Peripheral circulation health education

Chronic heart failure, also known as chronic congestive heart failure, is a common clinical syndrome. The main cause is heart valve disease, followed by hypertension and coronary atherosclerotic heart disease. According to clinical symptoms, it can be divided into left heart, right heart and total heart failure, of which left heart failure is the most common. The main symptoms of left heart failure are dyspnea, cough and expectoration, often accompanied by fatigue, insomnia, hypotension and other symptoms. The main manifestations of right heart failure are systemic congestion and edema. In complete heart failure, the clinical manifestations of left heart failure and right heart failure coexist. The treatment principles of chronic heart failure are: prevention and treatment of primary disease; Adaptation or compensation mechanism to stabilize heart failure; Relieve ventricular dysfunction. Common nursing problems are: (1) gas exchange is damaged; (2) Decreased cardiac output; (3) Excessive body fluid; (lack of endurance); (5) feel sad; (6) Lack of knowledge. Impaired gas exchange [related factors] Blood stasis in pulmonary circulation. Pulmonary infection. Can't expectorate and cough effectively. 【 Main manifestations 】 Hard breathing, sitting breathing and cyanosis. Cough, expectoration and hemoptysis. Abnormal breathing frequency and depth. [Nursing purpose] To improve or alleviate patients' dyspnea and hypoxia. It can effectively relieve cough and resolve phlegm. 【 Nursing measures 】 Assist patients to take prone positions conducive to breathing, such as high pillow prone position, semi-sitting prone position, sitting prone position, etc. Provide patients with a quiet and comfortable environment, keep the air in the ward fresh and ventilate regularly. According to the degree of hypoxia, give the patient (appropriate) oxygen, generally 1-2L/ min, moderate hypoxia 3-4L/ min, severe hypoxic pulmonary edema 4-6L/ min. Patients with pulmonary edema inhale 20%-30% alcohol humidified oxygen. Assist the patient to turn over and pat his back, which is conducive to the discharge of sputum and keep the respiratory tract unobstructed. Teach patients the correct way to cough and expectorate: sit up straight as far as possible and take a deep breath slowly. Hold your breath for 3-5s, cough up phlegm hard, and cough twice in a row. 6. If conditions permit, encourage patients to get out of bed and increase their vital capacity. 7. Explain to patients/family members the ways to prevent lung infection, such as avoiding colds, avoiding dampness and quitting smoking. [Key evaluation] Changes in respiratory frequency and depth, dyspnea and cyanosis. Whether the amount and color of sputum have changed, and whether the patient can cough and expectorate effectively. Blood gas analysis, changes of blood oxygen saturation. Decreased cardiac output [related factors] Increased cardiac preload. Cardiac afterload increases. Primary myocardial injury. 【 Main manifestations 】 Oliguria, pale skin, tachycardia, hypotension, fatigue and weakness. Difficulty in breathing. 【 Nursing objective 】 The patient's cardiac output is improved, such as normal blood pressure and heart rate, warm limbs, strong pulse and normal urine output. 【 Nursing measures 】 Closely observe the changes of patients' heart rhythm, heart rate, body temperature, blood pressure, pulse pressure difference and electrocardiogram. The changes of peripheral circulation, limb temperature and blood oxygen saturation were observed. Strictly control the infusion volume according to the doctor's advice, the speed is generally not more than 30 drops/minute, and limit the intake of water and sodium. Accurately record the 24-hour water inflow and outflow to maintain the water-electrolyte balance. Observe the curative effect and toxic side effects of drugs, such as diuretics can cause water-electrolyte balance disorder; Cardiotonic can cause digitalis poisoning; Vasodilators can cause blood pressure to drop. [Key assessment] Heart rate, blood pressure and pulse. The temperature and color of the skin. Changes of water inflow and outflow and urine volume. Excessive body fluid [related factors] Blood stasis in venous system leads to increased capillary pressure. Renin-angiotensin-aldosterone system activity and vasopressin level increase, causing water and sodium retention. 【 Main manifestations 】 The patient's drooping parts are edematous, even the whole body is edematous, and the skin is tight and shiny. Decreased urine output and increased weight. Poor spirit, fatigue, anxiety. 【 Nursing Objective 】 The edema subsided and the water inlet and outlet were basically balanced. The skin is not damaged. 【 Nursing measures 】 Give a low-salt and high-protein diet, eat less and eat more meals, and limit the intake of sodium salt and water according to the illness. Salt intake is severe edema 1g/d, moderate edema 3g/d, mild edema 5g/d ... weigh twice a week. Keep skin clean and dry, clothes loose and comfortable, sheets and clothes clean and flat. Observe the regression of patients' skin edema, change positions regularly, avoid pressing the edema area for a long time, and prevent skin damage and bedsore formation. Assist patients in life care to prevent patients from falling when they get out of bed. During the application of cardiac glycosides and diuretics, the water-electrolyte balance should be monitored and potassium should be supplemented in time. [Key evaluation] Water-electrolyte balance of patients. Whether the edema is relieved. Changes in body weight and urine output. Exercise intolerance [related factors] Decreased cardiac output, tissue ischemia and hypoxia, and weakness of limbs. The condition is serious, and chest tightness, shortness of breath, dyspnea and other discomforts occur repeatedly. Gastrointestinal congestion leads to loss of appetite and reduced food intake. [Main manifestations] Life cannot take care of itself. The duration of the activity is short. The chief complaint is fatigue and weakness. Objective: To improve patients' activity endurance and keep the best activity level. Master the methods of improving exercise endurance and be willing to carry out the activity plan. 【 Nursing measures 】 Encourage patients to participate in designing activity plans, so as to adjust patients' psychological state and promote patients' motivation and interest in activities. Determine the amount of activity according to cardiac function: cardiac function level 1: avoid heavy physical activity, and general physical activity is not limited. Cardiac function grade II: avoid heavy physical activity and appropriately limit general physical activity. Cardiac function grade III: Physical activity is strictly restricted. Cardiac function grade ⅳ: absolute bed rest, life care by nurses. Gradually increase the activity, pay attention to monitor the patient's heart rate, breathing and complexion during the activity, stop the activity immediately if there is any abnormality, and report to the doctor. Let patients know the causes of exercise intolerance and the necessity of restricting activities, and avoid the factors that suddenly increase the heart load. Instruct bedridden patients to move their limbs every 2 hours to prevent venous thrombosis and assist passive limb movement when necessary. [Key evaluation] The activity amount, activity endurance and duration of patients. Whether the ability of self-care has been restored or enhanced. V. A sad premonition [Related factors] The influence of the disease. Lack of confidence in treatment and prognosis. Fear of death. 【 Main manifestations 】 Mental fatigue, depression and disappointment. Easily excited. Treatment and nursing don't cooperate. 【 Nursing Objective 】 Patients have confidence in treatment and are emotionally stable. Have a good attitude and actively cooperate with the treatment. 【 Nursing measures 】 When the patient has dyspnea, chest tightness and other discomfort, wait for the patient to feel safe. Patiently answer patients' questions and give health guidance. Establish a harmonious relationship with patients/families, avoid mental stress, and care carefully and patiently. Minimize external pressure and create a relaxed and harmonious atmosphere. Provide relevant treatment information, introduce successful cases, pay attention to positive effects and establish patients' confidence. If necessary, find a suitable support system, such as unit leaders and family members, to comfort and care for patients. [Key evaluation] Whether patients have confidence in the treatment. The patient's psychological condition. Lack of knowledge [related factors] Lack of knowledge sources. Cognitive ability is limited. Lack of understanding of disease and treatment. 【 Main manifestations 】 Incorrect understanding and feelings about current health status, such as anxiety, doubt and anxiety. Patients can't cooperate with treatment and nursing correctly. 【 Nursing Objective 】 Patients and their families can talk about the etiology, inducement, prevention, follow-up and self-care of chronic heart failure. Can correctly implement a reasonable diet and rehabilitation plan. 【 Nursing measures 】 Choose appropriate education methods to make patients and their families know the following knowledge: etiology, treatment and course of chronic heart failure. Causes of chronic heart failure: infection, excessive physical activity, emotional excitement, improper diet, forced defecation, improper medication, etc. Common symptoms of chronic heart failure: dyspnea, edema, fatigue, epigastric fullness, loss of appetite or nausea and vomiting. If these symptoms appear, you should see a doctor. Dietary guidance: eat more high-protein, low-salt, low-fat and digestible foods, and eat a small amount to avoid satiety. No irritating food, no alcohol. Activity guidance: gradually increase the amount of activity to avoid fatigue, and don't be flustered and short of breath during the activity. Prevent colds, keep warm and avoid emotional excitement. Name, dosage, usage, function and side effects of commonly used drugs in publicity and education. [Key evaluation] The patients' understanding of the treatment, inducement, etiology, follow-up and self-care of chronic heart failure. Can you arrange your diet and activities reasonably? Can you talk about commonly used drugs?