First, the main nursing problems
1. Pain
Related to myocardial ischemia, the pain of coronary heart disease may be related to myocardial ischemia of patients, which will lead to the appearance of cardiac pain symptoms.
2. Activities have no endurance
This is related to the attack of angina pectoris that affects activity.
3. Irregular pulse
Myocardial ischemia in coronary heart disease is related to arrhythmia caused by myocardial lesions.
4. Edema and dyspnea
When the patient has edema and dyspnea, it may be related to heart failure in the late stage of coronary heart disease.
Second, the nursing measures
1. Absolute bed rest, close monitoring and quiet environment should be maintained when angina pectoris attacks.
2. Understand the patient's psychological state, eliminate bad emotions, avoid all kinds of incentives, and strengthen life care.
3. Stop the activity immediately when angina attacks, and take nitroglycerin under the tongue. To observe the adverse reactions of antianginal drugs. For example, after taking nitrous acid, there are often symptoms of vasodilation such as headache, head swelling, redness and dizziness. Sensitive person is prone to orthostatic hypotension.
4. Patients with coronary heart disease can't smoke and drink. In terms of diet, we should pay attention to eating some foods with low fat, low cholesterol and high vitamins. We should eat light food instead of eating too much at once.
5. Room temperature should not be too cold and too hot, because too cold and too hot will increase the heart load, and angina pectoris is easy to attack.
6. Give oxygen, 3-4 liters/minute.
7. After the pain is stable, you can carry out appropriate physical activities.
Closely observe the following indicators
(1) heart rate, heart rhythm, pain location, nature, duration and whether it is installed after medication.
(2) Patrol should be strengthened at night, because angina pectoris often occurs at night and early morning.
(3) If the nature of pain changes or the number of angina pectoris attacks increases and worsens, if the patient's pain lasts for more than 15 minutes or the medication is not relieved, the doctor should be informed immediately.
Third, health guidance.
1. Have a reasonable diet, a low-fat, low-calorie, low-cholesterol digestible diet, eat more light foods such as vegetarian dishes and fruits, and quit smoking and drinking. Do not overeat or overeat, and do not drink strong coffee or strong tea.
2. Balance your mind, avoid nervousness, anxiety, emotional excitement and anger, and ensure adequate sleep.
3. Keep the stool unobstructed and avoid exertion when defecating.
4. Introduce the prevention methods of angina pectoris, immediately stop activities and rest on the spot. Take nitroglycerin, nifedipine or Suxiao Jiuxin Pills under the tongue. If you have frequent attacks, you should go to the hospital immediately.
5. Do a good job in psychological care. When angina attacks, patients are afraid of death, so they should care and comfort them and relieve their ideological worries.
6. Teach patients to use nitroglycerin and its storage methods, be familiar with the side effects of drugs, and inform patients to carry it with them.
7. Insist on taking medicine according to the doctor's advice, and there are emergency medicines at home.
Speaking of heart failure, many people may not know what heart failure is. In fact, heart failure, also known as heart failure, is mainly caused by weakened myocardial contraction. How to care for heart failure? What are the nursing measures for heart failure? Today, I will introduce them to you one by one. If you are a heart failure patient and don't know how to care for it, let's take a look.
Nursing measures of heart failure
What are the nursing measures for heart failure? If you don't know, let me introduce you to the nursing measures of heart failure, so that you can know more about the nursing of heart failure.
1. ordinary care
(1) Ensure that patients get adequate rest.
The principle of activity and rest should be determined according to the situation of cardiac function: patients with cardiac function level can not limit their activities, but they should increase their lunch break; Patients with mild heart failure (secondary cardiac function) can get up and do some exercise, but they need to increase the interval between activities and sleep time; Patients with moderate heart failure (cardiac function grade ⅲ) should stay in bed and limit their activities. Patients with severe heart failure (cardiac function grade 4) must stay in bed strictly and be given a semi-recumbent position or a sitting position. Bedridden patients should take good care of their daily lives and facilitate their lives. After the condition improves, you can gradually increase the activity to avoid the adverse consequences such as muscle atrophy, venous thrombosis, skin injury, digestive dysfunction and psychopathy caused by long-term bed rest.
(2) Diet
Patients should eat low-calorie food. After the condition improves, you can properly supplement calories and high nutrition. A diet with less salt and easy digestion is appropriate; Choose foods rich in vitamins, potassium, magnesium and cellulose; Avoid eating gas-producing food and aggravate breathing difficulties; Avoid irritating food; It is advisable to eat less and eat more, and determine the potassium content in food according to the blood potassium level.
(3) Keep the stool unobstructed
It is an important nursing measure to keep the defecation unobstructed in patients with heart failure. Therefore, patients need to practice defecation, and dietary fiber can also be added to the diet to help patients defecate.
(4) Oxygen inhalation
The general flow rate is 2 ~ 4L/min. The changes of respiratory frequency, rhythm and depth of patients after oxygen inhalation should be observed, and the improvement of dyspnea should be evaluated at any time.
(5) Strengthen skin and oral care.
Qin Ying, a bedridden patient for a long time, turned over to prevent the skin from being damaged by local pressure. Strengthen oral care to prevent oral mucosal infection caused by flora imbalance caused by drug treatment.
(6) control the speed of intravenous infusion
Generally, it is1~1.5m1(20 ~ 30 drops) per minute.
2. Psychological care of patients
Psychological nursing is very necessary for patients with heart failure. This can reduce the psychological burden of patients and increase their sense of security.
3. Emotional observation and symptomatic nursing
(1) Pay attention to the clinical manifestations of early heart failure. Fatigue dyspnea or paroxysmal dyspnea occurs at night, and symptoms such as increased heart rate, fatigue, dizziness, insomnia, irritability and decreased urine output appear. You should contact your doctor in time and strengthen observation. Such as extreme irritability, sweating, blue lips, chest tightness, cough and difficulty breathing. Cyanosis, coughing up a lot of white or pink foam sputum, should be alert to the occurrence of acute pulmonary edema, and immediately prepare to cooperate with the rescue.
(2) Regularly observe the changes of water electrolyte and acid-base balance. Hypokalemia can cause fatigue, abdominal distension, palpitation, increased U wave in electrocardiogram and arrhythmia, and can also induce digitalis poisoning. A few people have hyperkalemia due to renal insufficiency and excessive potassium supplementation, which can cause cardiac arrest in severe cases. Hyponatremia is characterized by fatigue, loss of appetite, nausea, vomiting and drowsiness.
4. Prevention and nursing of complications
(1) respiratory tract infection
Indoor air circulation, ventilation twice a day, to avoid gusts, pay attention to keep warm in cold weather, encourage people who stay in bed for a long time to turn over and help pat their backs to prevent respiratory infections and pneumonia.
(2) Thrombosis
Due to the hemodynamic changes caused by long-term bed rest and diuretic use, lower extremity veins are prone to thrombosis. Patients should be encouraged to exercise in bed and contract their lower limbs, and assisted to massage their lower limbs. Soak the lower limbs with warm water to accelerate blood circulation and reduce venous thrombosis. When the patient has local swelling of the distal limb, it means that venous thrombosis has occurred and he should contact the doctor as soon as possible.
Four, coronary heart disease and angina pectoris nursing routine
Angina pectoris is a clinical syndrome caused by coronary insufficiency and acute and temporary myocardial ischemia and hypoxia. It shows tenderness behind sternum, which can be radiated to precordial region and left upper limb for several minutes, and can be relieved by rest or taking nitroglycerin.
Physical labor, emotional excitement, satiety, cold, smoking, tachycardia and shock are the inducing factors.
Nursing routine
1, when angina attacks, stay in bed absolutely, closely monitor and keep the environment quiet.
2, understand the patient's psychological state, eliminate bad emotions, avoid all kinds of incentives, and strengthen life care.
3. Observe the adverse reactions of antianginal drugs. For example, after taking nitrous acid, there are often symptoms of vasodilation such as headache, head swelling, redness and dizziness. Sensitive person is prone to orthostatic hypotension.
4. Give a light diet with low fat, low cholesterol, high vitamins and easy digestion, eat a few meals, don't be too full, and don't drink alcohol.
5, room temperature should not be too cold and overheated, because cold and hot will increase the burden on the heart, angina pectoris is easy to attack.
6. If the diagnosis is not clear or the condition needs to be further estimated, ECG should be recorded during the attack of angina pectoris, and the changes of consciousness, pulse and blood pressure should be closely observed.
7. If the patient's pain lasts more than 15 minutes or is not relieved after taking the medicine, it should be differentiated from the pre-myocardial infarction syndrome, immediately report to the doctor and take effective measures in time.
8, psychological care, angina pectoris attack patients have fear of death, to care for and comfort patients, remove ideological concerns.
9, teach patients to use nitroglycerin and its storage method, familiar with the side effects of drugs, and inform them to carry at any time.
Five, coronary heart disease and angina pectoris nursing routine
1. According to the general nursing routine of circulatory system.
2. Let patients eat more low-calorie and low-fat foods, eat more light foods such as vegetarian dishes and fruits, and quit smoking and drinking.
3. Avoid fatigue, mood swings, mental stress, full meals, colds and other inducing factors, and do a good job in psychological care and health education.
4. Pay attention to the typical manifestation of angina pectoris, which is sudden and transient (1-5 minutes can relieve) pain in the retrosternum or precordial area, which can radiate to the left arm, accompanied by cold limbs and pale face.
Conclusion: Through the above introduction, we must have a certain understanding of the nursing of coronary heart disease. Although our life is getting better and better in our modern society, some diseases are still not far from us. For patients with coronary heart disease, nursing becomes more important.
Further reading: nursing diagnosis of coronary heart disease correctly understand the nursing measures of coronary heart disease How to care for coronary heart disease How to treat coronary heart disease How to treat coronary heart disease How to treat coronary heart disease These methods keep yourself away from coronary heart disease What medicine to eat and how to treat coronary heart disease?
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