'Chest Pain Care Plan\r'

' perspicacious chest incommode link to ischaemic cardiomyopathy as evidence by tightness in chest. Patient pull up stakes be chest pain isolated for duration of shift. valuate for chest pain q 4 hours during shift.Monitor vital signs q 4 hours during shift.Educate forbearing on importance of lifestyle modifications such as weight loss.Goal was met. Pt was chest pain free during shift.NURSING diagnosis OUTCOME/GOALS INTERVENTIONS EVALUATIONExcess fluent ledger related to CHF as evidenced by patient weight come along of 2kg since hospitalization and +2 edema in lower extremities.Pt maintains adequate fluid volume and electrolyte balance as evidenced by vital signs within convening limits, and sort out lung sounds end-to-end shift. Assess for crackles in lungs, changes in respiratory pattern, shortness in intimation and orthopnea.Monitor weight daily and consistently with the uniform scale, at the same time of day, wearying the same amount of clothing.Educate pt on sig ns and symptoms of fluid volume excess, and symptoms to report.Goal was met. Pt had normal vital signs and clear lung sounds throughout shift.NURSING DIAGNOSIS OUTCOME/GOALS INTERVENTIONS EVALUATIONRisk for ineffective peripheral wander perfusion to ripe(p) leg related to catheterization use as evidenced by abeyance of arterial flow.Pt maintains create from raw material perfusion in make up leg as evidenced by baseline thump quality and loosen up extremity throughout shift. Assess right leg for pulse, skin color, temperature and sensation.Monitor cannulation position for swelling, bruits and hematoma.Educate patient on signs of reduced weave perfusion and to report these signs. Goal was met. Pt’s right leg maintained tissue perfusion as evidenced by pulse quality and warm extremity throughout shift.NURSING DIAGNOSIS OUTCOME/GOALS INTERVENTIONS EVALUATIONRisk for anxiety related to impending heart surgery as evidenced by poor midpoint contact and lack of questioning .Patient is able to emit signs of anxiety by end of shift. Assess patient’s level of anxiety.Encourage patient to talk about anxious feelings.Assist the patient in recognizing symptoms of increasing anxiety and methods to contest with it.Goal was met. Patient verbalized the signs of anxiety by end of shift.\r\n'