Many types of medications are prescribed for the treatment and management of heart prob- lems. It is important that you are familiar with those prescribed to your MHSU group and
Table 5.7 Factors to consider when care planning for someone with a coronary problem Activity of daily living Example of care planning activity
1 Maintaining a safe environment
This might relate to homeostasis of the internal body environment. We can achieve this by:
• monitoring baseline observations
• monitoring physical interventions such as medications
• evaluating the effectiveness of treatment
• revisiting the care plan if condition deteriorates
Physical environment is also important, as limiting physical exertion when moving around is necessary. Adapting the home environment to minimize levels of exertion and promote independence and mobility, e.g. installation of stair lift, adapting showers and toilet seats, and installing hand rails
2 Breathing Monitoring respirations is a core observation, as breathlessness is a clinical feature of coronary problems. Breathlessness can be anxiety-provoking due to the associated discomfort and its role as a reinforcing agent of illness.
Respirations should also be monitored during sleep. Observations and interventions include:
• respiration rate
• pulse oximetry
• oxygen therapy
• posture when sitting or lying
• collecting sputum samples for pathology and assessing any cough 3 Communicating Care planning and treatment for cardiovascular conditions can be very
complex. Any instructions or explanations should be:
• jargon-free
• easy to understand
• the subject of regular feedback to ensure comprehension, and clarification that things have been understood
You should also provide reassurance to alleviate anxiety. Encourage MHSUs to vent feelings and develop psychological coping strategies, or acceptance of the condition. This will decrease anxiety, as they find they can still have a social life as long as they are not over-exerting the heart
4 Mobilizing While encouraging fitness is important, this should not be too strenuous. Set small and safe targets, e.g.
• involving physiotherapy to develop an exercise plan
• walking short distances and gradually increasing this
• considering relaxation therapy to help the resting process and cope with stress
• encouraging the MHSU to rise slowly to prevent dizziness and light- headedness
• encouraging rest also
(Also refer to maintaining a safe environment above)
(continued)
Table 5.7 Factors to consider when care planning for someone with a coronary problem (Continued) Activity of daily living Example of care planning activity
5 Eating and drinking
Diet may need to change. If it does not, problems may be exacerbated. A dietitian can advise on nutrition:
• reduce calorie intake in obese MHSUs
• encourage fruit and fibre
• introduce a low-salt diet
• reduce salt intake, e.g. encourage no salt at the table but small quantities when cooking, consider low-salt alternatives
• reduce/abstain from alcohol
• reduce caffeine intake
Occupational therapy can help develop cooking skills 6 Eliminating • record fluid balance if required
• encourage adequate hydration
• monitor blood electrolyte levels
• prevent constipation to reduce risk of straining on elimination 7 Personal cleansing
and dressing
Promote independence here to illustrate that the MHSU can still function:
• ensure safety when bathing/showering, as this can be tiring
• use shower seat aids to minimize exertion
• observe skin integrity – reduced blood flow and oedema may compromise skin, so avoid rough towelling/drying following bathing
• use a moisturizer on dry, flaky skin to help recovery 8 Maintaining body
temperature
• monitor body temperature for any infection
• encourage appropriate attire 9 Working and
playing
• as for mobilizing above
• time off work may be required for those who are employed
• recreational activities may have to be less strenuous initially
• explore local self-help or support groups that might have social activities 10 Sleeping • observe for sleep difficulties relating to respiration
• use of extra pillows to assist breathing
• discourage sleeping during the day
• consider medication if required 11 Expressing
sexuality
• depending on the severity of the problem, sexual activity may decrease initially
• explain this to the MHSU as for working and playing above
• reassure that usual sexual activity will return 12 Dying MHSUs may be preoccupied with death or dying:
• allow MHSUs to express fears
• reassure that with treatment and lifestyle changes life can still be enjoyed
• discuss fears of the future openly and discourage catastrophic thinking
• encourage joining a support group to get peer support
both their desired and undesired effects. These medications can be taken in various forms and you should be aware of this to prevent maladministration. This is also an important factor for MHSU education – that they are aware of the route of administration when they are self- medicating. This section provides a quick guide to common medications. However, you will need to do some extra reading in this area yourself.
Different drugs have different effects. For example:
• drugs that ‘thin’ the blood, reducing its viscosity, decreasing the risk of blood clots;
• drugs that reduce heart rate to lower BP;
• drugs that cause vasodilation, which increases blood supply to the heart;
• drugs that reduce the risk of coronary problems by lowering cholesterol.
There are seven possible routes of administration for coronary medications:
• Orally: medication is swallowed via mouth.
• Sublingually: medication is dissolved under the tongue.
• Spray: medication is sprayed under the tongue.
• Patch: a patch is placed on the arm and the medication slowly released (similar principle to nicotine patches).
• Subcutaneously: medication injected under the skin (dermis and epidermis).
• Intramuscularly (IM): medication injected into a muscle.
• Intravenously: medication injected directly into a vein.