Please help with Cardio part of care plan. Really stuck!

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Specializes in Acute Mental Health.

I'm doing a care plan and am just about finished. I'm running into some difficulty in the cardio column though.

My patient is in for excessive diarrhea, but takes bp med (lisinopril 20mg at home). He has not been on it at all during his hospital stay (since2/3). His bp has been normal every shift (120/78, 102/80) even through intense cramping pain.

Here is what I know:

Patient reports history of hypertension for past couple of yrs.

Medication: Patient relates that he takes 20mg lisinopril at home, not in hospital.

Blood pressure: Normal range both days

102/80, 120/76 right arm.

Nail beds: pink

Lips: pink

Mucous membranes: moist and intact.

No edema.

No jugular venous distension.

CRT less than 3 sec all extremities.

No complaints of shortness of breath, chest pain (or physical indication).

Labs:2/4

Potassium: 3.3 Low

(other same as below)

Labs: 2/5

Potassium: 3.7 Normal range.

Sodium: 135 Low

Chloride: 103

CO2: 25.3

HGB: 15.1

HCT: 43.3

RBC: 4.96

MCV: 87

MCH: 31

RDW: 12.2

Platelets: 134 (low range is 150-450)

I know I shouldn't be putting a strength down in this column, but now that the K+ is in the normal range and his bp has been good, I can't figure out a risk for or ?? Any input is appreciated.

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Type in NANDA nursing diagnoses in yahoo or google. Poke aroung through what you find for the infamous list... then one by one, go through and select which apply to your patient. Some are broken down into sections (neuro, GI, CARDIO, etc). I hope this helps. It's been too long since I last did a careplan that I can't think of any cardio nursing DXs. The only time you see/do a careplan is when you're in nursing school ;)

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Specializes in Acute Mental Health.

Thank you, I'll do that first thing this am. I was thinking: At risk for increased bleeding related to decreased platelets. But, what can nursing do about this....... monitor, teach to use electric razor to decrease risk of cuts, teach to be careful with sharp objects, and what to do if he starts to bleed and it doesn't stop.

Well, let me go look up NANDA site like suggested.

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

i'm trying to understand your question. are you saying that for your care plan you have to come up with a nursing diagnosis that is related to the patient's cardiac system, but you can't figure one out for this patient?

lisinopril is an ace inhibitor that is given as an antihypertensive. was is discussed that the patient's diarrhea could be a side effect of the lisinopril? lisinopril causes gi irritation in some people. is it possible that he was taken off the lisinopril because of the diarrhea? (diarrhea r/t adverse effect of medication aeb __ loose liquid stools per day.) it is also not uncommon that patients are removed from all their medications when hospitalized so their physicians can evaluate their conditions while they are under close monitoring by hospital staff.

blood pressure consists of two main components:

  1. cardiac output
    • heart rate - beats per minute
    • 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. i noticed that this patient has a noticeable difference between his blood pressures: 102/80, 120/76 right arm. were these in the same arm or different arms? if they were in different arms you need to research why a difference like that would occur. that has to do with cardiac output. with platelets of 134 he is at risk for injury r/t abnormal clotting factors because he is at risk for bleeding (ecchymoses, petechiae, hematomas, epistaxis, hematuria, hemoptysis).

there are only two nursing diagnoses that specifically pertain to cardiac function:

i was thinking that activity intolerance might be feasible especially if the patient is deconditioned and gets sob with activity. their b/p, heart rate and respirations most likely elevate with activity as well. this diagnosis would work well if the patient were, say, obese. it has respiratory and cardiac required elements in it, but is generally classified in the oxygenation category. if you list immobility or sedentary lifestyle as the related factor (etiology) and the patient gets sob with activity that might fulfill your cardiac requirement. you can read about activity intolerance here:

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Specializes in Acute Mental Health.
i'm trying to understand your question. are you saying that for your care plan you have to come up with a nursing diagnosis that is related to the patient's cardiac system, but you can't figure one out for this patient?

lisinopril is an ace inhibitor that is given as an antihypertensive. was is discussed that the patient's diarrhea could be a side effect of the lisinopril? lisinopril causes gi irritation in some people. is it possible that he was taken off the lisinopril because of the diarrhea? (diarrhea r/t adverse effect of medication aeb __ loose liquid stools per day.) it is also not uncommon that patients are removed from all their medications when hospitalized so their physicians can evaluate their conditions while they are under close monitoring by hospital staff.

blood pressure consists of two main components:

  1. cardiac output
    • heart rate - beats per minute
    • 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. i noticed that this patient has a noticeable difference between his blood pressures: 102/80, 120/76 right arm. were these in the same arm or different arms? if they were in different arms you need to research why a difference like that would occur. that has to do with cardiac output. with platelets of 134 he is at risk for injury r/t abnormal clotting factors because he is at risk for bleeding (ecchymoses, petechiae, hematomas, epistaxis, hematuria, hemoptysis).

there are only two nursing diagnoses that specifically pertain to cardiac function:

i was thinking that activity intolerance might be feasible especially if the patient is deconditioned and gets sob with activity. their b/p, heart rate and respirations most likely elevate with activity as well. this diagnosis would work well if the patient were, say, obese. it has respiratory and cardiac required elements in it, but is generally classified in the oxygenation category. if you list immobility or sedentary lifestyle as the related factor (etiology) and the patient gets sob with activity that might fulfill your cardiac requirement. you can read about activity intolerance here:

thanks for your input! i don't think the diarrhea is from lisinopril. he's been on it for about 5 yrs. he came into the hospital due to painful cramping and severe diarrhea. stool culture came back negative for everything. so we have to expand on every column, but we can have a strength if it fits (no potential complication though). he is up ad lib and moves well. no c/o dizziness upon standing and moves easily by self from bed, to br, to chair. he's on his laptop and hasn't napped at all during the day. sleeps well at night. full liquid diet. intake is been over 3000 per shift po alone. he is also receiving iv fluids 0.9%nacl with 49meq kcl, running continuously at 125mls/hr. other than frequent trips to the br and painful cramping, the pt is doing very well. is using a pca pump, but only a couple of times per shift. vitals have all been normal. if it wasn't for him taking lisinopil at home and the low platelet count, i would come up with a strength. i'm just wondering if the low platelets have an underlying cause somewhere. wbc's are normal as are all other labs...sodium is 135 which is just low 1 point below range. other than that, patient is doing well.

blood pressure was in the left arm both times, but the higher one was related to painful cramping at the time.

due to the platelet count i was thinking at risk for ineffective protection related to decreased platelet counts.

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

Are they doing a GI workup on him? Is he GI bleeding because of the diarrhea? If he has occult bleeding he is at risk for anemia and therefore hypoxia (the Activity Intolerance, Ineffective Tissue Perfusion) or arrhythmias.

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Specializes in Cardiac Telemetry/PCU, SNF.

Only thing that I could think of for a cardiac issue may be "risk for arrhythmias d/t electrolyte imbalance" but without a Mag, Phos and Calcium to look at hard to say. You can have really horrid electrolyte imbalances with severe diarrhea, but it sounds like he's stable. They may have taken him off of the lisinopril due to renal issues, didn't see a creatinine listed, as ACEIs can have an effect on the kidneys.

It's been so long since I did a care plan I don't even know if what I threw out is a really nursing dx...:bugeyes:

Good luck!

Tom

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Specializes in Acute Mental Health.

Hi all,

Thanks for the help! I usually do fine with getting it all together, but this one little column was challenging. With only having him for 2 days I can only guess what is underlying with him. Hopefully, just a virus....but I'll never know. He was - for blood in stool. All other labs were normal except the ones I mentioned above.

I just did an at risk and emailed my instructor letting her know that I was stumped and her input would be appreciated. I may get a lower grade, but I'm there to learn so I can take it with me to the next (and very last ever) care plan from scratch!

Thank you all for your input. I'll let you know what she tells me as soon as I hear. :redbeathe

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