In Britain, every nurse is on grade. The grade depends on experience and skill, and each grade has different responsibilities and pay. On the bottom grades are unqualified auxiliary nurses who do the routine work on hospital wards. On the top grades are nursing officer, who are usually administrators.
Auxiliary nurses are on the bottom grades, but student nurses get the lowest pay. However, student don't stay at the bottom of the scale forever. When they qualify, they start working on a middle grade. As they get experience, they can get promotion and move up the ranks to become staff nurse, then sister (charge nurse if a man), and perhaps eventually nursing officer.
Many Nurse work shift, and often they work overtime to earn more money. After basic training, many nurses choose to do further study and become specialists. Nurses can specialize in many different fields, there are triage nurses working in Casualty, and Psychiatric nurses who treat the mentally ill. There are health visitors who visit patients in their own home, practice nurses working in GPs' surgeries, and midwives who deliver babies.
Many of them say they don't get enough pay and respect for the work they do. They say that the work is physically and mentally hard, that they work long hours and get very tired. But they also say that there are many great rewards which have nothing to do with money.
Nursing Care Plan For Heart Failure
Heart Failure also called as Cardiac failure, Congestive Heart Failure (CHF). Heart failure (HF) is a medical condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's metabolic needs.
Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should. It should not be confused with cardiac arrest. So, the Nursing Care Plan for Heart Failure cases are little different with others heart problems.
Heart failure can occur on the left-sided or right-sided of the heart. Left-sided heart failure causes mostly pulmonary sign and symptom, such as shortness of breath, dyspnea on exertion and a moist cough. Right-sided heart failure causes systemic sign, such as edema and swelling, jugular vein distention and hepatomegaly.
The possible causes of heart failure are atherosclerosis, cardiac conduction defects, chronic obstructive pulmonary disease, fluid overload, hypertension, MI, pulmonary hypertension, valvular insufficiency, valvular stenosis.
Nursing Care Plan For Heart Failure :
A. Assessment Findings on Heart Failure Cases
- Left-sided heart failure ; Dyspnea, Crackles, Orthopnea, Paroxysmal noctural dyspnea, Tachypnea, Tachycardia, Gallop rhythm (third or S3 and fourth or S4 heart sound), Fatigue, Anxiety, Arrhythmias and Cough.
- Righ-sided heart failure ; Dependent edema, Weight gain, Fatique, Jugular vein distention, Tachycardia, Gallop rhythm (S3 or S4), Nausea, Anorexia, Hepatomegaly and Ascites.
B. Diagnostic Evaluation
- Left-sided heart failure ;
- ABG levels indicate hypoxemia and hypercapnia.
- Blood chemistry test results reveal decreased potassium and sodium levels and increased BUN and creatinine levels.
- Chest X-ray shows increased pulmonary congestion and left ventricular hypertrophy.
- ECG may show left ventricular hypertrophy or acute ST-T wave changes.
- Echocardiography shows increased size of cardiac chambers and decreased wall motion. Hymodinamic monitoring reveals increased PAP and PAWP and decreased cardiac output.
- Righ-sided heart failure ;
- ABG levels indicate hypoxemia.
- Blood chemistry test results show decreased sodium and potassium levels and inc creatinine levels.
- Chest X-ray reveals pulmonary congestion, cardiomegaly, and pleural effusions.
- ECG may show left and right ventricular hypertrophy or acute ST_T wave changes.
- Echo cardiogram shows increased size of chambers and decreased in wall motion.
- Hemodynamic monitoring show increased right atrial pressure, CVP, and right ventricular pressure and also decrease cardiac output.
C. Nursing Diagnoses
- Excess fluid volume
- Activity intolerance
- Ineffective health maintenance
Due to possible cases above, the best treatment are :
- Low-sodium diet and limited intake of fluid
- Intra-aortic balloon pump (IABP)
- Oxygen therapy (possible intubation and mechanical ventilator)
- Left ventricular assist device (for left-seded heart failure)
- Paracentesis (for right-sided heart failure)
- Thoracentesis (for right-sided heart failure)
There are many of drugs therapy option, such as :
- Analgesic (morphine sulfat IV)
- Angiotensin-converting enzyme (ACE) inhibitor; {captropil (capoten), enalapril (vasotec), lisinopril (prinivil)}
- Beta-adrenergic blocker ; {carvedilol (coreg), metoprolol (lopressor)}
- Cardiac glycoside; digoxin (lanoxin)
- Diuretic; {bumetanide (bumex), furosemide (lasix), metolazone (zaroxolyn), spironolactone (aldactone)}
- Inotropic agent; {amrinone lactate (inocor), dobutamine hydrochloride (dobutrex), dopamine hydrochloride (intropin)}
- Nitrate; {isosorbite dinitrete (isordil), nitroglycerin (nitro-bid)}
- Vasodilator; nitroprusside sodium (nitropress)
D. Planing and Goals of Nursing Care
- The clients will understand how to cope with necessary lifestyle changes.
- The client won't develop preventable complication
- The client will will understand how to continue therapy at home.
E. Nursing Intervention For Heart Failure
- Assess cardiovascular status, vital sign and hemodynamic variable to detect signs of reduced cardiac output.
- Assess respiratory status to detect increasing fluid in the lungs and respiratory failure.
- Keep the client in semi-fowler's position to increase chest expansion and improve ventilation.
- Administer medication as prescribed, to enhance cardiac performance and reduce excess fluids.
- Administer oxygen to enhance arterial oxygenation.
- Measure and record intake and output, Intake greater than output may indicated fluid retention.
- Monitor laboratory test result to detect electrolyte imbalances, renal failure, and impaired cardiac circulation.
- Provide suctioning, if necessary assist with turning and encourage coughing and deep breathing to prevent pulmonary complication.
- Restrict oral fluid to avoid worsening the client's condition.
- Weigh the client daily to detect fluid retention. A weight gain of 2lb (0,9 kg) in 1 day or 5 lb (2,3 kg) in 1 week indicates fluid gain.
- Measure and record the client's abdominal girth. An increased in abdominal girht suggests worsening fluid retention and right-sided heart failure.
- Make sure the client maintains a low-sodium diet to reduce fluid accumulation.
- Encourage the client to express feelings, such as a fear of dying to reduce anxiety.
F. Evaluation of Nursing Care on Heart Failure Disease.
- The client accurately describes recommended dietary restriction and medication regimens.
- The client hasn't experienced complication
- The client verbalizes important sign and symptom to report.
Labels: NCP Heart Disease
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Management Nursing Care Plans @ 11:24 PM,
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Nursing Care Plan For Myocardial Infarction (MI)
Myocardial infarction (MI or AMI for acute myocardial infarction) is the rapid development of myocardial necrosis (die of heart cells) caused by a critical imbalance between oxygen supply and demand of the myocardium.
This is serious medical condition that sometimes called as a heart attack or a coronary thrombosis. The medical team should be take quickly action to give treatment and Nursing Care to prevent complication or die.
With myocardial infarction, reduce blood flow in one of the coronary arteries leads to myocardial ischemia, injury and necrosis. From the ECG result, with a Q-wave MI it's mean that the tissue damage extends through all myocardial layers. Non-Q-wave MI, ussually only the innermost layer is damage.
Possible causes of Myocardial infarction (MI) are : Coronary artery occlusion, Coronary spasm and Coronary stenosis. There are some risk factors to develop of Myocardial infarction such as :
- Aging
- Decrease serum HDL levels
- Diabetes Mellitus
- Drug use, specifically use of amphetamines or cocaine
- Elevated serum Triglyceride, LDL and Cholesterol levels
- Excessive intake of saturated fats, carbohydrates, or salt
- Family history of CAD
- Hypertension
- Obesity
- Post menopausal women
- Sedentary lifestyle
- Smoking
- Stress
Nursing Care Plan For Myocardial Infarction (MI):
Assessment findings on the patient with myocardial infarction are : Dyspnea, Diaphoresis, Arrhythmias, Tachicardia, Anxiety, Pallor, Hypotension, Nausea and vomiting, Elevated temperature. The specific complain from the patient is crushing substernal chest pain (may radiate to the jaw, back and arms) that unrelieved by rest or nitroglycerin (NGT) tablet.
Diagnostic evaluation patient with myocardial infarction:
- ECG show deep, wide @ wave ; elevated or depressed ST segment; and T wave inversion or cardiac arrythmias.
- Blood chemistry test result show increased creatine kinase (CK), lactate dehydrogenase (LD), lipid, and troponin T levels; increased WBC count; positive CK_MB fraction; and flipped LD1.
Nursing diagnoses for patient myocardial infarction (MI) are:
- Chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply
- Potential Arrhythmias related to decrease cardiac output
- Respiratory difficulties (dyspnoea) due to decrease CO
- Anxiety & fear of death related to his condition
- Activity intolerance related to limitations imposed
- Potential for complications of thrombolytic therapy
- Discharge medications, follow up & Health teachings
Planing and goals of nursing care plan;
- The patient won't develop preventable complication
- The patient will understand the necessary treatment and lifestyle changes.
Nursing Intervention for myocardial infarction (MI):
- Monitor ECG result to detect ischemia, injury new or extended infarction, arrhythmia, and conduction defects
- Monitor, record vital signs and hemodynamic variables to monitor response to the therapy and detects complication
- Administer oxygen as prescribe to improve oxygen supply to the heart
- Obtain an ECG reading during acute pain to detect myocardial ischemia, injury or infarction
- Maintain the patient's prescribed diet to reduce fluid retention and cholesterol levels
- Provided postoperative care if necessary to avoid postoperative complications and help the patient achieve a full recovery
- Allay the patient's anxiety because the anxiety increase oxygen demands.
Nursing Evaluation for myocardial infarction (MI):
- The patient explains how and when to take medicine and state reportable adverse reaction
- The patient describes appropriate lifestyle changes to reduce the risk of future cardiac event
- The patient experiences no complication after heart attack (myocardial infarction)
Labels: NCP Heart Disease
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Management Nursing Care Plans @ 3:01 AM,
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