Care of the clients with Cardiovascular Disorders

Assessment of the clients with Cardiovascular Disorders

Nursing history
✔ The factors may be classified as follows
• Non-modifiable risk factors
• Modifiable risk factors
Non-modifiable risk factors

Age
Gender
Race
Heredity
Modifiable risk factors

Stress
Diet
Exercise
Cigarette smoking
Alcohol
Hypertension
Hyperlipidemia/hypercholesterolemia
Diabetes mellitus
Obesity
Personality type or behavior factors
Contraceptive pills
Angina pectoris

Main Problem: Insufficient coronary blood flow results to inadequate oxygen supply to the
myocardium causing intermittent chest pain. Precipitating factors such as exertion, emotions,
eating heavy meal and environment
Clinical manifestation:
Squeezing chest pain
Burning chest pain
Pressing
Choking
Aching or bursting left sternal chest pain lasting not more than 30 minutes
Pallor
Diaphoresis

 Faintness
Palpitations
Dizziness
It feels like gas, heartburn or indigestion
Diagnostic test: electrocardiogram (ECG), stress test
Nursing diagnosis: Pain
Nursing Interventions:
Administer nitroglycerine sublingually to relieve the pain. Nitroglycerine therapy
✔ Teach the patient that a burning sensation under the tongue after nitroglycerine indicates
that the drug is potent
✔ The drug may cause facial flushing, headache, dizziness, faintness, tachycardia, these
are common during first few doses of the medication, do not discontinue the drug
✔ NTG may be administered 3x with 5 mins interval
✔ Assume sitting or supine position when taking the drug (to prevent orthostatic
hypotension)
✔ Gradual change of position to orthostatic hypotension
✔ Sublingual route produces onset of action within 1 to 2 minutes, duration of action is 30
minutes
✔ Offer sips of water before giving sublingual nitrates, dryness of mouth may inhibit drug
absorption
✔ Instruct client to avoid drinking alcohol, to avoid hypotension, weakness and faintness
✔ Advise client to always carry three tablets in his pocket
✔ Store NTG in cool, dry place, use dark/amber colored, air tight container (may be
destroyed by heat, light or moisture)
✔ Change stock of NTG every 6 months
✔ Transderm - nitropatch is applied once a day, usually in the morning, rotation of skin sites
is necessary, usually on the chest wall
✔ Evaluate the effectiveness; relief of chest pain
Prepare patient for Percutaneous Transluminal Coronary Angioplasty (PTCA)
✔ Mechanical dilatation of the coronary vessel wall by compressing the atheromatous
plaque
✔ It is recommended for clients with single - vessel coronary artery disease
✔ A specially designed balloon - tipped catheter is inserted under flouroscopic guidance
and advanced to the site of the coronary obstruction
Diet - low Na, low fat and low cholesterol, high fiber diet
Arrythmias

Main Problem: Abnormal electrical conduction or automaticity changes in the heart rate or
rhythm which affects cardiac output and blood pressure
Clinical manifestation:
Hypotension
Deteriorating level of consciousness
Diagnostic test: electrocardiogram (ECG)
Nursing diagnosis:
Ineffective tissue perfusion: cardiopulmonary
Decreased cardiac output
Nursing Interventions:
Watch out for hypertension
Assist with measures to flow treat underlying cause (electrolyte replacement, oxygen therapy
and pulmonary care
Hook on cardiac monitor and assess level of consciousness, RR, PR, BP and fluid and
electrolytes balance
Perform Advanced Cardiac Life Support (ACLS) measures
Administer antiarrythmics lidocaine, inderal, cordarone - hypotension common side effect,
perform CPR and intubation prn
Prepare patient for possible pacemaker insertion