The Procedural Work For Cardiac Diseases

1.  Vital Signs Monitoring:

• Pulse, respiratory rate, temperature, and blood pressure should be frequently assessed to monitor the patient's cardiovascular status.

2.  Complete Bed Rest:

• The patient should be on complete bed rest to minimize physical exertion and promote recovery.

3.  Leg Movement to Prevent Deep Vein Thrombosis (DVT):

• Leg movements should be encouraged regularly to prevent leg clots (DVT). Passive or active range-of-motion exercises may be recommended.

4.  Strict Adherence to Medication Regimen:

• Medications should be administered as prescribed by the physician, and the nurse must monitor for any side effects or adverse reactions to drugs.

5.  Monitoring Fluid Intake and Output:

• The nurse should evaluate and document the amount of fluid the patient consumes and excretes, as this can indicate kidney function, hydration status, or possible complications (e.g., heart failure or fluid retention).

6.  Observation of Symptoms:

• The nurse must be alert for signs of breathing difficulties, discomfort, chest pain, and monitor food intake and medication administration to ensure the patient’s condition is progressing appropriately.

Observation and Assessment of the Patient:

The nurse should perform both direct and indirect assessments of the patient to ensure a comprehensive evaluation:

Direct Observation:

• Visual inspection: Look for signs of distress, changes in the patient’s condition, skin color, or edema.
• Listening: Assess for any abnormal sounds like wheezing, abnormal heart sounds, or irregular respiratory patterns.
• Touch: Palpate the patient to check for tenderness, temperature changes, or abnormal pulses.

Indirect Observation:

• Blood pressure measurement: Regular monitoring of blood pressure is crucial to detect signs of hypertension, hypotension, or other complications.
• Monitor equipment (e.g., ECG, pulse oximeter): Use monitoring devices like ECG (electrocardiogram) or pulse oximeter to assess heart rhythm, oxygen saturation, and overall cardiovascular stability.

Duties of Nursing Staff:

1.  Early Detection and Prevention of Complications:

• The nurse should direct their efforts towards the early discovery of complications and the prevention of further injuries to the heart muscle, ensuring the patient feels comfortable.

2.  Continuous Monitoring in the ICU:

• Continuous monitoring of the patient’s condition while in the Intensive Care Unit (ICU), especially during intermediate care, and the ability to interpret and read the ECG to detect any complications or arrhythmias.

3.  Gas Exchange Impairment:

• The nurse should be aware of the signs of hypoxia (lack of oxygen in the brain), which include:
• Blood pressure changes
• Arrhythmias
• Difficulty breathing
• Dizziness
• Headache
• Unsteadiness
• Nausea
• Anxiety
• Discomfort
• If any of these signs occur, the nurse should inform the physician immediately.

4.  Administering Oxygen:

o   Administer oxygen according to the patient's condition. The nurse should also care for the patient's mouth, teeth, and lips, which may become cracked due to the use of oxygen (apply cream).

o   The nurse should:

• Listen to the patient's breath sounds.
• Measure the rate, depth, and rhythm of breathing every hour.
• Administer diuretics and monitor the body’s electrolyte levels.
• For chest pain, the nurse should assess and document a complete description of the pain and the activities that may have triggered it.
• Provide complete rest to reduce oxygen consumption.
• Perform an ECG during pain episodes.
• Administer pain-relieving medications and vasodilators as ordered.

5.  Encouraging Smoking Cessation:

• The nurse should encourage the patient to stop smoking, as it is a major cause of the condition.

6.  Care for Vomiting and Nausea:

• For patients experiencing vomiting and nausea, the nurse should:
• Position the patient comfortably (semi-sitting).
• Place a kidney dish beside the patient.
• Record and report the contents, color, quantity, and odor of vomit.
• Provide small, frequent meals and fluids.
• Administer antiemetic drugs as prescribed by the physician.
• Provide oral care.

7.  Dietary Care:

• The patient may be placed on a special diet based on their condition, such as:
• Reduced salt intake (e.g., in cases of hypertension or edema).
• Reduced fats and cholesterol for patients with high cholesterol.
• Low-calorie meals with 5 to 6 small, fat-free meals daily.
• Avoid foods that may cause bloating or excessive gas.
• Avoid foods that are extremely hot or cold.

8.  Reducing Anxiety:

• The nurse should help reduce the patient's anxiety by reassuring them, making them feel comfortable, and encouraging them to express their fears about the illness.
• The nurse should also encourage the patient to engage in activities (such as reading newspapers or books) to reduce fear.

9.  Sexual Activity:

• The nurse should offer the following advice to the patient and their partner to enjoy a fulfilling sexual relationship while minimizing stress on the heart:
• Ensure adequate rest before sexual activity.
• Find a comfortable position for both partners.
• Consider taking nitroglycerin before sexual activity to prevent chest pain.
• Avoid sexual activity 1-1.5 hours after eating a large meal.
• Notify the physician if any of the following occur during or after sexual activity:
• Increased heart rate for more than 15 minutes.
• Chest pain not relieved by nitroglycerin.

10.  Physical Exercise:

• The nurse should advise the patient to avoid strenuous physical and mental exercises, but engage in moderate exercises that do not induce chest pain, such as walking. Start with short distances in the room and gradually increase the distance over a week with continuous monitoring from the doctor.

11.  Helping with Bowel Movements:

• Most patients may experience constipation, so the nurse should:
• Provide fiber-rich food and adequate fluids.
• Avoid spicy foods and provide laxatives.
• Offer bedpans to patients who are immobile, ensuring privacy.
• Develop an activity plan based on the patient’s condition and the doctor’s recommendations.

12.  Medication Knowledge and Monitoring:

• If the patient lacks knowledge about the medication (including the type, dosage, frequency, side effects, and expected effects), the nurse should explain the medication regimen and encourage the patient to repeat the information.
• Encourage the patient to rest if they feel dizzy after taking medication.
• The patient should track chest pain frequency, the medication taken, its dose, and frequency.
• Advise the patient to avoid alcohol while taking the medication.
• Monitor for side effects and inform the doctor.

13.  Patient Education Before Discharge:

• The nurse should plan an individual education program for the patient and their family before discharge, covering:
• Control of risk factors.
• Sexual activity.
• Medications (name, dosage, effectiveness, side effects).
• Home exercise program.
• Importance of regular follow-up and medical check-ups.
• Warning signs and symptoms requiring physician consultation (e.g., chest pain not relieved by nitroglycerin, palpitations, arrhythmias, dizziness).
• Teaching family members cardiopulmonary resuscitation techniques.
• Importance of taking nitroglycerin before exertion.
• How to measure pulse.
• Adherence to a low-salt, low-cholesterol, low-fat diet, and controlling caloric intake.

14.  Health Education for Pacemaker Patients:

• Educate the family on providing a calm, respectful, and supportive environment, avoiding negativity, and following the doctor’s instructions.

15.  Work and Lifestyle:

• The patient should avoid any strenuous physical or mental work. If possible, replace demanding tasks with less stressful ones.
• Daily life should be free of noise, stress, and fatigue, but this doesn’t mean complete isolation from others.

16.  Rest and Environment:

• The patient should have adequate rest, and their living environment should be quiet, well-ventilated, and receive sunlight.
• Bathing water should be lukewarm (not too hot or cold), and the patient should avoid standing for prolonged periods.

17.  Visiting Policy:

• Visitors should be few in number and visits should be short, providing comfort and peace to the patient. Avoid discussions that could cause stress or discomfort.