CHAPTER 1 Cardiovascular System^35
- High Fowler’s position to ease breathing and enhance diaphragmatic
excursion. - Supplemental oxygen to meet increased demand of myocardium.
- Low-sodium diet to prevent additional fluid retention.
NURSING DIAGNOSES
- Impaired gas exchange
- Decreased cardiac output
- Excess fluid volume
NURSING INTERVENTION
- Monitor vital signs and look for changes.
- Record fluid intake and output—weigh daily to assess for fluid overload.
- Position patient in semi-Fowler’s position to ease breathing.
- Administer oxygen as ordered because it helps to decrease workload of heart.
- Tell the patient:
- Eat foods low in sodium to avoid fluid retention. (For these patients, there
is no such thing as “low-salt” cold cuts.) - Raise legs when sitting to lessen dependent edema.
- Call the physician, nurse practitioner, or physician assistant if experienc-
ing fluid retention, such as a weight gain of several pounds in 1 to 2 days.
- Eat foods low in sodium to avoid fluid retention. (For these patients, there
Hypertension (HTN)
WHAT WENT WRONG?
Pressure inside blood vessels exceeds 140 mmHg systolic and 90 mmHg diastolic
on more than one occasion resulting from a primary disease or no known cause.
These are the classifications of hypertension:
- Normal <120 mmHg systolic / <80 mmHg diastolic
- Prehypertension: 120–139 mmHg systolic / 80–89 mmHg diastolic
- Stage 1 hypertension: 140–159 mmHg systolic / 90–99 mmHg diastolic
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