Heart Attack Patient Care Plan

Heart Attack Patient: Care Plan
Student’s Name
University Affiliation
Heart Attack Patients: Care Plan
Background Information
Handling patients with heart problems is quite complex, and medics in the related field
need to have detailed knowledge about the disease and cause agents as well as understanding a
victim’s concerns in an accurate manner. This care plan involves a patient that got a heart attack
problem at home, advanced in age, allergic to sulfate supplements, tape, codeine and related
essentials while showing anaphylactic reactions. Fortunately, the patient is aware of the disease
which makes the approach less complicated. The problem is one that pressurizes medical
facilitators since one is required to act promptly and precisely regardless of the situation.
The patient’s fact sheet indicated historical data essential in the treatment process since
the patient usually uses a nasal cannula in case the levels of oxygen go down. Related medical
diagnoses include COPD, Respiratory Alkalosis, Respiratory Acidosis, Rheumatoid arthritis,
thrombocytopenia. Each has a separate function although they help to examine the root of the
problem in exactness. Other details vital towards the patient’s medication include the present
medication as she takes Aspirin to reduce the risk of heart attack, Docusate against constipation,
Synthroid to control hypothyroidism, Benadryl against allergies, Neurontin due to seizure issues,
and Lisinopril for the treatment of high blood pressure. There is no surgery history up to date.
In assessment as well, the existing details indicate a patient in critical condition as the
information available indicated the use of ambulation aids, the use of high glasses although she
was good in hearing. She isn’t in a stable condition considering that she preferred a different lab
setting but not able, has labored breathing and mostly orders cardiac diet which is a major
prescription for CHF patients. However, despite the situation at hand, the patient demonstrates
satisfactory progress and transitional home care can as well be a perfect option.
Laboratory and Diagnostic Tests
Several particular tests are vital for patients with such signs and symptoms. In the lab, a
medical practitioner can carry out drug level tests, chemistry analysis, hematology or coagulation
tests. In other cases, it is important to combine several or all for better results. In this case, the
laboratory tests included glucose and platelets test. The latter is for patients who usually have an
indication for high carbohydrate intake while the former is in situations where a patient has
thrombocytopenia which leads to low platelet levels. Another important examination includes
sodium checks necessary when a patient receives a lot of fluids via IV. Other important tests
include EKG and cardiac arrest test. On the same case, Chest X-ray is quite necessary if a patient
complains of SOB, chest pain, dyspnea and heart attack. If it happens to be the case, the RN
gives pain medicine before the procedure, and helps in repositioning during the process and
monitors the vital signs. After the procedure, the RN makes sure that the patient is stable enough
and does not complain of SOB. Far from that, it is essential to carry out aluminum tests for
patients receiving a lot of fluids via IV as well as AST and ALT for liver damage checks.
In advanced cases, CT scan is essential with contrast to rule out PE. In this case, RN
gives normal saline because the contrast dye used can cause kidney damage. During the
procedure, the RN assists in repositioning the patient and monitoring the vital signs. After the
procedure, the RN assesses the patient to make sure there is stability, and all the VS are stable
and measure the urine output as he/she continues to diuresis the patient. The diagnostic and
laboratory tests serve each other to provide diverse information about the patient’s condition and
should take place in conjunction as per the case.
Medication Procedures
When a person is healthy, the chest wall should be intact with no tenderness and masses.
There should be a full and symmetric expansion and the thumbs separate 2-3 cm during deep
inspiration when assessing for the respiratory excursion. The spine should be vertically aligned.
The right and left shoulders and hips are of the same height. However, the patient showed
crackles on the lung bases, and she manifested labored respirations. Moreover, with cardiac
impulses, one is expected to have strong pulses bilateral, no edema present, and there should be
no visible pulsations on the aortic and pulmonic areas. There is no presence of heaves or lifts,
and S2 is louder than S1. The patient showed Tachypnea, no edema present, but had diminished
pulses. These signs are possibly the cause of the attack.
In treatment procedures, different medications work differently in this situation. One that
is highly useful is Famotidine (Pepcid) although the patient is known to be hypersensitive to
other H2-receptor antagonists. Other medications include histamine H (2) although it causes
seizures in renal disease Dysrhythmias, and QT prolongation (impaired renal functioning). The
main reason for giving the patient this medication is the indication of Gastroesophageal reflux
disease, and the patient complains of chest pain and heartburn. However, it is vital for The RN to
teach the patient and the family that it is necessary to consume the product must for the
prescribed time and as advised to be effective; not to double dose.
The other medication is Enoxaparin(Lovenox), taken in units of 30mg a day for adults.
As an anticoagulant and highly antithrombotic, Lovenox helps against the risk of thrombosis. Its
major adverse reactions include hemorrhage, hypochromic anemia, thrombocytopenia, and
bleeding. As a nursing consideration, the medics are advised to teach the patient’s and family to
use a soft-bristle toothbrush to avoid bleeding gums. Also use an electric razor and report any
signs of bleeding gums. Bleeding is possible under the skin, in urine, stools, and to avoid OTC
products containing aspirin unless the prescriber approves it.
Another option is Furosemide(Lasix) which is loop diuretic. Its dosage is 40mg, and it is
vital for pulmonary edema; edema with CHF, hepatic disease, nephrotic syndrome, ascites, and
hypertension. Adverse effects include rash, pruritus, purpura, Stevens-Johnson syndrome,
sweating, photosensitivity, and urticaria. Regarding that, it is crucial to assess the BP while lying
and standing but postural hypotension may occur. It is necessary and highly recommended to do
metabolic alkalosis, drowsiness, and restlessness checks. Angiotensin-converting enzyme (ACE)
inhibitor is effective for hypertension problems. Taken in 2.5MG PO daily routine quantities its
only setback is its association with blurred vision, nasal congestion, nausea, vomiting, and
anorexia. Medics recommend patients to rise slowly to sitting or standing position to minimize
orthostatic hypotension and to avoid increasing potassium in the diet.
Nursing Diagnoses
Problem: Impaired gas exchange which is related to ventilation-perfusion imbalance. The
patient complains of a headache upon awakening, and is hypoxic, while the O2 is 88%. Other
signs include irritability and restlessness.
Outcomes: The patient will clear lung fields and remain free of evidence of respiratory
distress during the period at the hospital. Secondly, she should be able to exhibit improved
ventilation and adequate oxygenation as demonstrated by blood gas levels within normal
parameters, and thirdly, maintaining 95% oxygen saturation before the end of the shift.
Interventions: The RN will monitor oxygen saturation continuously using pulse oximetry
and note blood gas results as available, and use non-rebreather to increase the oxygen rate. The
RN will also monitor respiratory rate, depth, and ease of respiration, and watch for the use of
accessory muscles and nasal flaring throughout the shift. Moreover, the RN will calculate breath
sounds every 1 to 2 hours. The presence of crackles and wheezes may alert the nurse of airway
Nursing Diagnosis 2: Decreased cardiac output
It is caused by altered heart rhythm. The outcomes conclude the patient demonstrating
adequate cardiac output as evidenced by blood pressure, pulse rate and rhythm within standard
parameters before discharge. Secondly, the patient has no chest discomfort, and ability to tolerate
activity without symptoms of dyspnea, syncope, or chest pain before the end of the shift.
Nursing interventions: The RN will recognize primary characteristics of decreased
cardiac output as fatigue, edema, and dyspnea before the end of the shift. Secondly, the RN will
monitor orthostatic blood pressures and daily weights every shift. Thirdly, the RN will watch
laboratory data carefully, especially arterial blood gasses, CBC, electrolytes including sodium,
potassium, and magnesium, and B-type natriuretic peptide every shift.
“Risk for” nursing diagnosis: Depression
Depression from the patient’s inability towards self-care and those she is supposed to serve.
Outcomes: The patient will identify and verbalize symptoms of anxiety before the end of the
shift. Secondly, the patient will manage posture, facial expressions, gestures, and activity levels
that reflect decreased distress after 4 hours.
Nursing interventions: The RN will assess the patient’s level of depression and physical
reactions to the concern. Symptoms evaluated are mood, tension, fear, insomnia, concentration,
worry, depressed mood, somatic complaints, and cardiovascular, respiratory, gastrointestinal,
genitourinary, autonomic, and behavioral symptoms. Secondly, the RN will explain all activities,
procedures, and issues that involve the client; the RN will use nonmedical terms and calm, slow
speech in advance of methods and validate the patient's understanding every shift. Thirdly, the
RN will use therapeutic touch, healing touch techniques and use empathy to encourage the client
to interpret the depression symptoms as normal before the end of the shift.
Routine Nursing Management
Roles were limited to monitoring, interpreting response results, general patient care, and
patient education. Most importantly, spending significant time with the patient helps to analyze
and interpret the situation correctly which helps in sound medical decisions. In testing
procedures, I was responsible for assessing the patients’ problem level and physical reactions
that stem from subsequent treatment. In particular, I was involved in monitoring orthostatic
blood pressures and daily weights in every shift. I could also watch laboratory data carefully,
especially when applying arterial blood gasses. Other duties included analysis and explanations
where I could explain all activities, procedures, and issues that involve the patient to others.
Major observations in Intervention and Management
Firstly, as an intervention, an oxygen saturation of less than 88% (normal: 95% to 100%)
or a partial pressure of oxygen of less than 55 mm Hg (normal: 80 to 100 mm Hg) indicates
significant oxygenation problems. Pulse oximetry is useful for tracking and adjusting
supplemental oxygen therapy for clients with COPD (GOLD, 2015). Normal respiratory rate is
14 to 20 breaths per minute in an adult (Bickley &Szilagyi, 2012). In severe exacerbations of
chronic obstructive pulmonary disease (COPD), lung sounds can diminish or distant with air
trapping (Bickley &Szilagyi, 2012). Generalized depression disorder is the most common
anxiety with a 12-month prevalence of 3.1% in a population-based survey and between 5.3% and
7.6% of hospitalized patients. Women are almost twice as likely as men to be diagnosed with
GAD over their lifetime. Studies indicate that preoperative information reduced the anxiety of
clients undergoing surgery under regional anesthesia (GOLD, 2012).
Collaborative Management
The success of the situation cannot come out as deserved without the effort of various
members. It is a collaborative management where every member carries out a distinct function
for the good of all. The different members included the physician, pharmacist, lab and diagnostic
tests personnel, therapists, and the family. In effect, the role of the doctor remains paramount. In
his absence, all the other functions are unnecessary. For instance, the physician examines the
patient’s problem level and sets out the environment that follows. He is the one that advises on
the kind of tests to take, and advises on the treatment location depending on the situation.
In like manner, the role of pharmacists and the lab personnel is crucial but depends on the
RN’s observations. The pharmacists could give drugs while advising on the alternatives if need
be. On the other hand, the tests personnel prove vital since they give an accurate picture of the
patient’s situation which helps the physician to make the final decision. Family, as a community
is imperative considering that the recovery time of the patient also depends on the family efforts.
An important observation in regard is that the patient’s mood improved when her husband,
daughter and son-in-law came to visit her.
Therapeutic Modalities
It is vital to note that, the way a nurse interacts with a client influences his/her quality of
life. Providing psychological and social support can reduce the symptoms and problems
associated with all forms of illness. The nurse’s responsibilities are as well very different
compared to others since he/she must have knowledge in matters concerning oxygen therapy,
oxymetric pulses, dialysis and CRRT settings and distinct modes, for instance, FiO2. The
rationale for this difference is general in nature since he/she monitors respiratory rate, depth, and
ease of respiration as well as watching for the use of accessory muscles and nasal flaring
throughout the patient’s stay and recovery process.
Nursing Role Reflection
The critical roles that I played in the management of the critically ill patient proved vital in
knowledge expansion and improving communication skills. Overall, the mode and style of
communication with the interdisciplinary team stood elemental in the patient’s recovery speed.
In style, I am quite capable of respecting diversity and mannerism, considering that people
understand and interpret situations differently. There is also the need to take time before making
a critical decision. However, being professional makes the biggest difference as one can manage
relationships when dealing with diverse teams. Despite that, there were significant barriers that
hampered effective collaboration such as delays and lack of cooperation. If an organization is to
overcome the challenge of diversification, it is recommended for management to embrace
teamwork (Morgeson, 2005), and promote departmental autonomy in areas that involve privacy
(Passmore, 2013). It can be crucial in the lab tests units where things go slow when there is
unnecessary intervention. All in all, in professional development, becoming a useful member of
an interdisciplinary team just requires embracing teamwork, diverse opinions, and avoiding
generalizing cases. Overall, there is more to learn as a leader approaches different teams and
there is no universal mechanism that a person can ascertain to work well across all situations.
Regarding that, individual characteristics and understanding remains vital.
Bickley,L.S., &.Szilagyi, P. (2012). Bate's Guide to physical examination. Internet
GOLD: Global strategy for the diagnosis, management, and prevention of COPD (2015). Global
Initiative for Chronic Obstructive Lung Disease Retrieved April 23, 2015.
Morgeson, F. P. (2005). The external leadership of self-managing teams: intervening in the
context of novel and disruptive events. Journal of Applied Psychology, 90(3), 497.
Passmore, J. (2013). Diversity in Coaching: Working With Gender, Culture, Race and Age.
Philadelphia, PA: Kogan Page Ltd.

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