Coronary heart disease occurs due to:
- Narrowing of the coronary arteries
- Decreased blood flow / cardiac output
- The increase in myocardial oxygen demand
- Coronary artery spasm
Main causes of atherosclerosis. Although influenced by many factors, due to degenerative disorder, it often causes sudden death and attacked very productive age.
Input to the oxygen demand imbalance, namely:
- Hypoxemia (ischemia), caused by vascular disorders (coronary arteries). On ischemic vascular abnormalities that are reduced tissue perfusion to metabolic elimination caused by (eg lactic acid) decreased as well, so it will be faster symptoms appear.
- Hypoxia (anoxia), caused by lack of oxygen in the blood. Actual input of oxygen to the myocardium depends on the oxygen in the blood and the coronary arteries. Oxygen in the blood depends on the oxygen can be taken up by the blood. So influenced by Hb, lungs and oxygen in the breathing air.
Palpitations are manifestations of coronary heart disease although not specific. Manifestations of coronary heart disease varies depending on the degree of coronary artery blood flow. When coronary flow is still sufficient for the tissue will not cause any complaints / clinical manifestations. Factors that affect large and coronary flow properties such as the state of anatomical and mechanical factors, autoregulation system and peripheral resistance.
The trigger factor that adds to ischemia such as, physical activity, stress, etc.. Angina pectoris is the main symptom specific and typical for coronary heart disease. Shortness of breath began to feel short of breath while doing activities that are sufficiently severe, increasing shortness of breath. At a more advanced state of heart failure can occur.
5 Nursing Diagnosis and Interventions of Coronary Heart Disease
1. Nursing Diagnosis : Acute Pain related to heart tissue ischemia, or blockages in the coronary arteries.
Objective: The client is expected to be able to demonstrate a decrease in chest pain, showed a decrease in pressure and how relaxation.
Interventions:
- Monitor and review the characteristics and location of pain.
- Monitor vital signs (blood pressure, pulse, respiration, consciousness).
- Instruct the patient to immediately report instances of chest pain.
- Create an atmosphere of calm and comfortable environment.
- Teach and encourage the patient to do relaxation techniques.
- Collaboration in: Giving oxygen and drugs
- Measure vital signs before and after treatment.
2. Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand, and the presence of necrotic tissue in myocardial ischemia.
Objective: The client shows an increase in the ability to perform activities (blood pressure, pulse, rhythm within normal limits) the absence of angina.
Interventions:
- Record the heart rhythm, blood pressure and pulse before, during and after the activity.
- Instruct the patient to have more rest first.
- Instruct the patient not to "push" at the time of defecation.
- Explain to the patient about the stages of activity that may be performed by the patient.
- Show to patients about physical signs that activity exceeds the limit.
3. Nursing Diagnosis : Risk for Decreased Cardiac Output related to changes in the rate, rhythm, cardiac conduction, decrease preload or increased SVR, miocardial infarction.
Objective: There is no decrease in cardiac output during the action of nursing.
Interventions:
- Perform blood pressure measurements (compare the two arms in a standing position, sitting and lying down, if possible).
- Assess the quality of the pulse.
- Note the development of the S3 and S4.
- Auscultation of breath sounds.
- Stay with the patient at the time of the activity.
- Serve food that is easy to digest and reduce the consumption of kafeine.
- Collaboration in: serial ECG examination, chest radiographs, administering medications anti dysrhythmias.
4. Nursing Diagnosis : Risk for Impaired Tissue Perfusion related to decreased blood pressure, hypovolemia.
Objective: During done nursing action is not a decline in tissue perfusion.
Interventions:
- Assess the changes in consciousness.
- Inspection of the pale, cyanosis, cold skin and peripheral pulse degradation.
- Assess the Homans sign (pain in calf on dorsoflextion), erythema, edema.
- Assess respiration (rhythm, and effort into breathing).
- Assess gastrointestinal function (bowel sounds, abdominal distention, constipasi).
- Monitor intake and output.
- Collaboration in: Examination ABG, BUN, serum ceratinin and electrolyte.
5. Nursing Diagnosis : Risk for Excess Fluid Volume related to decreased organ perfusion (renal), increased sodium retention, decreased plasma protein.
Objective: There is an excess of fluid in the body of the client during the treatment.
Interventions:
- Auscultation of breath flare (examine the crackless).
- Assess the jugular vein distension, increased occurrence of edema.
- Measure intake and output (fluid balance).
- Assess the weight every day.
- Instruct the patient to consume a maximum of 2000 total liquids cc/24 hours.
- Serve a meal with a low-salt diet.
- Collaboration in the provision of diuretics.
