Ischaemic Heart Disease - 3 Nursing Diagnosis and Interventions

Ischemic Heart Disease (IHD) also known as Coronary artery disease (CAD), atherosclerotic heart disease, atherosclerotic cardiovascular disease, coronary heart disease is the most common type of heart disease and cause of heart attacks. The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. The risk of artery narrowing increases with age, smoking, high blood cholesterol, diabetes, high blood pressure, and is more common in men and those who have close relatives with CAD. Other causes include coronary vasospasm, a spasm of the blood vessels of the heart, it is usually called Prinzmetal's angina.

Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG).

Nursing Diagnosis and Interventions for Ischaemic Heart Disease

Nursing Diagnosis : Decreased cardiac output related to electrical factors (dysrhythmias), Decrease in myocardial contraction, structural abnormalities (papillary muscular dysfunction and ventricular septal rupture)

Outcome: The patient will demonstrate a stable cardiac condition or better.

  • Maintain bed rest with head elevation of 30 degrees during the first 24-48 hours.
  • Assess and monitor vital signs and hemodynamic per 1-2 hours.
  • Monitor and record ECG continue to assess the rate, rhythm, and order to each change per 2 or 4 hours.
  • Review and report signs of CO reduction.

Nursing Diagnosis : Acute pain related to an imbalance of oxygen supply to myocardial demands.

Outcome: The patient will express pain decreased

  • Assess pain location, duration, radiation, occurrence, a new phenomenon.
  • Review of previous activities that cause chest pain.
  • Create a 12 lead ECG during anginal pain episodes.
  • Assess signs of hypoxemia, give oxygen therapy if necessary.
  • Give analgesics as directed.
  • Maintain a rest for 24-30 hours during episodes of illness
  • Check vital signs, during periods of illness.

Nursing Diagnosis : Anxiety related to the needs of the body is Threatened.

Objectives: The patient will demonstrate reduced anxiety after nursing actions.
  • Assess signs and verbal expressions of anxiety
  • Take action to reduce anxiety by creating a calm environment
  • Accompany patient during periods of high anxiety
  • Provide an explanation of procedures and treatments
  • Encourage patients to express feelings
  • Refer to the spiritual adviser if necessary

Nursing Interventions for Depression

Depression is a condition that is more of a sad situation, when the depressed person's condition to cause the disruption of their daily social activities then it is called as a depression disorder. Some symptoms of depression disorders are feelings of sadness, excessive fatigue after usual routine activity, lost interest and enthusiasm, lazy bunch, and disruption of sleep patterns. Depression is one of the major causes of suicide.

Nursing Interventions for Depression

Goal :
There was no violence for Self-Directed or Other-Directed

1. Clients can build a trusting relationship.

Interventions :
  • Introduce yourself to the patient
  • Do interactions with patients as often as possible with empathy
  • Listen to the notice of the patient with empathy and patient attitude more use non-verbal language. For example: a touch, a nod.
  • Note the patient talks and give a response in accordance with her wishes
  • Speak with a low tone of voice, clear, concise, simple and easy to understand
  • Accept the patient is without comparing with others.

2. Clients can use adaptive coping

Interventions :

  • Give encouragement to express feelings and say that nurses understand what patients perceived.
  • Ask the patient the usual way to overcome feeling sad / painful
  • Discuss with patients the benefits of commonly used coping
  • Together with patients looking for alternatives, coping.
  • Give encouragement to the patient to choose the most appropriate coping and acceptable
  • Give encouragement to patients to try coping that have been selected
  • Instruct the patient to try other alternatives in solving problems.

3. Clients are protected from violent behavior to self and others.

Interventions :

  • Monitor carefully the risk of suicide / violence themselves.
  • Keep and store the tools that can be used by patients for violent behavior, self / others, in a safe place and locked.
  • Keep materials that endanger the patient's appliance.
  • Supervise and place the patient in the room that easily monitored by nurse.

4. Clients can improve self-esteem

Interventions :
  • Help to understand that the client can overcome despair.
  • Assess and mobilize internal resources of individuals.
  • Help identify sources of hope (eg, peer relationships, beliefs, things to be resolved).

5. Clients can use the social support

Interventions :
  • Review and make use of individual external sources (the people closest to, the health care team, support groups, religion).
  • Assess support system beliefs (values, past experiences, religious activities, religious beliefs).
  • Make referrals as indicated (eg, counseling, religious leaders).

6. Clients can use the drug correctly and precisely

Interventions :
  • Discuss about the drug (name, dosage, frequency, effect and side effects of taking medication).
  • Help using the drug with the principle of 5 correct (right patient, medication, dose, manner, time).
  • Encourage talking about effects and side effects are felt.
  • Give positive reinforcement when using the drug properly.

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Endocarditis - Nursing Diagnosis Activity Intolerance and Acute Pain

Activity intolerance related to inflammation and degeneration of muscle cells myocarditis, cardiac filling restriction (cardiac output).

Characterized by:

  • Complaints of weakness / fatigue / tightness during activity.
  • Changes in vital signs while the activity.
  • Signs of CHF.

  • Increased activity capabilities.
  • Reduction of physiological signs that do not fit.
  • Reveals the importance of limited activity.

Interventions and Rationale :
1. Assess the patient's response activities. Note the presence / emergence and change of complaints like weakness, fatigue and shortness of breath during activity.
R/ : Myocarditis causing inflammation and allow disruption in muscle cells that can lead to CHF.
Decreased cardiac filling / cardiac output will cause the liquid to collect in the pericardial cavity (if any pericarditis), which in turn can cause endocarditis and valvular dysfunction trend decline in cardiac output.

2.Monitor rate or rhythm of the heart / pulse, blood pressure and respiration amount, before / after and during activities as needed.
R/ : Help illustrate the level of the heart and pulmonary decompensation. Decreased blood pressure, tachycardia, and tachypnea are indicative of heart activity disorders.

3. Maintain bedrest during periods of fever and as indicated.
R/ : Control changes infection, during the acute phase of pericarditis / endocarditis.
Note: Fever increases oxygen demand, thereby increasing the ability of the heart and reduces the activity.

4. Plan of care by setting the rest / sleep period.
R /: Maintaining balance the needs of cardiac activity, enhancing the healing process and emotional coping skills.

5. Evaluation of emotional response to the situation / administration support.
R/ : R /: Anxiety will arise due to infection and cardiac responses (psychological). The level of anxiety and emotional needs of the patient will be a good coping posed by the possibility of life-threatening illness. Support is needed to face the possibility of frustration due to long hospitalization / healing period.

6. Collaboration: Provide oxygen therapy as indicated.
R /: Improved oxygenation ability to myocarditis, offset the increase in oxygen consumption. Can be seen in the activity.

Acute pain related to inflammation of the myocardium and pericardium, systemic effects of the infection, and ischemic tissue (myocardium).

Characterized by:

  • Chest pain radiating to the neck or back.
  • Joint pain.
  • Increased pain on deep inspiration, activity, and change the position.
  • Fever or chills.
  • Clients can identify ways to prevent pain.
  • Clients can control and report pain arising.
  • Clients can demonstrate relaxation techniques and a variety of activities that are indicated for individual circumstances.

Interventions and Rationale :
1. Observe for chest pain, record the time, factors complicate / originator, record the non-verbal signs of discomfort such as weakness, muscle tension and tears.
R /: Location of pain of pericarditis in the substernal radiating to the neck and back. But in contrast to myocardial ischemic pain / infarction. The pain will increase as the inspiration, position changes, and reduced the time to sit / lean forward.
Note: Chest pain is the presence or absence of endocarditis / myocarditis depends on the presence of ischemia.

2. Maintain or create a peaceful environment and a fun action such as changes in position, put a cold compress or warm, mental support, and so on.
R /: These measures can reduce the patient's physical and emotional discomfort.

3. Give the medication as indicated.
R /: To prevent the onset of pain or reduce the inflammatory response.

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