Notez On Nursing....: Cardiac Assessment

Showing posts with label Cardiac Assessment. Show all posts

Jul 23, 2015

Nursing Care for Hypertension......

Nursing can be a lot to take into sometimes. You have to study hundreds of diseases and pick out the most appropriate nursing actions to address them. But how do you do that when you have so much to learn? For cases such as hypertension, for example. Here’s a mnemonic trick that would help you remember the interventions needed and things to consider for hypertension.

When hypertensive, remember: DIURETIC

D -daily weight

If the patient is hypertensive or even suspected to be, then his/her weight must be monitored. He/she must be weighed daily. Indicators for risk of hypertension include obesity, abdominal obesity and weight gain.Weight gain was associated with increased risk of developing hypertension.On the other hand, weight-loss can lead to a significant drop in blood pressure.

I-Intake and Output

Intake and output of the patient must also be kept closely monitored. Sodium balance is precisely regulated by intake and output.High salt intake increases extracellular volume (ECV), blood volume, and cardiac output resulting in elevation of blood pressure. Normal blood pressure are attained by increased glomerular filtration and decreased sodium reabsorption. In some individuals, the kidneys have difficulty in excreting sodium, so the equilibrium is achieved at the expense of elevated blood pressure. At times, the sodium balance must be achieved via dialysis and ultrafiltration.

U-Urine Output

When BP is low, renal blood flow drops. This stimulates renin and angiotensin production by the kidney. Angiotensin is converted to angiotensin II in the lung. This is controlled by angiotensin-converting enzyme. Angiotensin II is a vasoconstrictor – which will increase SVR. Angiotensin II also stimulates the adrenal cortex to produce aldosterone. Aldosterone causes sodium and water to be retained by the kidney. This will increase the extra cellular fluid (ECF) volume and therefore the circulating blood volume. This is also supported by antidiuretic hormone (vasopressin) which is produced by the hypothalamus and released by the posterior pituitary in response to angiotensin II. Angiotensin II also stimulates thirst, leading to increased fluid intake.

R-Response of B/P

A person’s blood pressure is not fixed as it rises and falls throughout the day in response to what that person is doing and what is happening around him/her. It’s important that the BP be monitored so as to know whether it is responding appropriately to your interventions, or to modify the treatment regimen.

E-Electrolytes

Dietary choices, even the amount of electrolytes you consume, can influence the blood pressure. These electrolytes such as sodium and potassium play a major role in regulating a person’s blood pressure.One of the functions of electrolytes is the balance of fluid in and around your cells. Electrolytes partially break down in water to form an ion. When this occurs, they influence where the fluids inside your body go. Sodium boosts water retention, leading to excess fluid in blood vessels and higher blood pressure.

TI-Transient Ischemic Episodes (TIA)

A transient ischemic attack (TIA) occurs when blood flow to a part of the brain stops for a brief time.High blood pressure is the main risk for TIAs and stroke.

C-Complications: 4 Cs (CAD, CRF, CHF, CVA)

You also have to remember that if left untreated, hypertension can cause certain complications. Over time this extra pressure can increase your risk of a heart attack, stroke and kidney disease.High blood pressure can cause many different diseases of the heart and blood vessels (medically known as cardiovascular diseases) and can also damage the small blood vessels in your kidneys and stop them from working properly.

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Mar 11, 2015

Code Blue: Defibrillation......

You’re getting on with your duty as usual. Everything just started out right, conscious patient, not-so busy work environment. This ought to be a stress-free duty. You’re just beginning to prepare your due medications when everything turned upside down.
—-
“Mrs. Santos? Mrs. Santos?” You check for the pulse and breathing.
“She’s not breathing. Call the code!”
The rescue/code team has arrived as you perform continuous CPR. Ventilation and emergency medications have been given, O2 saturation and ECG tracings have been checked. The doctor orders defibrillation.
“Clear?”
“Clear!”
*Shock*
This is often the scenario we observe in movies and television shows. A busy clinical setting where doctors and nurses try to move as quickly and at the same time as accurately as possible. It’s as if everything’s a blur. The defibrillation scenario is a common act we play in demonstrations of happenings in the clinical area. We portray it so much that sometimes we think we already know and master what we are doing, but what we are yet to discover is that working in the hospital, dealing everyday with people’s lives is not always that conventional and that our job being nurses isn’t always as easy as it seems.
Overview

Defibrillation is defined as the process wherein an electric shock is sent to the heart to stop an arrhythmia with the use of an electrical device called a defibrillator, resulting in the return of a productive heart rhythm.
Defibrillation is often used in emergency cases for the purpose of correcting life-threatening arrhythmias such as countering the onset of ventricular fibrillation or pulseless ventricular tachycardia, which is a common cause of/ and cardiac arrest.
When it comes to cardiac emergencies, the procedure must be performed immediately after identifying that the patient is experiencing an arrhythmia. You may identify this through signs like lack of pulse and unresponsiveness, you may also confirm the arrhythmia in ECG tracings. You may note randomly occurring chaotic electrical activity without discernable depolarization or repolarization waveforms for V-fib. V-tach on the other hand appears as wide complex tachycardia on the tracings.
In non-life threatening situations, atrial defibrillation may be ordered to treat atrial fibrillation or flutter.
However, this procedure is not indicated for pulseless electrical activity and asystole or flatline wherein there is complete cessation of cardiac activity since they are not responsive to defibrillation.
Also, defibrillation in the clinical setting must only be done by professionals (doctors, nurses and health professionals) who are trained in Advanced Cardiac Life Support, though outside of the hospital, AEDs or automated external defibrillators are also available in schools and other establishments. These AEDs are very user friendly, providing step by step instructions that allow bystanders to defibrillate in an emergency until trained medical personnel arrive.
How it works
Cardiac arrhythmias like ventricular tachycardia, fibrillation, and cardiac arrest prevent the heart from pumping blood to the body and can possibly cause irreversible damage to the major organs such as the brain and heart. With every minute that the heart fibrillates, about 10% of the ability to restart the heart is and death can occur within minutes if left untreated.
In ventricular arrhythmias, defibrillation works by applying a controlled electrical shock to the heart causing depolarization of the entire electrical conduction system of the heart. Then, when the heart undergoes repolarization, the normal electrical conduction may occur and the myocardium ideally returns to a normal rhythm.
However, there must be enough used energy for defibrillation, if not then the heart may not be completely depolarized which may result to non-termination of ventricular tachycardia or fibrillation. In other cases, ventricular arrhythmia may recur, such as if the heart does not get enough oxygen or if there exists the instability of the electrolytes in the cardiac cells.
In the clinical setting, nothing is predictable. Anything could happen in just a blink of an eye that is why we nurses must always be ready at all times. However, amidst all these emergencies, it is important that we still stay as calm and composed as possible. Maintain a clear head. Don’t panic. In times like these, quick actions are not the only ones needed, but also a stable mind can come in very handy.
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