Decreased Cardiac Output - Nursing Care Plan for Angina Pectoris

Decreased Cardiac Output

NANDA Definition :

Inadequate blood pumped by the heart to meet metabolic demands of the body

Related Factors:

Myocardial infarction or ischemia, valvular disease, cardiomyopathy, serious dysrhythmia, ventricular damage, altered preload or afterload, pericarditis, sepsis, congenital heart defects , vagal stimulation, stress, anaphylaxis, cardiac tamponade

Angina Pectoris



Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand. Angina is a common presenting symptom (typically, chest pain) among patients with coronary artery disease. A comprehensive approach to diagnosis and to medical management of angina pectoris is an integral part of the daily responsibilities of health care professionals.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

Cardiac Pump Effectiveness
Circulatory Status
Tissue Perfusion: Abdominal Organs
Tissue Perfusion: Peripheral
Vital Signs Status


NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

Cardiac Care: Acute
Circulatory Care

Client Outcomes

Demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for client; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain
Remains free of side effects from the medications used to achieve adequate cardiac output
Explains actions and precautions to take for cardiac disease.

Nursing Intervention for Angina Pectoris

1. Monitor vital signs, eg heart rate, blood pressure.
   Rationale: Tachycardia can occur because of pain, anxiety, hypoxemia, and decreased cardiac output. Changes also occur in blood pressure (hypertension or hypotension) due to cardiovascular response.
2. Record the color and the presence / quality of the pulse.
   Rationale: decreased peripheral circulation when cardiac output falls, making skin color pale or gray (depending on the level of hypoxia) and decreased strength of peripheral pulses.
3. Maintain bed rest in a comfortable position during the acute episode.
   Rationale: Lowering the oxygen consumption / demand, lowering employment and risk of myocardial decompensation.
4. Provide supplemental oxygen as needed
   Rationale: Increase the supply of oxygen to the need to improve myocardial contractility, decrease ischemia, and lactic acid levels.

Nursing Care Plan: Assessment and Interventions for Self-Injury - Tentamen Suicide

CONCEPT OF SUICIDE

Definition of a conscious and purposeful effort to end the lives of individuals is consciously desire and attempt to carry out his desire to die. Suicidal behavior include cues, trial or verbal threats, which will result in death, injury or self-injury.

Suicide as the world's problems
The males are three times more likely to commit suicide than women, because men are more likely to use more effective tools for suicide, among others with a gun, hanging, or jumping from high buildings, while women more often use substances psychoactive drug overdose or poison, but now they are more likely to use a gun. In addition, women more often choose to save himself or others rescued.

Factors that contribute to children and adolescents

Family and immediate environment became a major pillar in charge of suicide attempts in children and adolescents, this statement is supported by Vygotsky's theory that the child's immediate environment contribute in shaping the character of the child's personality, according to Stuart Sundeen personality type most often commit suicide is an aggressive type , hostility, hopelessness, low self-esteem and antisocial personality. Children will be larger when made ​​a suicide attempt came from families who apply authoritarian parenting or family who had committed suicide, emotional disturbances and their families with alcoholism.

Other psychosocial factors such as parental history of divorce, broken relationships, lost jobs or multiple stress such as moving, loss and chronic disease is accumulating a collection of stressors in the form of a less constructive coping, children will easily take a shortcut because there is no longer the place that gave him a sense of safe, according to Kaplan mental disorders and suicide in children and adolescents will emerge when environmental stressors cause increased anxiety.



Nursing Care Plan for Self-Injury - Tentamen Suicide
Nursing Assessment for Patients with Self-Injury:

Environment and suicide attempts
Nurses need to examine the events that insulting or hurtful, preparation effort, verbal expressions, records, paintings, providing valuable objects, drugs, the use of violence, poison.

Symptom
The nurse noted the despair, self-reproach, feelings of failure and worthlessness, the natural feelings of depression, agitation, anxiety, insomnia persists, bewrat loss, slow speech, fatigue, withdrawal.

Psychiatric illness
Previous suicide attempts, affective disorders, addictive substances, teenage depression, elderly mental disorders.

Psychosocial history
Divorce, broken relationships, lost jobs, multiple stress (moving, loss, broken relationships, school problems, discipline crisis, chronic disease.

Personalities Factor
Impulsive, aggressive, hostile, negative cognition and kakuk, despair, low self jharga, antisocial

Family history
History of suicide, affective disorder, alcoholism

Nursing Diagnosis for Self-Injury - Tentamen Suicide

Risk for self mutilation / self-violence related to fear of rejection, the natural feeling depressed, angry reaction, the inability to express feelings verbally, the threat of self-esteem because of embarrassment, loss of jobs and so on.

Nursing Interventions for Self-Injury - Tentamen Suicide

• Observation of client behavior more frequently through the activity, and regular interaction, avoid the impression of surveillance and suspicion on the client.
• Establish verbal contact with the client that he would ask for help if you feel the desire to commit suicide (discuss feelings of wanting to kill herself with people you trust)
• If self-mutilation occurs, wound care not to disturb the client with the cause, do not give positive reinforcement for these behaviors (lack of attention to maladaptive behavior can reduce repetition mutilation).
• Encourage clients to talk about the feelings he had before this behavior to occur (in order to understand the problem)
• Acting as a model in which the right to express anger (suicidal behavior is seen as anger directed at ourselves)
• Remove all dangerous objects from the environment the client (the client security is a priority treatment)
• Navigate back with the distribution of physical mutilation behavior (physical exercise is a safe way to channel the pent-up tension)
• Commitment of all staff to give spirit to the client
• Give medication according to the result of collaboration, monitor effectiveness, and side effects
• Use of mechanical restrain when circumstances force according to the procedure remains
• Observation restrain clients in every 15 minutes / according to the procedure fixed by considering the safety, blood circulation, basic needs (safety of clients is a priority nursing)

Treatment and Prevention of Hepatitis B

 

Hepatitis B
  
Key facts

• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
• The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
• About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
• About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
• The hepatitis B virus is 50 to 100 times more infectious than HIV.
• Hepatitis B virus is an important occupational hazard for health workers.
• Hepatitis B is preventable with a safe and effective vaccine.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.
Worldwide, an estimated two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections.
A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer.

Treatment

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries.
Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.
Patients with cirrhosis are sometimes given liver transplants, with varying success.

Prevention

All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.
The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).
The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.
All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:

• persons with high-risk sexual behaviour;
• partners and household contacts of HBV infected persons;
• injecting drug users;
• persons who frequently require blood or blood products;
• recipients of solid organ transplantation;
• those at occupational risk of HBV infection, including health care workers; and
• international travellers to countries with high rates of HBV.

The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

http://www.who.int/mediacentre/factsheets/fs204/en/