Medical Diagnosis Pathophysiology

Impaired cardiac function Right bundle branch block (RBBB) is a cardiac

conduction abnormality that affects the
Medications
electrical signaling within the heart. In a healthy
NACL 0.9
heart, electrical impulses travel from the
IV 75mL/hr
30 days/continuous sinoatrial node to the atrioventricular node and
Nursing Diagnosis then to the bundle of His, which divides into the
Zofran Impaired cardiac function related to right bundle left and right bundle branches to activate the
4 mg branch blockage as evidenced by ECG changes left and right ventricles. In RBBB, the electrical
q6hrs PRN Nausea and symptoms of dyspnea, chest pain, and impulses are delayed or blocked within the
IV Push dizziness. right bundle branch, causing a delay in the
Morphine activation of the right ventricle. This can lead to
2-4 mg impaired cardiac function, including a decrease
PRN Pain 7-10 in cardiac output and an increased risk of
IV Push arrhythmias. The ECG changes associated with
Goals RBBB include a widened QRS complex and a
Aspirin characteristic pattern of ST-T wave changes.
325 mg QID, PRN, PO  Patient will maintain stable vital signs
Patients with RBBB may experience symptoms
within acceptable limits by end of shift.
Nitroglycerine such as dyspnea, chest pain, and dizziness,
 Patient will demonstrate hemodynamic by
(Nitrostat) which can be attributed to reduced cardiac
end of shift
1 tab 2.5 mg output and decreased oxygenation. Treatment
nitroglycerine, if not of RBBB may involve medication or other
relieved within 5 min interventions such as pacemaker implantation
administer a second or catheter ablation to restore normal cardiac
tab. PO, PRN
conduction and improve cardiac function.

Assessment data to support nursing

diagnosis
Support system Developmental
Subjective Data:

Wife, 2 Pt reports SOB Despair vs.

daughters, 1 son. Pt reports, “I have pain in my chest”. Integrity

Objective Data: Pt falls into

Pt ECG shows RBBB and ST elevation. Capillary refill is despair due to
1+, O2 saturation is 86% on room air. inability to
complete ADL,
related to fatigue.

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 Diagnostic exams,
Complications Laboratory test and results
& information related to nursing diagnosis
to report to MD Nursing Interventions
Troponin I, Troponin T
 h 1. Monitor the patient's oxygen saturation and (Cardiac Enzymes)
Elevated Troponin provide O2 via NC 4L. Results:
levels T1 (18:00) 16.4
2. Administer medications as prescribed. T2 (19:00) 25.5
Dyspnea w/low O2 T3 (20:00) 52
3. Monitor the patient's fluid balance and
stats electrolyte levels, and administer intravenous fluids
TT Positive
ECG
or diuretics as prescribed. 5 lead, continuous monitoring
ECG abnormalities Pt ECG shows widened QRS of
Chest Pain 1. Assess electrolytes levels q4hr. greater than 120 milliseconds,
elevated T waves, V6- showing
2.Asses troponin levels q1hrx3, asses q4hr inverted T waves
thereafter.

3. Administer medications and fluids as prescribed

to achieve hemodynamic stability.
Treatment
Plan/Procedures
 Continuous 5 Lead cardiac monitoring
 Monitor for DVTs
 Continue monitoring Troponin Levels.
 Monitor Pain
Scientific Rationale  Monitor )2 stats
1. Pts w/ low O2 saturation need supplemental O2 due to the
heart’s inability to pump oxygen-rich blood to the body.
Patient Teaching
2. Vasodilators open arteries/veins to allow for decreased vascular
resistance, increasing cardiac output and reducing ventricular
workload. Morphine and anti-anxiety medications help with
relaxing and calming the patient which can reduce cardiac
 Educate pt on activity limitations, provide guidance to
workload. Angiotensin receptor blockers (ARBs) lower blood
perform activities within limitations. Include
pressure and make pumping blood easier for the heart.
recommendations for modifying activities. Provide
information on the signs and symptoms of cardiac stress.
3. Pts with Mi have impaired heart function. Monitoring fluid
balance is important to identify and manage any imbalances to
 Educate pt on activity modification to prevent
prevent complications like heart failure, pulmonary edema,
overexertion and keep vital signs WNL,
and renal failure.

1. An MI can cause electrolyte imbalances that effect heart function

leading to further complications.

2. MI can cause cardiac enzyme levels to elevate.

3. Administer morphine, O2, nitroglycerine, aspirin can help

manage symptoms of MI.

Evaluation of Interventions

Pt has maintained normal ECG pattern

within the last 4 ours.

Goal(s)Met Pt labs reveal a slow decrease in

Partially Met
Troponins.
1.Goal met. Pt shows Normal ECG &
decreasing Troponins. Pt electrolyte values showing a trend
toward normal limits.
2.Goal met: Pt electrolyte levels
stabilizing.