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Thursday, November 7, 2013

Acute Pain - Nursing Care Plan for Hypertensive Heart Disease

Hypertensive Heart Disease

Hypertensive heart disease includes a number of complications of systemic arterial hypertension or high blood pressure that affect the heart.

Symptoms of heart failure include:

  • Shortness of breath
  • Swelling in the feet, ankles, or abdomen
  • Difficulty sleeping flat in bed
  • Bloating
  • Irregular pulse
  • Nausea
  • Fatigue
  • Greater need to urinate at night
Symptoms of ischemic heart disease may include:
  • Chest pain which may radiate (travel) to the arms, back, neck, or jaw
  • Chest pain with nausea, sweating, shortness of breath, and dizziness; these associated symptoms may also occur without chest pain
  • Irregular pulse
  • Fatigue and weakness


Acute Pain Definition

Pain is whatever the experiencing person says it is, existing whenever the person says it does (McCaffery, 1968); an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain) sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of  less than 6 months.



Nursing Care Plan for Hypertensive Heart Disease

Acute Pain (headache) related to increased cerebral vascular pressure.


Goal :

  • Client reported pain / discomfort disappeared / controlled .

Interventions and Rationale :

1. Maintain bed rest during the acute phase.

2. Give non-pharmacological measures to eliminate headaches eg, a cold compress on the forehead, back and neck massage, quiet, dim the room lights room lights, relaxation techniques (manual imagination, disktraksi) and leisure time activities.

3. Eliminate / minimize vasoconstriction activity that can increase headache eg, straining during defecation, coughing and bending length.

4. Assist patients in ambulation as needed.

5. Give liquids, soft foods, regular oral care in the event of bleeding nose or nasal pack has been done to stop the bleeding.

Rationale:

1. Minimize stimulation / promote relaxation.

2. Actions that reduce cerebral vascular pressure and the slow / block sympathetic response is effective in relieving headaches and complications.

3. Activities that increase vasoconstriction causing headaches in an increase in cerebral vascular pressure.

4. Dizziness and blurred vision often associated with pain kepala.pasien can also experience episodes of postural hypotension.

5. Increase the general comfort, compress the nose can interfere with swallowing or breathing requires mouth, causing stagnation oral secretions and mucous membranes dry out.

Physical Examination for Congestive Heart Failure (CHF)

Nursing Care Plan for Congestive Heart Failure - CHF

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