allie86

Hey I just did a cardiac care plan last week and got some great feedback on here too. If you go to this link or do a goggle there may be some things to help you https://allnurses.com/nursing-student-assistance/care-planning-decreased-827162.html Good luck!

I hear what your saying. However, our program tells us to do it this way. Trust if it was up to me I would do it much different. We ALWAYS have to assess for our EO first and monitor teach and treat. Thats what they want and since I am the student and not the instructor....I must follow! I know many nursing programs are different and these instructors all have their preferred ways. I definitely use my NANADA list. They only allow us to use a select few and in my case here, I was told to use decreased cardiac output. On the contrary I think I really do think like a nurse I have always thought critically. In class its a different method. Not so critically but how they want us to learn. Im ok with that. I dont mind learning and I thank you for your input too. Just want you to know that this way is one of many that some school teach...whether its good or not.

Thank you. Yes that I what I did instead. Having EF as a AMB was too difficult. IN my program anything and everything in the AMB has to be addressed and made into an EO. I just didnt see how EF could be improved in a short term goal so I replaced it with other evidence.

Thank you I use Ackley too. I got some good NI from here but had to change my EO. I just took out the EF and used DOE and c/o fatigue... We worked on improving that in my NI. Thanks again

Oh thank you so much. This was very informative. I also use Ackley! I like it but I just was confused on how to use EF. I winded up changing it after the input from here! Thanks again!

Thanks again everyone. Yes he is CHF. He has had multiple stents placed and his diabetes doesnt make things better. I want to do BP, pulse etc but there are all WNL during my assessment. When he initially came in he was defiantly showing some s/s that I could have worked with but by the time I came to work with him he was stable with the meds. I wish I could do impaired gas exchange or another but my instructor thinks his priority is decreased CO so I have to process this one. I think i will have to take EF off because I do not have another order for the EF. I did however make that a NI: Consult with MD on ordering subsequent imaging test...

Ok thanks to both of you! I guess I better stick with this EO and just focus my NI on increasing CO, MAP which will inadvertently increase EF. Thanks

That's my issue haha. I havent found a sound number for a normal EF. I know that

Thanks I will change that!! My assessment was the DOE, diminished lung sounds, weak peripheral and femoral pulses, chest pain, impaired vision and hearing, orthopnea limitations in all ROM, Upper and lower extremities weak against resistance, he has no feeling in his lower extremities or feet, obesity bmi 33, he was really lethargic answers questions slowly, skin: pale for ethnicity, as far as labs go he has increased WBC, CK (206 units) Troponin, HCT, Triglycerides, BUN, Creatnine, Hgb A1c (11.2%), decreased albumin The thing is I have to do decreased cardiac output but i dont feel like I have enough to do the two EO's we have to do. My other care plan for him is activity intolerance which is easier but this one has me stuck!

HI! I was hoping someone could help me out with this care plan I have. I have spent hours and trolled the internet for answers to no avail! BTW I am a 2nd semester RN student! My patient is a young man with an ejection fracture of 28%. He came in through ED with c/o chest pains unrelieved with nitroglycerin and increased troponin and CK with elevated BP 221/87; normal echo in sinus rhythm and the following hx: Insulin dependent DM (uncontrolled) X 7 yrs CABG X 3 yrs ago with 6 stents Hypertension X yrs Amputation of left great toe X yrs ago Hyperlipidemia X yrs Amputation of right third toe X yrs ago CAD X 3yrs Ischemic Cardiomyopathy x yrs Peripheral neuropathy X yrs Retinopathy X yrs His v/s BP: 136/80; Pulse: 76 regular 2+/3, Apical pulse: 82 regular, radial pulses 2+/3 regular bilat.; femoral and pedal pulses 1+/3 weak bilaterally; lung sounds dimishined throughout. O2 sat 96% on 2L n/c He had an AICD placed the day prior to my shift. My care plan is Decreased cardiac output r/t alterations in preload, afterload and myocardial contractility 2° cardiomyopathy and cardiac ischemia x 4 yrs ago amb (as manifested (evidenced) by) dyspnea on exertion, orthopnea, c/o "dizzy and tired when I walk", ejection fracture of 28% I have completed my expected outcome for the DOE, orthopnea and weakness; however my program requires us to have an EO for each amb. So for the ejection fracture i am stuck. I have the EO stated as Patient will have an improved ejection fracture within 2 days but now I am thinking this isnt possible. After reading through my books and journals it seems as though an ejection fracture seldom improves and when it does they dont know why?! And now my EO sounds more like a MD problem than a RN one. I have made some NI for this EO but I am not sure if they are even accurate or good. Here is what I have so far 2a. Assess ejection fracture 2b. Monitor lab results daily 2c. Review results of diagnostic imaging (ECG, EKG, radionuclide) Q shift 2d. Administer Coreg, nitrate, rouvastatin ,Lasix, spironolactone, Norvasc, Lisinopril, Spironolactone as scheduled 2e.Consult with case manager to refer to cardiac rehabilitation program for education, evaluation. And guided support to increase activity Do you think I am on the right track with using EF as a EO? Or should I change it? If I change it, what else would show decreased cardiac output? His BP is not bad, he has no peripheral pulses but that is more r/t neuropathy I think... His HR is WNL and well controlled on his current medications....thanks in advance

God is good! Congrats on the RN program! I will be starting Aug 20th as well. I am nervous and excited in the same breath! I know God will see us through these next two yrs though

Thank you so much for your post. I am so nervous starting my program! I also have my BA with science in the background like others. I have three small children and I had to leave my job to accept NS. I use to work 50 plus hrs a week with the commute so I am not afraid of the time away from the fam....I can make that work! The financial issue is my biggest hurdle. I really need to work at least 15 hrs a week to help my husband with the expenses. We are trying to see how long we can survive off of the income we have now but thats is where my anxiety loves. Did I make the right decision or is it selfish? I already have two BA!! Ugh! Your post really helps me and gives me positivity. So often we hear the negatives about NS I am glad you gave both sides. I know it will be hard and I hope so...we are training to care for peoples LIVES. :) Thanks again!

Congrts to all that recieved the scholarship! I am praying I can recieve it too but if not it wasnt part of Gods plan! NS will be tough without it but I am going to try my best to succeed!!

I have so much anxiety about starting its crazy! I keep thinking can I do it, am I smart enough, what about my kids? Will they be okay? Will I pass my clinicals etc etc. Its nerve racking but I try to have faith that God will see me through and if its meant to be it will be!

So happy for you! Go make it count! Become a great RN