Medical Management

DIET: Low Salt, Low Fat, Free Of Simple Sugar Diet A healthy heart diet means eating the right foods to control the weight and lower the risk for heart disease. Eating low fat foods and high fiber foods helps control the amount of cholesterol in the blood. This helps prevent hardening of the arteries and heart attacks. Low Salt Diet

A low salt (low sodium) diet may reduce extra cellular volume, thus reducing preload and afterload, and thus myocardial oxygen consumption. The purpose of sodium restriction is to decrease the amount of circulating volume, which would need for the heart to pump that volume. Furthermore, an estimated 40% of people with hypertension are sodium sensitive. Restriction of sodium intake can be used to lower blood pressure in some cases of Stage 1 hypertension. Sodium restriction may reduce the degree of potassium depletion that often accompanies diuretic therapy. In short, this helps control the blood pressure and also improves the health of your heart.

Usually, when a client has hypertension or other cardiac problems, they are asked to reduce sodium consumption by avoiding: a.) canned soups, ketchup, and mustard, b.) salted, smoked, cured, or pickled meats (e.g. ham and bacon), poultry and fish, c.) adding salt when cooking foods or at the table.

 Low Fat Diet

Modification of dietary intake of fat by decreasing the fraction of saturated fat and increasing that of polyunsaturated fat has little, if any, effect on decreasing blood pressure but can reduce the cholesterol level significantly. Because dyslipidemia is a major risk factor in the development of coronary artery disease, diet therapy aimed at

reducing lipids is an important adjunct to any total dietary regimen. In addition to the usual recommendations for sensible eating following the food pyramid, the dietary approaches to stop hypertension (DASH) diet which is rich in fruits, vegetables, nuts and low fat dairy foods with reduced saturated and total fats, should be recommended for clients who need a more structured, fat-limited dietary intervention.

Free of Simple Sugar

Diet prescribed in treatment of Diabetes Mellitus, it usually contains limited amount of simple sugars or readily digestible carbohydrates and increased amount of protein, complex carbohydrates and unsaturated fats.

Nursing Considerations:

Instruct the patient to strictly comply with the prescribed diet, modifying calories, fat, and sodium as prescribed.

Instruct to avoid large meals and hurrying while eating. Encourage patient to avoid caffeine-containing beverages, because caffeine can affect heart rate, rhythm and blood pressure.

Explain to the patient that she will be required a special meal plan to help control her blood glucose level.

Discuss concentrated sweets (food high in simple sugars) with the patient. Arrange for a dietitian to teach the patient how to plan her meal

INTRAVENOUS FLUIDS (IVF) : D5W Fluids that are classified as isotonic, such as D5W, have a total osmolality close to that of the ECF and do not cause red blood cells to shrink as well. The composition of these fluids may or may not approximate that of the ECF. Isotonic fluids expand the ECF volume. One liter of isotonic fluid expands the ECF by 1L; however it expands the plasma by only 0.25 L because it is a crystalloid fluid and diffuses quickly into the ECF compartment.

D5W is used as an Adult intravenous solution to keep vein open, vehicle for mixing medications for I.V. delivery for all age groups, and may be the primary adult I.V. fluid for medical emergencies, though many services use only L.R. or N.S.

Nursing Interventions in Administering Intravenous Fluid:

Prepare the client.

a. Explain the procedure to the client before the procedure to allay anxiety.

b. A venipuncture can cause discomfort for a few seconds but there is no discomfort while the solution is on going.

Administer intravenous fluid as ordered.

a. For fluid and electrolyte balance.

Observe and monitor flow rate, and patency of the tubing. a. Check the physicians order for solution to be infused and determine the rate. Infusions that are off schedule can cause harm to the patient.

b. To check for the patency, lower the IV bottle below the incision site and observe for the return of blood coming from the vein, if blood comes out this indicates that the needle is in place. Blood returns in this instance because venous pressure is grater than the pressure in the IV tube.

Inspect the insertion site for fluid infiltration and bleeding.

a. The escape of IV fluid into the interstitial tissues often causes swelling.

ACTIVITY: Complete Bed Rest Without Bathroom Privileges

Complete bed rest without bathroom privileges are initiated simultaneously to help preserve the myocardium and are used to reduce oxygen demand.

Nursing Considerations:

Instruct patient to avoid any activity that produces chest pain, dyspnea, or undue fatigue.

Avoid extremes of heat and cold and walking. Offer bedpans and or urinals when needed.

OXYGEN THERAPY

AIM: To supplement a patient with oxygen safely and effectively. To reverse hypoxemia.

Oxygen therapy was given to provide extra oxygen to the tissues of the body through the lungs especially when the patient has respiratory distress.

Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly. The body needs oxygen to survive. The heart relies on oxygen to beat and pump blood, its hard for the tissues of the heart to keep pumping. The way oxygen is given depends on the persons age the condition being treated. Children may need to use an oxygen mask or tent. Oxygen therapy was given to provide extra oxygen to the tissues of the through the lungs especially when the patient has respiratory distress, dyspneic episodes. NURSING MANAGEMENT: Ensure equipment is functioning correctly at beginning of each shift. Patients requiring oxygen therapy should have their oxygen saturation checked with a pulse oximeter continuously. Arterial blood gases should be taken as ordered or if there is concern about patients condition

 Oxygen level is checked and documented (including amount of supplemental oxygen and SpO2 levels): Streptokinase Infusion

Streptase, Streptokinase, is a sterile, purified preparation of a bacterial protein elaborated by group C (beta) -hemolytic streptococci. It is supplied as a lyophilized white powder containing 25 mg cross-linked gelatin polypeptides, 25 mg sodium Lglutamate, sodium hydroxide to adjust pH, and 100 mg Albumin (Human) per vial or infusion bottle as stabilizers. The preparation contains no preservatives and is intended for intravenous and intracoronary administration. Acute Evolving Transmural Myocardial Infarction: Streptase, Streptokinase, is indicated for use in the management of acute myocardial infarction (AMI) in adults, for the lysis of intracoronary thrombi, the improvement of ventricularfunction, and the reduction of mortality associated with AMI, when administered by either the intravenous or the intracoronary route, as well as for the reduction of infarct size and congestive heart failure associated with AMI when administered by the intravenous route. Earlier administration of Streptokinase is correlated with greater clinical benefit. Intravenous infusion of Streptokinase is followed by increased fibrinolytic activity, which decreases plasma fibrinogen levels for 24 to 36 hours. The decrease in plasma fibrinogen is associated with decreases in plasma and blood viscosity and red blood cell aggregation. The hyperfibrinolytic effect disappears within a few hours after discontinuation, but a prolonged thrombin time may persist for up to 24 hours due to the decrease in plasma levels of fibrinogen and an increase in the amount of circulating fibrin(ogen) degradation products (FDP). Depending upon the dosage and duration of infusion of Streptokinase, the thrombin time will decrease to less than two times the normal control value within 4 hours, and return to normal by 24 hours. Intravenous administration has been shown to reduce blood pressure and totalperipheral resistance with a corresponding reduction in cardiac afterload. These

expected responses were not studied with the intracoronary administration of Streptase, Streptokinase. The quantitative benefit has not been evaluated. Nursing Responsibilities: Discontinue heparin, unless ordered specifically coronary artery infusion. Arrange for regular monitoring of coagulation studies. Apply pressure dressings to control superficial bleeding (at invaded or disturbed areas) Avoid any arterial invasive procedures. Arrange for typing and cross-matching of blood serious blood loss occurs whole blood transfusions are required. Institute treatment within 2-6 hrs. Of onset of symptoms for evolving MI; within seven days of other thrombotic event. Monitor cardiac rhythm continually during coronary artery infusion.