PERIPHERAL VASCULAR DISEASE PATIENT CARE
Elevate the feet when the patient is sitting in a chair for a long period of time. When the
feet are not elevated, make sure that the patient's feet are flat on the floor. If they are
not, support the feet with a footstool. Discourage the patient from crossing the legs when
sitting. Discourage the patient from using circular garters.
Discourage smoking - it interferes with circulation.
Avoid using the knee gatch of the bed.
Avoid using heating pads or hot water bottles. The patient may not feel temperatures that are too hot.
Maintain body warmth. Make sure the patient has warm clothes, including well-fitting
socks. Provide blankets for the bed.
Prevent injury to the feet:
- Instruct the patient to wear shoes when out of bed.
- Check to see that the shoes are in good repair and that they fit well.
- Avoid pressure to the legs and feet from any source.
Inspect the feet carefully when you bathe the patient or if the patient complains of any
discomfort in the feet. Promptly report any signs of inflammation, injury, or circulatory problems:
- Broken skin.
- Color change (redness, whiteness, or cyanosis).
- Heat or coldness.
- Cracking between toes.
- Corns or calluses.
- Swelling.
- Pain.
- Loss of function.
- Drainage.
Bathe the feet regularly:
- Dry thoroughly and gently between the toes.
- Use a moisturizing lotion on the feet and legs if the skin is dry.
Do not cut the toenails of patients with peripheral vascular disease without instructions
from the patient's health care provider.
CARING FOR PATIENTS WITH HEART CONDITIONS
The heart must receive a constant supply of oxygen or it will die. Oxygen is delivered to
the heart muscle by a complex system of arteries. As long as the coronary arteries (arteries
of the heart) continue to supply the heart with an adequate amount of oxygen, the heart can
continue to function properly.
As the body ages, however, the coronary arteries may become narrower as a result of a
disease process called atherosclerosis. Atherosclerosis causes layers of fat to coat the
inner walls of the arteries. Progressive atherosclerosis can cause angina pectoris, heart
attack, and even cardiac arrest.
ANGINA PECTORIS
As atherosclerosis progresses, the blood (oxygen) supply to the heart is reduced enough to cause
pain or pressure in the chest. The heart simply needs more oxygen than the narrowed coronary
arteries can deliver. This pain is known as angina pectoris, or simply "angina".
When a patient has chest pain, your first action is to ask the person to describe the pain.
Angina is often described as pressure or heavy discomfort. The patient may say something like,
"It feels like an elephant is sitting on my chest." Angina attacks are usually brought on by
exercise, emotion, or eating. Crushing pain may be felt in the chest and may radiate to either
or both arms, the neck, the jaw, or any combination of these sites. The patient is often short
of breath and sweating, is extremely frightened, and has a sense of doom.
Ask the patient whether they are already being treated for a diagnosed heart condition. If the
patient's answer is "yes", ask the patient if there is a pill or spray he or she can take for
angina pain. A patient who has suffered previous bouts of angina usually has medication that can be
taken (placed or sprayed under the tongue) to relieve pain. The most common medication of this
type is nitroglycerin. Often the patient has already taken a nitroglycerin pill by the time
you arrive on the scene.
If the patient has nitroglycerin but has not taken it during the past 5 minutes, help place one
of the tiny pills under his or her tongue or help the patient to administer the aerosol form
of the medication.
Nitroglycerin usually relieves angina pain within 5 minutes. If the pain has not diminished after
5 minutes, help the patient take a second pill. If the pain has not lessened 5 minutes after the
patient has taken the second pill, assume that the patient is having a heart attack. You should
follow your local emergency care protocols regarding the administration of nitroglycerin.
HEART ATTACK
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A heart attack (myocardial infarction) is caused by complete blockage of a coronary artery. Blockage
may be caused by severe atherosclerosis or by a blood clot that has broken free somewhere else
in the circulatory system and has become lodged in the artery. If one of the coronary arteries
becomes blocked, the part of the heart muscle served by that artery is deprived of oxygen and dies.
Blockage of a coronary artery causes the patient to suffer immediate and severe pain. The pain
of angina pectoris and heart attack may be similar at first. The pain of a heart attack is not
relieved by nitroglycerin pills. Most heart attack patients describe the pain as crushing. The
pain may radiate from the chest to the left arm or to the jaw. The patient is usually short of
breath, weak, sweating, and nauseated, and may vomit. The pain of a heart attack persists, but
angina rarely lasts more than 5 minutes.
If the area of heart muscle supplied by the blocked artery is either critical or large, the heart
may stop completely. Complete cessation of heartbeat is called cardiac arrest. CPR is your first
emergency treatment for cardiac arrest.
The signs of cardiac arrest are:
- Unconsciousness.
- Absence of respirations.
- Absence of carotid pulse.
Most heart attack patients do not experience immediate cardiac arrest. To support the patient
and reduce the probability of cardiac arrest, you can take the following actions:
- Summon additional help.
- Talk to the patient to relieve his or her anxiety.
- Touch the patient to establish a bond. Hold the person's hand.
- Reassure the patient that you are there to help. The person is afraid that death is close,
and fear can create tension and make the pain worse.
- Move the patient as little as possible and do not allow the person to move! If the patient
must be moved, you and other bystanders must move the patient.
- Place the patient in the position he or she finds most comfortable. This is usually a
semi-reclining or sitting position.
- If oxygen is available and you are trained to use it, administer it to the patient. Supplemental
oxygen increases the amount of oxygen the blood can carry. The increase in oxygen reduces pain
and anxiety. It also eases the minds of the patient's family and friends to see that something
is being done to relieve the patient's physical distress.
Since you do not have extensive equipment available to help the heart attack patient, your
primary role is to provide psychological support and arrange for prompt transportation to an
appropriate medical facility. Because the patient's emotional state can affect his or her
physical condition. Psychological support is valuable. It can prevent cardiac arrest.
Immediate medical treatment has saved many people. The treatment is directed toward:
- Relieving the pain.
- Reducing heart activity.
- Altering the clotting ability of the blood.
- Administering drugs to dissolve the clot.
NURSING CARE
During the acute stage, heart attack patients require professional care. Many hospitals provide
intensive cardiac care units for these patients. Nursing care supports the therapy ordered.
Special attention must be given to:
- Noting signs of a recurrence and reporting immediately to the nurse.
- Watching for bleeding and reporting immediately.
- Assisting with activities of daily living.
- Monitoring vital signs.
CONGESTIVE HEART FAILURE
Congestive heart failure (CHF) is not directly caused by narrowing or blockage of the coronary
arteries, but by failure of the heart to pump adequately.
The heart has 2 sides. The right side receives "used" blood from the body and sends it to the
lungs; the left side receives oxygenated blood from the lungs and pumps it to the body. If one
side of the heart becomes weak and cannot pump as well as the other side, the circulatory
system becomes unbalanced, resulting in circulatory congestion. In CHF, the failure is in the
heart muscle, but the congestion is in the blood vessels.
The figure above shows what happens if CHF occurs on the left side of the heart, which sends
blood to the body. More blood is sent to the lungs than to the body. This results in congestion
(overload) in the blood vessels of the lungs.
The major symptom of CHF is breathing difficulty, not chest pain. If you are called to assist
a patient who has respiratory problems but no signs of injury or airway obstruction are present,
look for the signs and symptoms of CHF, which include:
- Shortness of breath.
- Rapid, shallow breathing.
- Moist or gurgling respirations.
- Enlarged neck veins.
- Profuse sweating.
- Anxiety.
- Swollen ankles.
As blood pressure builds in the vessels of the lungs, fluid is forced into the lung tissue,
causing it to swell. The patient may make a gurgling sound when breathing and start spitting
up a white or pink froth or foamy fluid. At this point, the patient is actually "drowning" in
his or her own body fluids. The patient is very anxious but is usually in little or no pain
(unless he or she is suffering a heart attack coupled with CHF).
As soon as you determine that the patient is suffering from CHF, take these simple, lifesaving actions:
The most important action is to place the patient in a sitting position with the legs down.
This position helps relieve CHF symptoms until more highly trained EMS personnel arrive.
The major symptoms of heart attack is chest pain, the major symptom of CHF is difficulty breathing.
Medical Treatment Involves:
- Drugs to help the heart beat more strongly and regularly and to increase the output of
fluids (diuresis) by the kidneys.
- Low-sodium diet.
MoonDragon's Nutrition Information: Diet Index
- Restriction of fluids, if ordered.
- Weighing patient daily to monitor level of fluid retention.
- Monitoring apical pulse and observing for pulse deficit.
Positioning patient in orthopedic position or high Fowler's supported by pillows, or supported
in a chair. The position must be changed frequently, but changes in position should be made
slowly. Padded footboards help keep the weight of the bedding off the toes.
- Applying elasticized stockings or TED hose. TED hose are elastic anti-embolism stockings.
TED hose and Ace bandages help channel blood to the deeper vessels. They must be checked
often and reapplied every 6 to 8 hours. Check the extremities carefully for adequate
circulation. The skin should be normal color and warm.
- Assisting with activities of daily living as needed.
- Attending to general hygiene. Complete bathing is tiring, but partial baths can stimulate
circulation and provide comfort. Special attention must be given to the skin because the
combination of position, edema, and poor circulation contributes to tissue breakdown.
- Assisting with oxygen therapy. Oxygen therapy may be provided either by face mask or nasal
cannula. Because cardiac patients often breathe through the mouth, the mouth tends to be very
dry. Special mouth care may be needed.
- Providing for elimination. A bedside commode is convenient. The use of a commode is less
tiring for the patient than using a bedpan for elimination.
- Encouraging adequate nutrition. Small, easily digested meals should be provided. You may
need to assist in feeding the patient to prevent fatigue.
- Monitoring and recording fluid intake. Patients with acute heart failure may be given drugs that
increase the output of urine and alter the heart rate. Measuring the intake and output and taking
daily weights are ways of determining if fluid is being retained.
- Regularly checking vital signs. Sometimes the force of heart contraction, which propels the
blood forward into the blood vessels, does not have enough strength to make the vessels expand.
HEART BLOCK
When caring for a patient with a pacemaker:
- Count and record the pulse rate.
- Report any irregularities or changes below the present rate.
- Report any discoloration over the implant site.
- Report hiccuping, because this may indicate problems.
- Keep the patient away from microwave ovens and cellular phones, because they may disrupt
the function of the pacemaker.
Patients usually function very well with pacemakers so long as they are adequately monitored.
CARING FOR PATIENTS WITH BLOOD ABNORMALITIES
ANEMIA
Treatment is aimed at:
- Improving the quality and quantity of the blood by giving iron supplements.
- Eliminating the basic cause of the disease.
- Giving blood transfusions as needed.
LEUKEMIA
Treatment is aimed at:
- Easing symptoms and keeping the patient comfortable.
- Maintaining normal blood levels. Transfusions may be needed to combat the anemia that
accompanies the condition.
- Combating infection by using antibiotics.
- Slowing the production of abnormal white cells through chemotherapy and/or radiation therapy.
SPECIAL CARE
Patients who have cancer or anemia require special care.
- Check vital signs.
- Encourage rest and a good diet.
- Handle the patient very gently.
- Give special mouth care, because the mouth and tongue become sensitive.
- Be sure to report any signs of bleeding, such as bruises or discolorations, because further
blood loss makes the condition worse.
- Keep patient warm.
- Protect patient from falls that may result from dizziness or weakness.
- Change the patient's position often, at least every two hours.
- Provide emotional support.
RELATED HEALTH CARE LINKS
MoonDragon's Health Care: Cardiovascular Patient Care
MoonDragon's Health Care: Common Medical Abbreviations
MoonDragon's Health Care: Cardiopulmonary Resuscitation (CPR) Adult - One Rescuer
MoonDragon's Health Care: Cardiopulmonary Resuscitation (CPR) Adult - Two Rescuers
MoonDragon's Health Care: Cardiopulmonary Resuscitation (CPR) Complications
MoonDragon's Health Care Index
MedLib.com: Heart Sounds
MedStudents.com: Cardiology Heart Sounds Wave Files
MoonDragon's Nutrition Information: Diet Index
MoonDragon's ObGyn Information: Smoking
MoonDragon's Health Therapy: Biofeedback
MoonDragon's Health & Wellness: Hypertension
MoonDragon's Health & Wellness: Cardiovascular Nutrition & Recommendations
MoonDragon's Health & Wellness: Introduction to the Circulatory System
MoonDragon's Health & Wellness: Circulatory Disorders
MoonDragon's Health & Wellness: Common Heart Problems & Procedures
MoonDragon's Health Care Information: Cardiovascular Patient Care
MoonDragon's Health & Wellness: Arteriosclerosis/Atherosclerosis
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
MoonDragon's Health & Wellness: High Cholesterol
MoonDragon's Health & Wellness: Hypothyroidism
MoonDragon's Health & Wellness: Raynaud's Phenomenon
MoonDragon's Health & Wellness: Varicose Veins
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