underlying pathology of the admitting symptoms? and why the hypotension? calcium and magnesium levels are low in patients with nutritional problems because both of these electrolytes are replenished through dietary sources and if the patient hasn't been eating, then he isn't going to be getting the calcium and magnesium that his body needs. did you happen to get weight information?

with the patient being on anticoagulant therapy he is at risk for injury.