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Cardiac Problems ASSESSMENT DATA (Appropriate data to support nursing diagnosis, include subjective and objective data) NURSING DIAGNOSIS (Must include scientific rationale for the diagnosis, include references*) PLANNING I. Goals (include realistic short and long term client- centered goals) A.Short Term B.Long Term II. Nursing Interventions NURSING IMPLEMENTATION (What actually was done, must include scientific rationale with references and delegation of tasks*) EVALUATION (Actual outcome of care and appropriate follow-up actions) Objective Subjective O: Pulse: High 112 B/P: High 154/108 Tachycardic w/ S3 gallop Hypertension 3+ pitting edema: feet and ankles, eight pounds gain. S: Client reports: Shortness of breath Fatigue, dry, hacking cough, swelling in feet. Patient states "I take care of my wife". Decreased Cardiac output R/T left sided heart failure as evidenced by Systolic BP is >100. Risk for Impaired tissue integrity R/T Edema as manifested by swelling in feet and ankle. Scientific Rationale: In addition to the increased risk of injury to the skin from edema, loss of perivascular collagen in the small vessels of the skin makes them more susceptible to damage. Risk for Activity Intolerance R/T dyspnea upon exertion. Scientific Rationale: Response to activity can be evaluated by comparing preactivity BP, pulse and respiration with postactivity results. These in turn, are compared with recovery time. Pg 101 Risk for caregiver role strain R/T Patient sole caregiver of wife. Scientific Rationale: Respite and the sharing of care responsibilities are vitals to prevent the caregiver-care recipient dyad from becoming the center of the universe, with all others viewed as less competent or less essential. STG: Patient will maintain adequate fluid volume and electrolyte balance as evidenced by vital signs by the end of the shift LTG: STG: Patient will exhibit decreased edema from his feet and ankle by day two LTG: Client will demonstrate knowledge on proper dietary intake by discharge. 1.Monitor daily and weekly dietary intake of food and fluids. 2.Assess client's knowledge of diet, medications and the use of knee high stocking to reduce pressure on skin areas 3. Teach client to decrease salt intake by reading the labels for sodium content and by cooking without or minimal salt. 4.Teach client to plan weekly menu that provides protein. 5.Assess client's skin for redness and blanching. STG: Clients will perform active range of motion (ROM) at least twice a day. LTG: Client will progress activity by walking from his room to the nurse's station twice a shift. 1.Monitor client's response to activity 2.Assess client's BP, pulse, respiration 3.Assess client's capability for increased activity 4.Encourage gradual increases in activity and ambulation to prevent a sudden increase in cardiac workload. 5.Teach on how to control breathing for use during increased activity STG: Client will relate a plan on how to continue social activities despite caregiving responsibilities by the end of the shift. LTG: Client will establish a plan for weekly support before discharge. 1.Encourage client to accept offers of help. 2.Assist client to identify activities for which he desires assistance. 3.Encourage client to set realistic goals for self and wife. 4.Assist client with accessing informational and instrumental support Pt fluid balance assessed by measuring input and output, Pt vital signs and weight were implemented by UPA. Pt wore stocking to promote venous return and edema from ankle and feet. Pt walked twice a shift from room to nurse's station without assistance with no complains of insufficient energy.I Assessed fluid balance and measured input and output and Vital signs in expected range. Edema from feet and ankle not present. Patient verbalizes having sufficient energy to complete desired activities.

hi I need help with my care i finished it already but my professor told me that i have to make some changes in it but i do not know what i did wrong. Case Study #4 Cardiac Problems ______________________________________________________________________________ Case Scenario: Mr. John Jamison exertion (“I get so out breath when I walk to the corner of our street”), fatigue, a dry, hacking cough, and sudden swelling in his feet. He states, “I had an eight pound weight gain overnight”. He has a history of hypertension with poor control, despite taking atenolol 10mb every day (q.d.). Upon physical exam, Mr Jamison is tachycardic with an S3 gallop, and has expiratory crackles in the bases of both lung. His feet and ankles have 3+ pitting edema. His vital signs are T= 98.2, P = 112, R = 26, BP = 154/108. Mr. Jamison lives with his wife at home and “takes care of her because she has had several mild strokes”. He states that they have one adult child in the area, who comes to visit them every week. And, Mr. Jamison states that they have live in the area of over 30 years and consequently have many friends in the nearby region. His laboratory and diagnostic results are: Sodium: 142 mEq/L Potassium: 3.9 mEq/L Chloride: 100 mEq/L Creatinine: 1.0 mg/dl BUN: 15 mg/dl Hgb: 15.0 g/dl TSH: 2.5 uU/ml Chest x-ray: left ventricular hypertrophy ECG: normal sinus rhythm., age 67, comes to his primary care provider complaining of dyspnea with mild

my case scenario: Endocrine Problem have a hard time to come up with Implementation & evaluation : 41 years old Hispanic female complaints with weight gain, muscle weakness, and fatigue, noticed that her skin is fragile and bruises easily. states she has difficulty rising from low chairs. her last menstrual period was 8 months ago. has truncal obesity with thin arm and legs. has moon-shaped face and coorifice , thin hair , dorsocervical fat pad. abdomen has purple striae, has 1+ non-pitting edema in her feet. diagnose with Cushing's Syndrome 64 IN height , weighs 170 lbs vital signs on admission are: P =72, R=18, B/P=152/96, T=98.2 *F LAB VALUES: PLASMA CORTISOL LEVEL AT MIDNIGHT: 12.6ug/dl 24 hour urine sample for free vortisol: 375ug/24 hours dexamethasone suppression test: 12.2 ug/dl TSH: 2.2 mU/L FASTING BLOOD GLUCOSE: 122mg/dl