Cardiac Diseases

Policy:

Managing Patients with Angina

definition

It is chest pain caused by insufficient blood supply to the heart muscle due to narrowing of the coronary arteries.

Steps:

1. Take the patient’s medical history to confirm their condition and determine the location of the pain.

2. Calm the patient and position them in a semi-sitting posture.

3. Connect the patient to a monitor for continuous condition tracking.

4. Administer oxygen to the patient.

5. Perform an electrocardiogram (ECG) and present the results to the doctor.

6. Administer medications as prescribed by the doctor (e.g., aspirin, heparin, nitroglycerin, etc.).

7. Regularly assess the pain using a pain assessment chart.

8. Continuously monitor the patient’s condition through vital signs and ECG, and keep the doctor informed promptly.

Policy:

Sudden chest pain caused by the blockage of one of the coronary arteries, usually due to a blood clot, leading to deprivation of blood supply to a portion of the heart muscle, resulting in its death.

Steps:

1.  Take the patient’s medical history to confirm their condition and identify the location of the pain.

2.  Calm the patient and place them in a semi-sitting position.

3.  Connect the patient to a monitor for continuous observation and administer oxygen.

4.  Perform an electrocardiogram (ECG) and present the results to the doctor.

5.  Insert 1-2 peripheral cannulas and take a blood sample for a complete lab workup, including cardiac enzymes (Troponin, LDH, CPK).

6.  Administer medications as prescribed by the doctor (e.g., painkillers, Tridil, Nitroglycerin, Streptokinase, etc.).

Nursing Observation When Administering Streptokinase:

1.  Monitor the patient’s blood pressure and pulse, and observe for complaints such as shortness of breath, vomiting, excessive sweating, or itching. These may indicate an allergic reaction. In this case, stop the streptokinase administration and administer a large dose of hydrocortisone.

2.  The antidote for streptokinase is Cyclokapron, which should be given in case of bleeding.

3.  Perform an electrocardiogram (ECG) on the patient before, during, and after the administration of streptokinase.

4.  Do not administer intramuscular or subcutaneous injections to the patient during or immediately after the administration of streptokinase.

5.  Monitor for signs of bleeding from the nose or mouth.

Important Notes that Nursing Staff Must Follow:

-   Continuously assess pain using a pain assessment scale.

-   Evaluate and record a complete description of the pain.

-   Provide complete rest for the patient to reduce oxygen consumption.

-   Perform an electrocardiogram (ECG) during pain episodes.

-   Administer oxygen if the patient experiences shortness of breath and inform the doctor.

Policy:

Inability to pump an adequate amount of blood to the rest of the body, in order to minimize the patient's complications.

Tools and Equipment Used:

·   Electrocardiogram (ECG) machine

·   Stethoscope

·   Blood pressure monitor

Steps:

·  Place the patient in a quiet, cool room to help them sleep.

·  Connect the patient to a monitor to observe heart rate and perform an electrocardiogram (ECG).

·  Ensure that all necessary items are within the patient's reach.

·  Keep the patient in a comfortable resting position at all times.

·  Reassure the patient about their health.

·  Perform the necessary tests for the patient.

·  Educate the patient on the importance of rest when they return home.

·  Inform the patient about the symptoms of Digitalis toxicity (nausea, vomiting, diarrhea, headache, depression, anxiety, dizziness, seizures, hallucinations, memory loss, increased or decreased heart rate, hives).

Nursing staff should perform the following before administering Digitalis (Lanoxin):

·   Take the patient's pulse for a full minute using a stethoscope on the chest.

·   Carefully observe the pulse rate to determine if it is regular or irregular, and document the findings.

·   Stop the dose and inform the doctor if the patient's pulse is too fast or below 60 beats per minute.

·   Observe the patient closely for any signs of Digitalis toxicity.

·   Provide the patient with potassium-rich meals.

·   Avoid giving the patient any foods that contain sodium salts.

·   Weigh the patient daily at the same time, typically before breakfast, using the same scale.

·   Care for the patient’s skin, as swollen skin is more prone to cracking.

·   Administer oxygen to the patient if they experience difficulty breathing.

·   Keep a fluid balance chart for the patient.

Definition:

Pulmonary edema is lung congestion resulting from an increased amount of blood in the blood vessels within the respiratory system, which leads to significant difficulty in breathing.

Symptoms:

1- Severe difficulty breathing, especially in the horizontal position.

The primary goal of our care for this patient is to help the patient receive the necessary amount of oxygen they require.

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The Role of Nursing Staff Towards the Patient:

1- Position the patient at a 90-degree or 45-degree angle or have them sit on a chair, as this position facilitates easier breathing for the patient.