Constipation
1. Characteristics: What is the frequency, consistency, color
of the stools? Is this a change in bowel habits? If a change,
has this been gradual or sudden? What is the size of the
stools? Have there been dietary changes? Is there blood or
mucus in the stools? Any laxative use?
2. Associated factors: Are there periods of diarrhea? Is
there abdominal pain or distention? Is the patient expe-
riencing stress? Is there a change in activity level? Does
the patient have a regular time for defecation? Does the
patient use antacids containing calcium or an anti-
cholinergic? Have there been any fevers, chills, night
sweats, or weight loss?
3. History: Any family history of colorectal cancer? Any
history of depression or metabolic disorders, such as
hypothyroidism or hypercalcemia?
Dysphagia
1. Characteristics: Is the onset acute or gradual? Is the prob-
lem with swallowing intermittent or continuous? Is this
associated with solid foods, liquids, or both? Has there
been any nasal regurgitation? Where does the food stick:
neck (cricopharyngeal), midesophagus, or sternal xiphoid
process?
2. Associated factors: Is there any regurgitation, heartburn,
chest or back pain, weight loss? Any hoarseness, voice
change, or sore throat? Have there been any fevers, chills,
night sweats, or weight loss?
3. History: Is there a family history of esophageal cancer?
Is there a history of stroke, palsy, or any other neuro-
logic conditions? Is there a history of alcohol or tobacco
intake?
PHYSICAL EXAMINATION
When performing a physical examination of the abdomen,
include the following: inspection of the abdomen, ausculta-
tion of all four abdominal quadrants, percussion for tympany
or dullness, light and deep palpation.
NURSING ALERT Auscultation should be performed before
percussion and palpation, which may stimulate bowel sounds.
Deep palpation in noted areas of tenderness or pain should be per-
formed last.
Saturday, October 5, 2019
Avoiding Complications
1. Monitor ECG continuously for arrhythmias.
a. Evaluate possible cause of dysrhythmias—inadequate
oxygenation, electrolyte imbalance, MI, mechanical
irritation (eg, pacing wires, invasive lines, chest
tubes), and any vasopressor or inotropic medications.
b. Treat dysrhythmias immediately because they may
lead to decreased CO. Atrial or AV pacing is used to
treat sinus bradycardia or junctional rhythm with
heart rates less than 70 beats/minute.
2. Assess for signs of cardiac tamponade—arterial hypoten-
sion; rising CVP; rising left atrial pressure; muffled heart
sounds; weak, thready pulse; jugular vein distention;
falling urine output.
a. Check for diminished amount of drainage in the
chest-collection bottle; may indicate that fluid is accu-
mulating elsewhere.
b. Prepare for pericardiocentesis.
c. Assist with echocardiogram to evaluate tamponade.
3. Check cardiac enzyme levels daily. Elevations may indi-
cate MI. (Symptoms may be masked by the usual postop-
erative discomfort.)
a. Watch for decreased CO in the presence of normal
circulating volume and filling pressure.
b. Obtain serial ECGs and isoenzymes to determine
extent of myocardial injury.
c. Assess pain to differentiate myocardial pain from inci-
sional pain.
4. Monitor for hypertension or hypotension.
a. Mild systolic hypertension occurs in 48% to 55% of all
CABG patients within the first 6 hours postopera-
tively.
b. Hypotension can occur within the first 12 hours.
c. Patients with blood pressure above 70 mm Hg, with
normal preload and CO, may be treated with low-dose
dopamine.
5. Initiate measures to prevent embolization such as antiem-
bolic stockings, not putting pressure on popliteal space
(leg crossing, raising knee gatch), and starting passive and
active exercises.
a. Assess for signs of DVT and pulmonary embolism.
b. Maintain integrity of all invasive lines.
6. Monitor for bleeding.
a. Watch for steady and continuous drainage of blood.
b. Assess for arterial hypotension, low CVP, increasing
pulse rate, and low left atrial pressure and PCWP.
c. Prepare to administer blood products, I.V. solutions,
or protamine sulfate or vitamin K (AquaMEPHY-
TON).
d. Prepare for potential return to surgery for bleeding
persisting (over 300 mL/hour) for 2 hours.
e. Monitor hemoglobin levels; if the patient’s hemoglo-
bin drops below 8 g/dL, transfusions of red blood cells
or platelets may be necessary.
f. During the first 4 to 12 hours, blood recovered from
mediastinal tubes can be autotransfused to the patient.
7. Be alert for fever and signs of infection. Check blood glu-
cose levels as ordered.
a. Administer prophylactic antibiotics, as ordered, for
the first 48 hours.
b. Control higher degrees of fever through use of
hypothermia mattress.
c. Evaluate for atelectasis, pleural effusion, or pneumonia
if fever persists. (The most common cause of early
postoperative fever [within 24 hours] is atelectasis.)
d. Evaluate for urinary tract infection and wound
infection.
e. Draw blood cultures to rule out endocarditis if fever
persists.
8. Measure urine volume; less than 20 mL/hour can indicate
decreased renal function.
a. Watch BUN and serum creatinine levels as well as
urine and serum electrolyte levels.
b. Give rapid-acting diuretics and/or inotropic drugs
(dopamine [Intropin], dobutamine [Dobutrex]) to
increase CO and renal blood flow.
c. Prepare the patient for peritoneal dialysis or hemodial-
ysis if indicated. (Renal insufficiency may produce
serious cardiac dysrhythmias.)
Community and Home Care Considerations
Preparing the patient with cardiovascular disease or after car-
diac surgery for the return home and/or optimizing the
patient’s health status in the home are important nursing
functions. The key areas on which to focus include assessment,
education, and evaluating responses.
Assessment
1. Optimally, the discharge plan begins at facility admission.
The patient’s physical condition will determine to some
extent his needs at home (ie, ability to care for self).
However, the available support systems will allow the
nurse to individualize the care plan.
2. Assess the patient’s functional abilities. Patients with car-
diovascular disorders may need to conserve their energy
and rest of
1. Monitor ECG continuously for arrhythmias.
a. Evaluate possible cause of dysrhythmias—inadequate
oxygenation, electrolyte imbalance, MI, mechanical
irritation (eg, pacing wires, invasive lines, chest
tubes), and any vasopressor or inotropic medications.
b. Treat dysrhythmias immediately because they may
lead to decreased CO. Atrial or AV pacing is used to
treat sinus bradycardia or junctional rhythm with
heart rates less than 70 beats/minute.
2. Assess for signs of cardiac tamponade—arterial hypoten-
sion; rising CVP; rising left atrial pressure; muffled heart
sounds; weak, thready pulse; jugular vein distention;
falling urine output.
a. Check for diminished amount of drainage in the
chest-collection bottle; may indicate that fluid is accu-
mulating elsewhere.
b. Prepare for pericardiocentesis.
c. Assist with echocardiogram to evaluate tamponade.
3. Check cardiac enzyme levels daily. Elevations may indi-
cate MI. (Symptoms may be masked by the usual postop-
erative discomfort.)
a. Watch for decreased CO in the presence of normal
circulating volume and filling pressure.
b. Obtain serial ECGs and isoenzymes to determine
extent of myocardial injury.
c. Assess pain to differentiate myocardial pain from inci-
sional pain.
4. Monitor for hypertension or hypotension.
a. Mild systolic hypertension occurs in 48% to 55% of all
CABG patients within the first 6 hours postopera-
tively.
b. Hypotension can occur within the first 12 hours.
c. Patients with blood pressure above 70 mm Hg, with
normal preload and CO, may be treated with low-dose
dopamine.
5. Initiate measures to prevent embolization such as antiem-
bolic stockings, not putting pressure on popliteal space
(leg crossing, raising knee gatch), and starting passive and
active exercises.
a. Assess for signs of DVT and pulmonary embolism.
b. Maintain integrity of all invasive lines.
6. Monitor for bleeding.
a. Watch for steady and continuous drainage of blood.
b. Assess for arterial hypotension, low CVP, increasing
pulse rate, and low left atrial pressure and PCWP.
c. Prepare to administer blood products, I.V. solutions,
or protamine sulfate or vitamin K (AquaMEPHY-
TON).
d. Prepare for potential return to surgery for bleeding
persisting (over 300 mL/hour) for 2 hours.
e. Monitor hemoglobin levels; if the patient’s hemoglo-
bin drops below 8 g/dL, transfusions of red blood cells
or platelets may be necessary.
f. During the first 4 to 12 hours, blood recovered from
mediastinal tubes can be autotransfused to the patient.
7. Be alert for fever and signs of infection. Check blood glu-
cose levels as ordered.
a. Administer prophylactic antibiotics, as ordered, for
the first 48 hours.
b. Control higher degrees of fever through use of
hypothermia mattress.
c. Evaluate for atelectasis, pleural effusion, or pneumonia
if fever persists. (The most common cause of early
postoperative fever [within 24 hours] is atelectasis.)
d. Evaluate for urinary tract infection and wound
infection.
e. Draw blood cultures to rule out endocarditis if fever
persists.
8. Measure urine volume; less than 20 mL/hour can indicate
decreased renal function.
a. Watch BUN and serum creatinine levels as well as
urine and serum electrolyte levels.
b. Give rapid-acting diuretics and/or inotropic drugs
(dopamine [Intropin], dobutamine [Dobutrex]) to
increase CO and renal blood flow.
c. Prepare the patient for peritoneal dialysis or hemodial-
ysis if indicated. (Renal insufficiency may produce
serious cardiac dysrhythmias.)
Community and Home Care Considerations
Preparing the patient with cardiovascular disease or after car-
diac surgery for the return home and/or optimizing the
patient’s health status in the home are important nursing
functions. The key areas on which to focus include assessment,
education, and evaluating responses.
Assessment
1. Optimally, the discharge plan begins at facility admission.
The patient’s physical condition will determine to some
extent his needs at home (ie, ability to care for self).
However, the available support systems will allow the
nurse to individualize the care plan.
2. Assess the patient’s functional abilities. Patients with car-
diovascular disorders may need to conserve their energy
and rest of
HEART SURGERY
Open heart surgery is most commonly performed for CAD, valvu-
lar dysfunction, and congenital heart defects. The procedure
requires temporary cardiopulmonary bypass (blood is diverted
from the heart and the lungs and mechanically oxygenated and
circulated) to provide a dry, bloodless field during the operation.
Newer and less invasive procedures include minimally invasive
direct coronary artery bypass (MIDCAB) and port access proce-
dures. Heart transplant will not be discussed. For information on
percutaneous ventricular assist devices, see Box 12-2.
Types of Procedures
Coronary Artery Bypass Graft
1. Traditional CABG surgery involves anastomosis of a
bypass conduit or a graft (leg and arm veins) anastomosed
to the aorta, with the other end of the graft secured to a
distal portion of a coronary vessel. The graft “bypasses”
the obstructive lesion in the vessel, and adequate blood
flow is restored to the heart muscle supplied by the artery.
(The vessel of choice is usually an internal mammary
artery because it remains unobstructed for longer than
saphenous vein grafts.)
a. Multiple grafts can be placed to bypass lesions.
b. Traditional procedure is done through sternotomy.
c. The heart is stopped, and the cardiopulmonary bypass
machine is used.
2. Primarily done to alleviate anginal symptoms and
improve survival and quality of life.
3. Indications for CABG include:
a. Left main coronary artery stenosis of 70% or greater.
b. Proximal vessel disease greater than 50% to 70%
stenosis of three main coronary arteries.
c. Multivessel disease and decreased left ventricular
function.
d. UA.
e. Chronic stable angina that is lifestyle-limiting and unre-
sponsive to medical therapies or PTCA and stenting.
4. Relative contraindications for CABG include:
a. Small coronary arteries distal to the stenosis.
b. Severe aortic stenosis.
c. Severe left ventricular failure with coexisting pul-
monary, renal, carotid, and peripheral vascular disease.
Valvular Surgery
1. Prosthetic or biologic valves are placed in the heart as
definitive therapy for incompetent heart valves. Mechan-
ical valves are of man-made material and require a life-
time of therapy with anticoagulation medications.
2. Valve repair or replacement can be done in conjunction
with CABG surgery.
Open heart surgery is most commonly performed for CAD, valvu-
lar dysfunction, and congenital heart defects. The procedure
requires temporary cardiopulmonary bypass (blood is diverted
from the heart and the lungs and mechanically oxygenated and
circulated) to provide a dry, bloodless field during the operation.
Newer and less invasive procedures include minimally invasive
direct coronary artery bypass (MIDCAB) and port access proce-
dures. Heart transplant will not be discussed. For information on
percutaneous ventricular assist devices, see Box 12-2.
Types of Procedures
Coronary Artery Bypass Graft
1. Traditional CABG surgery involves anastomosis of a
bypass conduit or a graft (leg and arm veins) anastomosed
to the aorta, with the other end of the graft secured to a
distal portion of a coronary vessel. The graft “bypasses”
the obstructive lesion in the vessel, and adequate blood
flow is restored to the heart muscle supplied by the artery.
(The vessel of choice is usually an internal mammary
artery because it remains unobstructed for longer than
saphenous vein grafts.)
a. Multiple grafts can be placed to bypass lesions.
b. Traditional procedure is done through sternotomy.
c. The heart is stopped, and the cardiopulmonary bypass
machine is used.
2. Primarily done to alleviate anginal symptoms and
improve survival and quality of life.
3. Indications for CABG include:
a. Left main coronary artery stenosis of 70% or greater.
b. Proximal vessel disease greater than 50% to 70%
stenosis of three main coronary arteries.
c. Multivessel disease and decreased left ventricular
function.
d. UA.
e. Chronic stable angina that is lifestyle-limiting and unre-
sponsive to medical therapies or PTCA and stenting.
4. Relative contraindications for CABG include:
a. Small coronary arteries distal to the stenosis.
b. Severe aortic stenosis.
c. Severe left ventricular failure with coexisting pul-
monary, renal, carotid, and peripheral vascular disease.
Valvular Surgery
1. Prosthetic or biologic valves are placed in the heart as
definitive therapy for incompetent heart valves. Mechan-
ical valves are of man-made material and require a life-
time of therapy with anticoagulation medications.
2. Valve repair or replacement can be done in conjunction
with CABG surgery.
Thursday, October 3, 2019
"If a patient is cold, if a patient is feverish, if a
patient is faint, if he is sick after talking food,
if he has a ded-sore, It is generally the fault
not of the disease, but of the Nursing."
- Mis. Florance Nightigale -
- 01
Introduction
She stated in her nursing notes that nursing "is
an act of utilizing the environment of the patient
to assist him in his recovery"
Her contribution during Crimean war is well
known.
She was a statistician using bar and pie charts,
highlighting key points.
International nurses Day, May 12 is observed in
respect to her contribution to Nursing.
Biography of Florence
Nightingale
Name : Florence Nightingale (madam)
Bron : Florence, Tuscany in Italy
Mother : Frances Nightingale nee smith
(1794-1874)
Father : William Edward Nightingale
(1792-1874)
Date of Birth : 1820.05.12
Age : 90
Died : 13 August 1910
Known for : Pioneering modern nursing
Lernt : Latin, German, French, Italian, Greek,
Mathematics, Science, Politics,
Music, Drawing
Awards : Royal Red Cross 1883
Order of Merit (1907)
Nationality : British
- 01
The English nurse Florence Nightingale was the founder of
Modern nursing and made outstanding contributions to the
knowledge and improvement of public heath.
Florence Nightingale was born in Florence, Italy. On May
12.1820. She was named after the city of her birth. Her
father is Willicim Edward Nightingale. And was a wealthy
landowner who had inherited and estates in Derbyshire
England. Like many members of the wealthy class, he had
Florence's mother fanny, dedicated themselves to the
pursuit of active social lives.
Florence and her sister, Parthenope were tutored by their
father in languages, mathematics and history. Through
Florence was tempted by the idea of a brilliant social life and
marriage, she also wanted to achieve independence.
The Nightingales lived at Lea Hall from 1821 to 1825,until
their new home. Lea hurts was completed However, Fanny
deemed Lea hurts inadequate almost immediately, with
"only 15 bedrooms" and located too far form London. It
became their summer home. William purchased Embley
Park, a Large estate in hampshire, which became their
permanent residence.
It was at Embley park in February 1837 that Florence
received a calling form God: she wrote,
"God has spoke to me and called me to his service"
Through she did not know what that service would be, she
knew that society life her parents and sister enjoyed so
much was not going to be enough for her.
Nightingale was attractive, slender and graceful. While her
demeanor was often sever, She could be very charming and
her smile was radiant.
Florence Nightingale treates captain an injured dog.
Florence Nightingale In The
Crimean War
England and France were helping Turkey in
a war against Russia.
Ÿ Russia and France had religious sisters to
care for their wounded.
Ÿ But England had only trained men.
Ÿ Florence Nightingale received a letter of
apple from the minister of war.
Ÿ With 38 nurses form catholic and
protestant olders she set for crimea.
Subscribe to:
Posts (Atom)