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Pain
• Commonly accompanies ↓ in circulation-compensatory mechanisms body tissues
switch from aerobic to anaerobic metabolism (inadequate circulation fail)
• By product of anaerobic is lactic acid
• Lactic avid irritates nerve endings and produces pain
• Restoration of circulation is priority to prevent damage to tissues and nerves
Anxiety
• ↓ circulation
• Pain
• Cerebral hypoxia
• Brain needs constant O2 to function
Activity Intolerance
• Assess tolerance level
• muscles with ↓ O2 supply fatigue quickly
Planning
Outcomes depend on chronic/acute cardio problems
DIET
LOW CHOLESTEROL/ FAT DECREASES FATS AVAILBLE TO
FORM ATHEROSCLEROTIC DEPOSITS
O AVOID FATS ESPECIALLY COCNUT OIL
O REMOVE SKIN BEFORE COOKING
FATS PROVIDE 9KCAL/G – CARBS AND PROTEIN 4KCAL/G
EXERCISE
o INCREASES PROPORTION OF HDL’S IN BLOOD
o HDL’S PROTECT BLOOD VESSELS
o STIMULATES DEVELOPMENT OF COLLATERAL CIRCULATION
AND NEW BLOOD VESSELS
o EXERCISE REGULALY/ENERGETICALY
o RYTHMIC CONTRATIONS OF LARGE MUCSLES
o 3-5 TIMES/WEEK 20-30- MIN/SESSION
o CHECK PULSE MAINTAIN TARGET RATE FOR 20 MINUTES
PREVENTING VASOCONTRICTION
Causes of vasoconstriction
IMPROPER POSITION COLD TEMP, NICOTINE, EMOTIONAL
STRESS
Positioning
Frequent repositioning
Do not cross legs for prolonged time
Do not place pillows behind knees
Do not use knee elevator on Gatch bed
Elevate legs for venous insufficiency uses gravity to improve
circulation
Stocking for external support/minimize venous pooling
Cold Temperatures
Dress warm to minimize vasoconstriction
Nicotine
Vasoconstriction
Gum/patches help
American Heart Association, American Cancer association sponsor
community programs
Emotional stress
Activates flight/fight response---vasoconstriction diverts blood to
essential organs
To reduce deep breathing, relaxation, imagery
Administering Medications
High risk clients anticoagulant therapy
Antiplatelet aggregates (acetylsalicylic acid-aspirin and
clopidogrel-Plavix) reduce stickiness
Anticoagulants
o Interrupt step in clotting cascade
o Warfarin ( Coumadin) and Heparin- risk for bleeding
o PT/ INR for Coumadin
o PTT for Heparin
o Report to MD before giving
o Assess for signs of bleeding
Vasodilating medications-enlarge lumens of blood vessels-
greater blood to tissues
o Nitrates: Nitroglycerin (Nitro-Bid, Transderm-Nitro)
Relaxes smooth muscle/decreases venous return
and preload
Dilates coronary vessels
Dilates systemic vessels/decreasing afterload
Side effects
o Headache
o Flushing
o Hypotension
Nursing Responsibilities
o Monitor B/P – *position change
o Report dizziness, headache
o Avoid alcohol
Side effects
o Hypotension
o Dizziness
o Constipation
o Peripheral edema
Nursing Responsibilities
o Monitor v/s
o Encourage intake- fluids/fiber
o Assess for edema
o Report all meds to MD-interaction (Digoxin, GI
meds)
Beta-Adrenergic Blockers
Carvedilol (Coreg)-Metoprolol (Lopressor, Toprol) Atenolol (Tenormin),
Labetalol (Normodyne)-
Side effects
o Fatigue
o Hypotension
o Bradycardia
o Insomnia
o Depression
o Heart failure
Nursing Responsibilities
o Monitor B/P, pulse
o S/s heart failure
o Consult before exercise
o Never discontinue abruptly
Interventions To Improve Cardiac Output - primary nursing goal lessen need for
O2 at tissue level – ease heart’s workload
○ Promoting rest
○ conserves energy-decrease O2 demand
○ rest periods
○ assist with ADL’s
○ monitor v/s, skin color-before, during, after activity
○ place items in reach
○ quiet environment-darkened room-relaxing music
• Inotropic Meds
○ Increase contractility of heart muscle, thereby increasing cardiac output
○ Digoxin (Lanoxin) common inotropic med
○ Apical pulse 1 min before giving
○ Report AP < 60 and >110
○ Check potassium low K+ predisposes to digitalis toxicity
○ Digoxin level (0.5 to 2.0 mg/mL)
• Antidysrhythmic meds (?)
• Antihypertnsive meds
○ ACE inhibitors to treat left ventricle systolic dysfunction
○ Superior to digitalis in reducing mortality rate
○ Meds that lower B/P-nitrates (nitroglycerin), captopril (Capoten, Nifedipine
( Procardia)
○ Ease workload and improve cardiac output
○ Dilation decreases afterload, enables heart to eject blood with less effort
○ Monitor B/P
○ Check for orthostatic hypotension=decreases B/P when position changes
from lying to sitting to standing
○ Check for dizziness, lightheadedness
○ Prevent falls-call for help, sit on side o bed before standing
Increasing O2 supply: clients with impaired cardiac output deliver less O2-rich blood to
tissues
• Administering O2
○ Need carful balance between O2 demand a and supply
○ See chapter 34
• Avoiding Smoking
• Positioning to facilitate breathing
○ Elevating HOB facilitates respiration by shifting abdominal organs
downward and providing maximum space for expansion
Interventions to prevent peripheral neurovascular dysfunction
• Largely preventable
• Identify at risk clients
• Detect early S/S
• Carful assessment cornerstone
• Follow protocol for casts and angiography
• Assess involved extremities for color, temperature, pulses, numbness, tingling,
pain
• Objective symptons:Pale , cold skin, decreased or absent pulses require
immediate attention
• Subjective symptoms: numbness, tingling, pain- instruct client to report
• Elevate to reduce edema
• Encourage movement of extremity to enhance venous return
• Notify MD of abnormal findings
• Immediately report-absence of pulse, pallor, pain, paralysis
Intervention to manage shock
Client usually In ICU,
Manifestations of shock
• Rapid, weak, thready pulse
• Rapid shallow respirations
• Systolic B/P <90
• LOC restlessness progressing to lethargy
• Skin pale, cool, clammy
• Urine output <20mL/hr
• Increase thirst
Maintaining O2
• Depends on cause
• Hypovolemic shock elevate feet 15 to 20 inches above heart level-uses gravity to
increase venous return helping to maintain stroke volume
• Cardiogenic shock can not expel blood effectively from heart- position for
decrease venous return- semi-fowlers to high-fowler-position not always straight
forward check MD orders and s/s
Maintaining circulating Blood Volume