Primary Nursing Diagnosis

Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) associated with atherosclerosis, spasm, or thrombosis

OUTCOMES. Cardiac pump effectiveness; Circulation status; Comfort level; Pain control behavior; Pain level; Tissue perfusion: Cardiac

INTERVENTIONS. Cardiac care; Cardiac precautions; Oxygen therapy; Pain management; Medication administration; Circulatory care; Positioning

H PLANNING AND IMPLEMENTATION Collaborative

The physician usually prescribes oxygen therapy, often at 2 to 4 L/min to provide increased oxygen to the myocardial tissue. If it has been less than 4 to 6 hours since pain began, and if the clinical picture suggests an MI, thrombolytic agents may be given to dissolve the coronary thrombus. A cardiac catheterization may be performed when the patient's condition is stable to identify the areas of blockage in the coronary arteries and to assist in determining treatment. Medical treatment with medications as described here may be the treatment of choice if the blockage is extensive and if the patient has conditions that increase mortality or morbidity with surgery. A percutaneous transluminal coronary angioplasty (PTCA) may be performed if the blockages are limited and are accessible with a balloon catheter. The cardiologist inflates the balloon catheter at the area of blockage and compresses the plaque or pushes the arterial wall out to enlarge the arterial lumen. The cardiologist may also place a stent at the area of dilation to maintain patency. An arthrectomy, which involves shaving off the plaque in the coronary artery and removing the debris to obtain arterial patency, in another nonsurgical option.

Continuous cardiac monitoring, along with intermittent 12-lead electrocardiograms, helps the healthcare team monitor the resolution of ischemic and injured areas. Hemodynamic monitoring may be initiated, and a flow-directed pulmonary artery catheter may be used to measure filling pressures in the ventricles, to determine pulmonary artery pressures, and to calculate the cardiac output. Notify the physician for significant signs of decreased cardiac output, such as hypotension, diminished urine output, crackles in the lungs, cool and clammy skin, and fatigue.

The surgical option for patients with coronary blockages caused by plaque is coronary artery bypass grafting (CABG). To restore blood flow to the heart muscle distal to the blockages, the surgeon uses the left internal mammary artery or the saphenous vein to bypass the areas of blockage within the coronary arteries.

Diet restrictions begin in the hospital and should be continued at home. A collaborative effort among the patient, dietician, physician, and nurse plans for a diet low in cholesterol, fat, calories, and sodium (salt). Drinks in the coronary care unit are usually decaffeinated and not too hot or cold in temperature, although some experts question the need to restrict extremes of temperature. Foods with fiber may decrease the incidence of constipation.

Pharmacologic Highlights

Medication or

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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