Heart Patients

Running Head: HEART ATTACK PATIENT: CARE PLAN 1

Heart Attack Patient: Care Plan

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HEART ATTACK PATIENT: CARE

PLAN

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

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PLAN

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

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PLAN

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

HEART ATTACK PATIENT: CARE

PLAN

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

HEART ATTACK PATIENT: CARE

PLAN

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

obstruction.

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

HEART ATTACK PATIENT: CARE

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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

HEART ATTACK PATIENT: CARE

PLAN

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.

HEART ATTACK PATIENT: CARE

PLAN

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

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(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.

References

Bickley,L.S., &.Szilagyi, P. (2012). Bate's Guide to physical examination. Internet

Resource

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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